Secured Texting in the Operating Room

One evening after a presentation, I was asked if I used secured texting in the Operating Room at my place of employment.  I was not expecting that question and I was afraid to answer, however; I was honest with my reply and stated no.  After returning to work, I searched my work’s intranet for our policy and procedure manual on texting messaging.

Per Baptist Health Policy (2014) on text messaging, the policy is for all who access the Baptist Health information systems and sending, instant electronic messages to and from any computing device, whether Baptist Health or personally owned. The purpose for this policy at Baptist Health is to remain Health Insurance Portability and Accountability Act (HIPAA) compliance and to protect patient information.  Also, Baptist Health has executed a secure texting which provides end-to-end protection with authentication and encryption technology.  Baptist Health Policy (2014, p.1) defines encryption as “the process of converting information into a form unintelligible to anyone except holders of a specific cryptographic key”.  Using unsecured text messaging at my place of employment is prohibited (Baptist Health Policy 2014, p.2).



Identification and Explanation of Problem

     In the OR where I am employed, most surgeons prefer to communicate by text messages than using a landline or even their own smartphones. Some surgeons have informed me that texting is more convenient than answering their smartphones and holding a conversation.  Texting messaging may be more convenient for them however, I have discovered through conversation with them, they do not use secured texting.  The surgeons are not following Baptist Health Policy (2014).  Using standard text messaging in the OR, it is not secured and communications are “clear text” (not encrypted) and does not require authentication (Baptist Health Policy, 2014, p.2). Using an unsecured device can lead to patient information being exposed.

It is pros and cons about using smartphones in the OR. One surgeon stated he can address patient-care much faster and want to take advantage of the technology. Using unsecured devices in the OR can also lead to inappropriate distractions.  A few years ago, an anesthesiologist was accused of sending text messages during a surgical procedure.  The patient’s oxygen levels dropped and the anesthesiologist did not notice for 20 minutes and the patient died in the OR and we all remembered the incident with Joan Rivers.  It has been stated, once you start using your smartphone, we are separate ourselves from reality of where we are.  If you are staring at your smartphone, you are not staring at the monitor or providing patient care (Luthra, 2015).


Description of Proposed

      An article by Snell (2017) states maintaining HIPPA compliance in physician-to-physician communication and health care provider-to-patient communication is serious, and why secure text messaging has increased.  With technology processing, health care providers cannot afford to accept standards that are lower or jeopardize Protected Health Information (PHI) through SMS text messaging or unsecured email (Snell, 2017).  Text messaging has reinvented the way we communicate.  In 1995, text messaging was first provided in the United States and has become on the most popular form of communication, with 74% cellphones users and 2.4 billion worldwide use SMS to communicate (HIPAA Journal, 2015).

In health care, it is pertinent too all to use secure text messaging.  PHI transmitted over the wireless network can potentially be viewed by unauthorized individuals.  An unsecured text message can be delayed and routed to many carriers, the text message may remain on servers for many months and there is no way to know if the intended recipient received and read the text (HIPAA Journal, 2015).  Even though, text messaging improves communication and efficiency in the OR, only secure text messaging should be allowed to communicate with staff and physicians.  Smartphones and tablets increase efficiency and improves productivity and permit better decisions, however; HIPAA does not allow PHI to be communicated by unsecured text messaging.  PHI must be protected always (HIPAA Journal, 2015).  Between cases in the OR, surgeons using secured text messaging can access and communicate patient health records, text results and view radiology reports faster than calling or leaving the surgical department to walk to radiology department.  Also, secured text messaging increases communication improvement between departments and decrease time for surgeons to diagnose and treat patients.  Working in a major hospital secure text messaging eliminates phone tag (HIPPA Journal, 2015).

The benefits of secure text messaging: (a) nurses save 3-4 hours a day using secure texting, (b) 80% reductions in email and phone tag, (c) 95% of patient questions can be answered in 60 seconds or less, (d) Physicians can see 15 more patients a day using secure texting on patient admissions, discharge, consultations and approval, (e) reduce prescription refills time in half, (f) hospitals see a 50% reduction in patient wait times and (g) reduces overhead paging which leads to higher patient satisfaction and higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores (HIPAA Journal, 2015).   To ensure HIPAA compliant each health care organization’s administrator must mandate all employees connect and download a secure texting app.  TigerText is the leading provider in secure text messaging (Kelleher, 2017).

Baptist Health uses Imprivata Cortext secure text messaging communication system.  Cortext is a HIPAA complaint texting application with the same appearance and feel of a regular texting application on Android, IPhone and a computer (desktop or laptop).  It is unacceptable for any licensed independent practitioners or physicians to text orders for patients within any hospitals in Baptist Health System or any other health care providers.  Secured text messaging orders are prohibited (Baptist Health Policy, 2016).

Over 80% of health care providers surveyed admit using unsecure text messaging from their personal smartphone or computer.  The reason, because health care providers find texting to be more efficient than any other communication device.  However, using unsecured text messaging can result in a HIPAA violation and cost up to $1.5 million per event, per hospital.  Health care organizations need to remain secure PHI and improve workflows (Imprivata, 2014).  Cortext is the secure communication that enables health care providers to use inside and outside the hospital.  Cortext provides detailed read information with timestamps, so the health care provider can know who is reading texts and when they are received.  It has many functions, for one it allows the health care provider to have organization groups, for example, CODE BLUE team (Imprivata, 2014).  Over 60% of health care providers practice at multiple health facility, Cortext allows the clinicians to communicate across health organizations, replacing paper (Imprivata, 2014).

During my inquiry at work in the OR, to find out who is using or not using secured text messaging, I was surprised to find only one person was consisted in using secured text messaging. It was the pharmacist.  I often wondered why he always walked around with his laptop.  He was nice enough to show me how he use it and he also stated he does not know why more people are not using secured text messaging.  After speaking with him, I called the Help Desk and someone got me in touch with Imprivata and when I returned to work the next day, it had been installed on my desktop.

Implication for Nursing

      The impact of smartphone technology has been devastating to the paging system. Since 1991 from 60 million subscriptions to 6 million paging contracts today.  Smartphone device has increased communication with the capability of text messaging within a single platform (Imprivata, 2017).  Patient safety and patient care quality are immediately related to the amount of care health care providers can achieve through (a) communication, (b) ensuring timely access to actionable and (c) meaningful information.  Secure text messaging help facilitate quick connections to stakeholders.  Interoperability with Electronic Health Record (EHR) vital information can be access fast and provide better patient care (Imprivata, 2017).  Using a secured text messaging system like TigerText or Imprivata Cortext increase efficacy of pertinent care coordination communication and improving patient care and increasing workflow efficiency.

The Joint Commission (TJC) had reinstated its ban on the mHealth platform, the use of secure text messaging, however; TJC states more guidance was needed to ensure the safety of secured text messaging.  Now working with the Centers for Medicare and Medicaid Services (CMS), TJC states certain pieces must be in place before secure texting to be utilized safety (Snell, 2017).

I was just wondering if our President uses secured text messaging while communicating with the head of The United States Department of Health and Human Services (HHS).  The administrator will not comment on how Mr. President is text messaging.





Baptist Health System. (2016).  Cellphone/smartphone allowance for work usage.  (Policy 4.3).  Retrieved from

Baptist Health System. (2014).  Text messaging.  (Policy 4.6).  Retrieved from

HIPAA Journal. (2015).  Does your organization need a secure text messaging service?  Retrieved from

Luthra,  S.  (2015).  Texting from the operating room.  The Atlantic.  Retrieved from

Kelleher,  A.  (2017).  How to make your organization compliant with health insurance portability and accountability act privacy, security and breach notification rules.  Retrieved from

How hospitals can avoid the biggest healthcare communications mistake.  (2017).  Retrieved July 31, 2017, from

Secure messaging solution for healthcare.  (2014).  Retrieved July 31, 2017, from

Snell,  E.  (2017).  Secure texting rules clarified in joint commission newsletter.  HealthIT Security.  Retrieved from

Snell,  E.  (2017).  Utilizing secure texting for efficient, simple communications.  HealthIT Security.  Retrieved from