So I certainly understand when colleagues say that they often text about, or to, patients. I know that my colleagues are more burnt out, hurried, and frustrated than ever before in the history of medicine in the US. And I know that anything that seems like a shortcut is tempting. In fact, it’s more than tempting — it may feel like an imperative.

We’ve spoken pretty extensively about the penalties and punishments for texting about or with patients. Texting patient’s information is very rarely, and only in certain circumstances, compliant with HIPAA. But the more I've observed texting in action in medical contexts, and for use in healthcare collaboration, the more I've realized that the biggest problem with texting isn't even HIPAA...

Yes, despite the huge penalties for texting in ways that aren't HIPAA compliant, I believe that the biggest problem with texting is actually that it's failing our patients and putting us at risk for malpractice lawsuits. Let me explain...

Texting had its 25th anniversary this past December. Over those 25 years, we've become used to communicating via text, such that in some social circles, it's more polite to text than to call. So as healthcare providers, we naturally tend to want to text in a medical context, especially when we have a quick question for a colleague. More recently, like over the past 5 years, there's even been a shift from emails to texts, as it better fits our hyper-fast lifestyle. 

The problem is that texting on behalf of, or to, our patients gives the illusion of adequate care coordination and collaboration, but simply does not deliver. So the biggest mistake you may be making when you text in a medical context is that you are shortchanging yourself and your patients. 

Texting in a medical context, or for healthcare collaboration, is: 

• Enmeshed with all of your personal communication.
  When you text a colleague, those messages are in the same place as texts about your daughter's recital. The truth is that it becomes very difficult to be responsive and responsible when there is no separation between personal texts and medical texts. 
• Not archived. 
  If you text a colleague about a patient, you may get a quick answer now, but what happens in a day, week, year or decade when you need to refer to that message, either to inform care or to share the case with a colleague? 
• Not organized. 
  We feel that organization, structure and amplification are important components of true collaboration. It is not enough to yell “fire” in an movie theater. One most also show and help theater goers to the exits and prevent panic. Ultimately, texting doesn't allow messages about a case to be sequenced, organized, and accessible so busy providers can use the information well. 
• Not collaborative among multiple people on a team. 
  Texting is between two people, not among multiple members of a team. 
• Words only. 
  Secure texting is almost always just text -- not voice or videos -- because it becomes very difficult to keep that information secure in a text message. 
• Usually not HIPAA compliant.
  In order to text in HIPAA compliant ways, you need to have the permission of the patient (if you are texting them), not using any PHI, not using the patient's first and last name in the text thread, etc. In other words -- if you're texting, you're probably not HIPAA compliant. 

So what is a person to do, when texting is so convenient, but doesn't truly meet our needs as medical providers? You may have interesting ways of collaborating you'd like to share, but we're certainly passionate about iClickCare as a solution. iClickCare allows all of the ease and speed of texting, but in a way that allows the entire team to collaborate using chat-like messages, videos, and photos -- and that collaboration is organized, archived, and HIPAA secure. 

What you do is too important to use tools that don't meet your needs. Demand more for yourself, and more for your patients.

If you're looking for ways to use your smartphone to do medical collaboration, but without all of the downsides of texting, download our free white paper on BYOD (Bring Your Own Device) Policies here: 

Healthcare providers -- especially doctors -- are not known as the most receptive, malleable folks. In fact, in the world of private pilots, it's commonly accepted that doctors are the most dangerous pilots because they have too much confidence in their own abilities. 

So it's no surprise that providers almost universally hate that they've been forced to use EMRs/EHRs. The widespread frustration with the technology would be practically a galvanizing force in the medical world, were it not for the complete impotence we have to actually reject EMRs.

That said, I've always struggled to understand why so many healthcare providers resist the implementation of tools like telemedicine or other telehealth advances. Many of these tools are beautifully designed, save huge amounts of time, and greatly advance care. And yet many providers resist them with a vehemence I find hard to fathom.

But some recent research brought these reasons clearly into focus for me...

Two recent studies look at the adoption of EMRs/EHRs and dig into the true reasons that healthcare providers resist the usage of technology in many contexts.

This study looks at why healthcare providers are so resistant to EMRs/EHRs. The researchers look at the institutional beliefs in the institution of medicine -- the profession, they say, is "based upon main values such as professional autonomy, status role and expertise." These are values that butt directly against the coercive implementation of difficult-to-use EMRs/EHRs in so many settings.

This piece, in turn, surveyed 199 physicians practicing at a large US hospital. They found that -- consistent with our life experience -- healthcare providers largely deeply dislike EMRs/EHRs and see them as infringing on their time with patients and inhibiting of their ability to practice as they wish. No surprises there. However, the researchers go on to summarize, "when faced with a decision between alternate IT systems [for instance, choosing between an EMR and paper records], individual users tend to select and make use of the technology or system that is most readily accessible."

In other words, the physicians were simply trying to navigate their overloaded days by choosing the system that felt most accessible or "easy" to them. The researchers found two dimensions to this perceived accessibility: logical and physical. The physical accessibility had to do with the placement of the computer in the office or exam room, how many computers the practice had, etc. The local accessibility had to do with how difficult it was to log into and use the EMR system. The study concludes, "Both dimensions of accessibility act as barriers to EMR use intentions through their indirect effect on physicians' perceptions of EMR usefulness and ease of use."

I found this particularly fascinating because these two dimensions are the two foundations that we built iClickCare on: 

• Physical accessibility: iClickCare works in a HIPAA compliant way on any iPhone, Android, or web browser. Which means that you can use it on the computer in your office, on your phone in the exam room, on your home computer, or on a floor down from your office in the hospital. This is huge for physician's perceptions of accessibility. (Not to mention making it practical to use in home-based or long term care settings.) 
• Logical accessibility: iClickCare is technology for people who hate technology. Getting a consult on iClickCare is as simple as posting a Facebook update. And the workflow integrates with any other technology or Health IT systems you may be using. 

So if you're exploring implementation of a Health IT system -- whether telemedicine for medical collaboration or something else -- we recommend considering these same dimensions:

• Physical accessiblity: will the system work on multiple hardware pieces (e.g., the "hardware" in everyone's pocket)? Does it require a hardware investment? 
• Logical accessibility: does the system work with providers' existing workflow? Does it make sense with providers' days? How well-designed is the user interface and how hard is it to use? Do providers need to change their schedules to use the system? Will they need to use hardware they are unfamiliar with?

A Bring Your Own Device (BYOD) policy, especially in combination with smart software, can open up the possibilities for technology implementation that providers will really use and really benefit from. We always recommend investing in software, not hardware and using that software on as many devices as providers use already. 

The determinants of technology adoption aren't complicated, but working in harmony with them can be transformative.

Download our full white paper on Bring-Your-Own-Device (BYOD) policies here:

Photo by Mia Baker on Unsplash