Secure Chat: Balancing Efficiency and Safety

The electronic health record (EHR) has transformed clinical documentation, but even the most advanced technology cannot replace the need for clear, effective communication among healthcare professionals (HCPs). When communication breaks down, the likelihood of error and adverse outcomes increases. Although face to face conversation is the most effective way to communicate critical information, it is not always feasible in a fast-paced clinical environment. As new EHR communication tools emerge, understanding how to use them safely and appropriately has become essential to ensuring patient safety.

One of those tools is secure chat, a HIPAA-compliant, private messaging feature built directly into the EHR. Accessible on desktop and mobile devices, secure chat allows HCPs to communicate in real time without relying on pagers or external applications. By enabling quick, encrypted communication, it can efficiently streamline tasks, support patient specific discussions, and reduce communication delays among the healthcare team. Unlike patient portal and inbox messaging, which facilitates formal communication between HCPs and patients, secure chat is intended for informal, operational communication among healthcare team members, and its message content is not automatically stored in the EHR.

Increased efficiency, however, does not always translate into safer care. A recent survey found that while many HCPs valued secure chat’s efficiency and usability, 46.2% reported safety concerns, particularly when the tool is inappropriately used for urgent or time-sensitive communication and when closed loop communication is lacking. Another 34.7% cited workflow and integration challenges, highlighting the need for clarity around when and how to use secure chat. 

HCPs are responsible for understanding the tools they rely on to deliver and document patient care. At the same time, healthcare organizations must provide comprehensive training, ongoing education, and clear expectations to ensure staff use secure chat appropriately, consistently, and in ways that support safe, effective clinical communication. 

Risk Recommendations

EHR-integrated secure chat tools offer fast, convenient communication for healthcare teams, but these benefits come with important safety, documentation, and workflow considerations. Consider the following when examining your organization’s secure chat use: 

• Know the law. Work with an attorney to understand state and federal regulatory and legal requirements related to the use of secure chat features, such as how the medical record is defined, the discoverability of secure chat content, record retention requirements, and state and federal requirements regarding protection of electronic patient information.
• Develop policies and procedures. Well-drafted policies and procedures are essential to ensuring secure chat is used safely, consistently, and in a manner that supports safe patient care. In them, address the following key elements:
  • Appropriate use of secure chat. Secure chat is suitable for communicating routine, non-urgent issues, or operational updates. Do not use it for time-sensitive issues, critical results, care escalation, and high-risk clinical decisions.
  • Documentation requirements. Specify what information must be documented in the EHR. Secure chat is not a substitute for documenting clinical decision-making, assessments, or patient status changes. Enter all clinically relevant information into the medical record.
  • Message retention. Define your organization’s message retention time frame and specify whether messages are to be stored, archived, or purged. Inform users that although the EHR may not retain messages, metadata may still be discoverable in litigation for the duration of the retention period.
  • Behavioral expectations. Outline expectations for staff professionalism and conduct while using secure chat. Prohibit disrespectful language, inappropriate content, slang, unapproved abbreviations, or phrasing that could be misinterpreted.
  • Response expectations: Provide guidance on expected response times, when escalation to phone or in-person communication is required, how to manage misdelivered messages, and expectations for closed-loop communication.
• Educate staff. Train staff on proper use of secure chat software and understand how it fits into existing workflows. Review best practices, such as attaching the patient record to chats to support efficient chart review, documentation, and order entry. Train staff on setting availability status, including out of office notifications and auto forwarding features, to ensure messages reach the covering clinician. Document initial and ongoing education.
• Monitor and assess regularly. In addition to annual technology-security risk assessments, regularly audit secure chat communication to assess content integrity, message volume, and compliance with organizational policies. Use audit findings to identify trends and guide staff education and to assess the need for ongoing policy/procedure updates and process improvements. 

As healthcare technology continues to evolve, balancing efficiency with safety is crucial. To ensure features like secure chat truly support clinical care, organizations must refine how they are used so they enhance workflows without introducing new risks. Ongoing monitoring, regular evaluation, and thoughtful adjustments to policies and practices will be indispensable for protecting patient outcomes and sustaining provider well being as these tools continue to expand.