Texting with Patients: The Risks and Safer Alternatives

Nearly everyone texts to communicate. It’s quick, easy, and convenient. However, texting with patients carries professional, legal, and ethical risks, including:

1. Privacy and HIPAA compliance. Standard texting is not secure. Messages can be intercepted, viewed on shared devices, or accidentally sent to the wrong number. Therefore, any patient’s personal health information sent via text risks a HIPAA violation and possible fines.
2. Blurred professional boundaries. If you allow patients to communicate with you via text, they may expect you to immediately respond, even outside of work hours and interrupting personal time. Additionally, texting is inherently informal and may inadvertently shift the professional relationship to a personal relationship.
3. Documentation issues. If text conversations with patients are not included in the patient’s medical record, important clinical information could be missed or lost, which could put the patient at risk. Lack of documentation also puts the healthcare provider at risk in the event of allegations of malpractice.
4. Patient safety issues. Patients may text in an inappropriate situation, such as in an emergency, putting the patient at risk if you do not see the text quickly. Patients could misconstrue a text message from you which could lead to patient harm. Texting can also lead to auto-correction, typos, and text-typical abbreviations which may result in misunderstandings.

Safer Alternatives to Texting
There is a safer alternative to standard texting that allows you to text your patients and your patients to text with you by utilizing a secure messaging platform via a patient portal, HIPAA-compliant app, or an EHR-integrated system. Secure texting can improve patient engagement and patient satisfaction. It can also reduce missed appointments by sending appointment reminders.

Office Policies for Staff
It is imperative to establish clear policies and procedures for staff and patients regarding communications, including approved communication channels (i.e., patient portal or office phone), response time, appropriate use of text messaging, and documentation of communications. Written consent for texting should be obtained from the patient.

Examples of appropriate use of text messaging via a secure messaging platform include clarifying instructions, requesting prescription refills, asking non-urgent questions, or scheduling or confirming appointments. Text messaging should not be used for emergency concerns, or lengthy discussions that would be better to have during an office visit.

To further reduce risks of texting with patients, do not give patients personal cell numbers of staff members and do not allow staff members to use personal devices for texting patients.

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Disclaimer: The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. In the event any of the information presented conflicts with the terms and conditions of any policy of insurance offered by ProAssurance Insurance Company of America, the terms and conditions of the actual policy will apply. All information contained on the blog is subject to change.