The use of short message service in hospitals.

The purpose of this column is to describe recent concerns about the use of short messaging service (SMS) within hospitals and implications for the clinical nurse specialist (CNS). Short messaging service is more commonly known as text messaging and is available on most mobile phones. Mobile phones have become ubiquitous among adults within American society. The Pew Research Center’s Internet and American Life Project recently released a report indicating that 88% of American adults own a mobile phone. Of these mobile phone users, 73% send and receive text messages. A recent review of studies about the use of text messages to remind patients about hospital appointments indicated that nonattendance rates were improved by 34% whether reminders occurred by phone call or SMS, with automated phone messages resulting in a lower reduction. Furthermore, use of text messaging for health and wellness purposes is also increasing and effective with diverse audiences. A feasibility study concerning weight loss for a group of African American women indicated that text messaging was effective and well received by study participants. Despite the convenience and brevity of text messages, a recent report by Amcom software highlights 8 points of concern for using SMS within the hospital environment. Those concerns and implications for the CNS follow. Concern 1: Messages sent via SMS lack security and encryption. As most health providers are aware, the Health Insurance Portability and Accountability Act of 1996 provides regulations concerning security for electronic protected health information, known as ePHI. Patient data are highly sensitive, and messages sent via SMS are not encrypted. If patient care messages are sent via SMS, this may create a security risk for the hospital. Short messaging service messages cannot be secured for access with a PIN number or removed automatically from an inbox. Personal andbusiness SMSmessages are combined in the same inbox, so messages cannot be segregated. The technology support team within a hospital is unable to clear messages from a phone without clearing all messages from the device. There is a solution for secure, encrypted messages. There are smartphone applications that allows for critical messaging to occur within a secure, encrypted environment. They require use of a PIN to access messages, and messages can be remotely removed if the device is lost or stolen. Concern 2: SMS cannot integrate with your hospital’s staff directory or on-call schedules. One advantage of a smartphone application within the hospital’s communication strategy is the access to a centralized roster of employees and physicians. This facilitates ensuring that messages are delivered to the intended party within a timely manner. Concern 3: SMS cannot show full traceability or escalations. When messaging is used to deliver critical messages, it is often important to track that the message was sent, received, and acknowledged by the recipient. Short messaging service can often track that messages were sent and delivered. However, it cannot track whether a message was acknowledged or ignored. Some smartphone applications will even redeliver messages with a priority code if they were not acknowledged the first time. Concern 4: SMS cannot ensure priority delivery of messages. Short messaging service message delivery can be influenced by the volume on the cellular network. High message volume may delay delivery of important hospital communications. Further, messages can be blocked by a provider, often without notice. Concern 5: SMS inboxes cannot separate critical hospital notifications from those sent by friends and family. Messages are mixed in 1 inbox with personal and professional messages posted as they are received, without any opportunity to prioritize critical communication. There is no way to separate messages or highlight those that are Author Affiliation: Professor and Associate Dean for Clinical and Community Affairs, College of Nursing, University of Colorado, Denver, Centennial. The author reports no conflicts of interest. Correspondence: Amy J. Barton, PhD, RN, FAAN, College of Nursing, University of Colorado, 7983 S Trenton St, Centennial, CO 80112 (amy.barton@ucdenver.edu). DOI: 10.1097/NUR.0b013e31826e3dc1