Ask a lawyer: Texting updates to other health professionals

Question: 

Lately, I have been using my personal smartphone to text updates to physicians regarding patients. Is this practice acceptable? 

Answer:

Mobile devices offer nurses and other healthcare professionals a convenient, user-friendly way to communicate with each other. Texting is fast, direct and simplifies the pager system that hospitals and other health care organizations have traditionally used.  

However, texting personal health information may lead to a privacy breach. Privacy legislation and regulations require custodians of health information (also known as “trustees” in some jurisdictions), as well as their agents, affiliates, or employees to be diligent in protecting patient information from theft, loss, and unauthorized access, collection, use, disclosure, or destruction.1 Nurses who are texting health information to other care providers in the workplace may therefore wish to consider the relevant privacy issues surrounding this practice.  

First, using your personal device to send and receive health information concerning a patient may result in unauthorized disclosure of the information, which could be inappropriately accessed or disclosed if the device is lost, stolen, or viewed by a third party. It is prudent to take steps to ensure that reasonable safeguards are in place to protect from a potential privacy breach, such as omitting personal identifiers when discussing patients or ensuring that your text messages are encrypted and only accessible with a password or biometric authentication such as a fingerprint or face scan.   

Second, it is best to avoid using public Wi-Fi to text or access patient information, as data transferred on public Wi-Fi can be easily intercepted. Whether using a private internet connection or using a cellular network, texting should be done on a secure channel through an instant messaging app that encrypts data transfer. To address these concerns, many health care organizations have implemented secure text messaging networks in which health care professionals can send and receive patient information. These networks ensure that information transmitted is adequately encrypted and are often integrated with the patient’s electronic record, ensuring that the details of the message are accurately reflected in the chart.  

Nurses are advised to only use personal devices with their employer’s consent and send communications on their organization’s secure network and on their organization’s secure messaging app, if available. Nurses using their personal mobile devices in the workplace should follow employer policies surrounding this practice. 

Finally, all texts pertaining to the provision of care should be accessible in the relevant medical record in order to meet professional and legal obligations surrounding documentation. Where possible, including a screen shot of the messages in the patient’s file will ensure that an accurate and unedited copy of the exchange is recorded. Nurse should consult their employer’s policy on privacy and use of mobile devices and consider deleting the messages from their device after the information has been appropriately documented in the patient records to minimize the chance and scope of an unintended privacy breach. Texting with other health care providers may be used as evidence in a legal proceeding or regulator complaint, so it may be prudent to ensure that your text communications with other providers is clear and professional. 

For more information and other advice surrounding this issue, see our CNPS InfoLAW on Mobile Devices in the Workplace. 

CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.

1. See, for example, the Personal Health Information Protection Act, S.O. 2004, s. 12(1). https://www.ontario.ca/laws/statute/04p03#BK19

For more information, please see the CNPS Article: Are you a custodian or trustee of health records?

Revised March 2023

THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.