A new study from the Regenstrief Institute, Indiana University School of Medicine and Indiana University Health Methodist Hospital found that, although replacing pagers with clinical texting systems has benefits, some doctors are critical of the high volume of messaging.

"Communication is essential to hospital workflow, yet we found that there is a lack of shared understanding among clinicians regarding how to use clinical texting," said study corresponding author Joy L. Lee, a Regenstrief Institute research scientist and IU School of Medicine assistant professor of medicine, in a statement.  

"Clinical texting is a double-edged sword. It’s easy to contact fellow clinicians, which can be viewed as good or bad," Lee said.  

WHY IT MATTERS  

As the researchers noted, pager use is dropping 11% every year in U.S. hospitals, with communications increasingly reliant on smartphone messages.  

"With this change comes shifting norms regarding communication about clinical care, because phones and pagers require different processes and considerations for sending and receiving messages," observed the team.   

"Many clinical texting platforms also include more functions than traditional pagers, such as the ability to include pictures. Despite the increased prevalence of these clinical texting systems, professional guidelines and etiquette for team communication by CTS are still evolving," they added.  

For the study, which was recently published in Applied Clinical Informatics, in the autumn of 2019 researchers conducted focus groups with 21 hospitalists and eight nurses about their impressions of using smartphones to send and receive secure messages concerning patient care.   

Overall, researchers observed that the clinicians were still adjusting to text communications.   

The study participants cited ease of access, the capacity to send photos – especially regarding dermatology consults – and the ability to record a conversation as benefits of clinical texting systems.  

However, implementation challenges, high text volume and lack of shared understanding about texting emerged as drawbacks.   

For instance, emojis are "just so unnecessary," the researchers quoted one participant as saying. "Why should we have emojis?"

"While hospitalists and nurses alike shared consensus on some aspects of texting: that it should be professional, focused on important issues, and replace traditional pagers, there were many interpretations of how that was to be operationalized," said the researchers.   

"Frustrations arose when senders and recipients disagreed," they added.  

The research team said their findings could have important implications for healthcare team members.  

"Team members may need periodic, brief trainings on how to establish a shared understanding in communication preferences," they said.  

THE LARGER TREND  

Although the study is among the first to investigate clinicians' experiences with texting, the research team observed that the dissatisfaction with volume echoes physician frustration with electronic health record systems.

The problem of EHR "alert fatigue" has, by contrast, been well-documented, with hospitals and health systems tweaking their systems to try and adjust accordingly. The issue goes beyond burnout, too. ECRI listed alert fatigue as one of its top health hazards for 2020.

ON THE RECORD  

"Each hospital or hospital system needs to figure out how to use clinical texting to optimize communication, workflow and patient care and then develop use guidelines," said the research team's Lee in a statement.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.