For most people, texting has become second nature as a fast, easy way to communicate. But the technology hasn’t always kept pace with the complexities of health care. Physicians know, for example, that confidential information about patients cannot be transmitted via text messages.

But that’s changing. New privacy-compliant texting platforms are making it possible for Canadian doctors to use their smart phones to conveniently and securely exchange information about patient care.

In 2018, physicians working at the University Hospital of Northern BC (UHNBC) in Prince George agreed that texting could be a valuable tool for their day-to-day work. While texting does not replace in-person clinical conversations, it provides many advantages to support communication: it is less intrusive and more responsive than a phone call or voicemail, and it is a simple, quick way to access and share information, especially when a timely response is needed.

With this potential in mind, seven UHNBC physicians representing the medical staff approached Northern Health’s information technology (IT) department to see if a means of secure texting could be found. Unknown to them at the time, the IT team had already been looking into technology for secure texting. The timing was good: an opportunity for the two groups to collaborate was available through the Specialist Services Committee Facility Engagement Initiative, a BC-wide program that is increasing physician involvement in health authority decision making. It provides funding for physicians to help identify, plan, and lead improvements in their clinical environment and patient care.

Together with Dr Bill Clifford, Northern Health’s chief medical information officer and a former family doctor in town, and Ron Klausing, a project manager for Northern Health IT, the physicians got to work to explore secure texting options. They explained their practical, day-to-day needs that texting could support, and the IT team advised on functionality and appropriate use of the technology. The group settled on an application for purchase by Northern Health that would meet their respective needs as well as BC’s privacy requirements.

The benefits

Once in place, the texting application worked better than anyone imagined it would. The app allows physicians to connect to the patient rec­ords system, search for a patient’s name, and link to their chart. As well, physicians can exchange information and photos securely with each other and other clinical providers for consults and handovers, and communicate with nurses and residents. For example, doctors can alert radiology to prepare for an urgent CT and then receive a text back with the results.

The app’s features offer a welcome change for physicians. When using pagers and voicemail, it isn’t always clear if a communication has been received, but with texts, doctors get an acknowledgment when a message is read and can move on to focus on other things.

Other features include alerts when a patient is admitted to hospital. Physicians can also access a directory of all Northern Health departments and on-call schedules, and with one click, connect with other doctors across the region. More functionality will be added over time, including notifications for doctors about critical lab results.

Safe and secure

Information sent by text remains secure because it is transmitted through the app but never stored in the app, on the company’s software, on the phone itself, or in cloud storage. All information flows through and is stored on Northern Health’s servers, with details of conversations retained for legal purposes. Security software is installed on the phone itself and in the app, with a six-digit passcode, facial recognition, and encryption features. Further, Northern Health IT can control the device—including locking or erasing information—if it is lost or stolen.

Collaboration: key to success

Since it was introduced in spring 2019, secure texting has been embraced by more than half the UHNBC physicians and other clinical staff and residents, with further adoption expected over time. While it is not the main or only method of communicating, it is a convenient, secure way of improving the efficiency of physicians’ medical practice to support patient care.

Throughout this process, collaboration was key to success. Having physician users work with the IT design team to consider needs from their respective viewpoints ultimately led to higher uptake and satisfaction with this exciting new tool at UHNBC.
—Brian Hillhouse, MD
Family Doctor, Emergency Room Physician, University Hospital of Northern BC

The following mocked-up screenshots show various example exchanges using the texting app. These screenshots do not include any patient information. The ankle image is a stock photo.

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This article is the opinion of the Specialist Services Committee and has not been peer reviewed by the BCMJ Editorial Board.