August 16, 2010

Text Appeal
By Annie Macios
For The Record
Vol. 22 No. 15 P. 14

Documentation experts offer their opinions on the viability of technology that allows medical information to be exchanged via text message.

We use them to communicate, to surf the Web, and even to calculate tips at restaurants. Mobile phones have evolved into versatile devices that allow us to perform an array of tasks that once seemed far-fetched.

Now this multitasking marvel is making major inroads in the healthcare industry. For example, new texting technology can help physicians improve patient care by getting important information into their hands sooner. Globaltel Media and Scribe-Well, medical transcription providers, have developed a system that enables medical transcriptionists to share digitized patient records and clinical notes, along with embedded images, via text messaging.

Globaltel Media CEO Robert Sanchez says the two companies have taken common short-message-service technology and expanded its purpose to allow healthcare professionals to work in a wireless environment. “Doctors are in a mobile environment and often away from their desk, so we came up with a way to launch a new product to send any electronic file in a text message,” says Sanchez.

Instead of paging physicians and waiting for a series of communications to take place, the texting technology enables doctors to receive patient information directly on their mobile phone or tablet after entering a password. Authorized users can then reply to the request, make a diagnosis, report it to the doctor’s office, and so forth down the continuum of care. Globaltel’s delivery system provides an audit trail that tracks who accessed the file and when.

Scribe-Well CEO Rewa Lazatin says because physicians are often out of the office performing rounds, having images or dictations available on a mobile phone is helpful. “They want to be able to get the information anytime, anywhere. With this technology, they don’t need to go into the office to make a diagnosis, so the quality of care automatically goes up,” she says.

Sanchez adds that by storing and disseminating the information through a HIPAA-compliant server and following security procedures, physicians can click on a link to dictate a diagnosis and then send it to a facility. In addition, the technology can be incorporated for use with a PACS system. “So if there is a critical MRI or x-ray, the physician could click on the image and even send it to another physician for an immediate consult, all with a full audit trail,” he says. Narrative notes can also accompany the image for delivery to a mobile phone.

Lazatin explains that without adequate information, physicians can’t always come up with a full diagnosis. “Physicians often perform what is known as a ‘wet reading,’ which is the first impression of what you see as a doctor treating a patient’s symptoms. With the possibility of sending information from PACS to a mobile phone, you don’t miss out on anything,” she says, adding that a slide or x-ray viewed in a reading room is naturally larger than what will be received on a phone but having the information—even on a small screen—kick-starts the process until the doctor can make a personal consult.

Implications for Medical Transcription
From a medical transcription perspective, Sanchez says physician dictations can be converted to text for inclusion with images or in a patient’s file. In addition, audio clips with diagnoses or narrative notes can be sent via mobile phone. “This provides file delivery with a two-way response,” he says.

With the prevalence of mobile phones, the technology can theoretically be used to send data anywhere in the world because the information and images are embedded into the medical record. In addition, it opens the door for communication among physicians located anywhere in the world, as long as they have a mobile phone. “A key aspect of the technology is that it uses a text channel, so physicians can get support from others who are offshore. The information is reliably trapped, and it works on every cell phone because it is a text channel,” Sanchez says.

“It may be ‘old’ technology, but using it in this way enables us to potentially reach the 4 billion cell phones in the world,” he adds.

Industry Response
Industry experts find the idea of exchanging health information via text message intriguing, with some viewing it as part of an overall trend toward more widespread use of digital information exchange. Others, however, raise concerns associated with security and practicality.

Claudia Tessier, RHIA, president of the mHealth Initiative, supports the notion of using mobile technology to boost quality of care. “Mobile technology offers the opportunity to leapfrog other technologies that have come across roadblocks. One opportunity is interoperability and the ability to communicate across devices, carriers, and systems,” she says.

Tessier notes the potential for providers to gain quicker access to information at the point of care for better decision making. “That is what healthcare is all about. There may be current information available but access to it might be limited, even across healthcare departments in the same facility,” she says. “The more we can facilitate access to and exchange of current and relevant record information that is accurate and secure—anytime, anywhere—the better, more efficient, and less costly patient care will be.

“This kind of technology is certainly not unique in Third World countries where in some instances the ability to communicate by texting provides the only way to send and receive information, all without voice. In today’s times, voice is becoming secondary,” adds Tessier, who points out that one concern relates to how information that is accessed and recorded on mobile devices will be recorded in a patient’s record. She believes this may be an issue at first but not for long.

Kathleen Dominguez, CMT, AHDI-F, the mid-Michigan chapter president of the Association for Healthcare Documentation Integrity (AHDI), says while the concept of text messaging digitized records sounds enticing, there are concerns associated with the source of the reports and how they will be accessible. “Who generates the reports? Transcription? Physicians? And if Globaltel and Scribe-Well are holding the information, it [the data] will have to be accessible and secure,” she says.

Dominguez doesn’t believe the technology will affect the work habits of medical transcriptionists (MTs) employed in hospitals. “We will still be on a PC, and we already have the ability to blend images with our reports using a secure portal within a facility,” she says. But depending on who is holding the transcription records, it could cause some difficulties for the instances when MTs encounter dictations that aren’t clear. “In those situations, we need to go back to previous documents on that patient to make sure we have a solid record for 100% accuracy. We have the same access as most physician assistants and nurses for this purpose,” says Dominguez. Without access to previous transcriptions, accuracy could be jeopardized.

Then there’s the matter of security issues. “I know they say this is HIPAA compliant, but so many questions surface: How will patients be able to get a copy of the record since that is their right? What if a mobile phone gets stolen?” Dominguez says. “Hospitals already have this technology for medical records and images, so why give the control to an outside company? As MTs, we sign a confidentiality agreement but with this technology, you might as well throw that out the window.”

According to Scribe-Well, patient information is protected because it resides on an encrypted secure server. “Information only goes to individuals cleared to receive it. So Globaltel looks at the cell phone number replying. If the PIN and cell phone numbers match our records, then the information is sent to ensure delivery to the right person. We can also limit the number of downloads of a particular image that a physician can ask for,” explains Lazatin, who adds that the solution supports AHDI and Medical Transcription Industry Association guidelines regarding the accurate, secure capture of patient encounters.

Globaltel’s technology delivers the image, audio, or video files while Scribe-Well holds the patient information. (The records can be accessed through the database or an FTP transfer.)

Nevertheless, Dominguez doesn’t see the technology being a fit for every healthcare organization. “I can see how this could be useful for physicians in a rural area but for most hospitals, it just seems like a big security risk,” she says.

Scott Faulkner, principal and CEO of medical transcription provider InterFix, voices concerns with the technology’s ease of use. “While my first impression is that it is a wildly creative idea, the presentation of the information on a portable device is challenged by the screen real estate of the device. Medical records are dense, complicated pieces of information, and reading a four-page report or an x-ray with any degree of precision on the screen of an iPhone poses significant challenges,” he says.

Faulkner also raises questions about how the disseminated information will be kept secure. “Speeding information to the right people at the right time is crucial and important, but think about how text messaging works. Whoever is near a cell phone when a text message arrives can often see the text in addition to the intended recipient, and if that happens, protected health information is compromised. My questions would be how do you ensure confidentiality and how do you properly dispose of the information once it’s consumed?” he says.

In addition, Faulkner points out that healthcare professionals working with an EHR typically have an established level of permission based on their role and position to view certain patient information. “With texting, it seems that the roles and permission are based simply on a phone number. Trying to apply roles and permission in this way might be a challenge from a legal aspect,” he notes.

For now, Faulkner is taking a wait-and-see approach. “The real issue with this technology is going to be the huge difference between healthcare information and most all other information, and that difference is confidentiality,” he says. “It’s a nice idea, but it has a long way to go to be applicable in the healthcare arena.”

Peter Preziosi, PhD, CAE, CEO of both the AHDI and MTIA, says establishing stringent privacy safeguards through the HITECH Act is a top priority for federal officials as they try to promote expanded HIT use, including mobile technologies.

“As we help to shape policy around digital record creation and narrative reporting of patient encounters, AHDI and MTIA have developed an ethical best-practices manual to assist documentation professionals and medical transcription companies in maintaining transparent policies and procedures in managing protected health information consistent with new federal requirements,” he says.

Healthcare organizations considering Globaltel and Scribe-Well’s transcription solution should take all the proper precautions, Preziosi says. “As with any new technology, providers must consider the implications for privacy and security. What’s the purpose of the technology, and what is it used for?” he says.

Security concerns associated with mobile phone technology mirror some of those faced in other situations where the transfer of protected health information occurs, Preziosi notes. For example, the transmission of faxed health information, access to protected health information in unsecured areas of a clinical practice, and home-based dictation are areas where breaches are more likely.

“In healthcare, as in other industries where public trust is involved, we very much rely on the healthcare provider’s ethics and integrity that goes with the job of making the best choices on behalf of the patient, and that includes protecting their health information. As with medical transcription professionals, it’s important for them to want a career in this field because they really care about ensuring accurate, secure documentation,” he says.

— Annie Macios is a freelance writer based in Doylestown, Pa.