Advanced Medical Imaging is committed to providing the highest quality patient care possible while doing so in a professional environment. The purpose of this secure messaging policy is to facilitate effective communication and proactive discussion for the clinical management of the patient. Secure messaging is not intended to replace verbal communication when necessary to discuss the patient’s clinical condition or to replace Computer Provider Order Entry (CPOE) within the Clinical Information System.
Halo is a secure messaging platform that enables secure communication of content, images, videos, voice files, and attachment messages. Using Halo ensures proper regulatory compliance and protection of your patients’ Protected Health Information (PHI) while communicating in real-time with colleagues and patient care teams.
1. PROTECTED HEALTH INFORMATION (PHI)
1.1 Communicating Orders
According to the Joint Commission, texting orders is prohibited; any order sent via Halo requires a verbal callback by the receiving staff member to the sending provider.
1.2 Transmission of PHI
Non-verbal PHI communication between providers and other patient care team members must occur using the secure messaging system, Halo. Under no circumstance should an Advanced Medical Imaging employee or affiliate with Halo send, or respond to, a text message, or other unsecure means. Beyond face-to-face communication or secure email, Halo is the clinical communication system and standard.
1.3 Photographs and Screenshots
Photographs and screenshots of reports and test results (i.e., patient pathology, lab, imaging results) may be transmitted via Halo to another provider. Proper escalation policies must be followed in the communication of critical values. Photographs and screenshots are prohibited from being saved in any other medium outside of Halo.
1.4 Clinically Significant Messages
The content of clinically significant secure messages must be properly documented in the medical record.
2. SENDING AND RECEIVING SECURE MESSAGES
2.1 Personal Messages
Halo will not be used for personal messaging between users; this is a professional tool only.
2.2 Sent Status
Messages still in the Sent Status are indicative of a message recipient’s being in a poor Wi-Fi zone, not on the data network, signed off the application, not having downloaded the app on a mobile device and not utilizing the web app, or having the device turned off. In the instance of messages in a Sent Status, escalate to the next form of communication (Review Appendix A).
2.2 Read Status
If a message’s status is listed as Read and a response is solicited but not received, escalate to the proper escalation policies.
2.2.1 Set the Callback Number
Ensure the Callback Number field in Halo is appropriately set.
3. SETTINGS MANAGEMENT
The auto-forward functionality can only be used when the forwarding party has obtained verbal consent for the forwarding recipient party.
Colleagues should only employ the off-duty functionality outside of working hours.
4. MESSAGING ETIQUETTE
4.1 Off-duty Override
Nursing staff should only initiate the off-duty override on messages to providers when there is a professionally deemed, clinically emergent, critical issue impacting patient care and condition.
4.2 Nurse-initiated communication
Nursing staff should exercise good clinical and professional judgment when initiating communication with a provider outside of the patient’s care team.
4.3 Responding to messages
The status of the Halo message is included on each message. Respond promptly to messages soliciting a response.
4.4 Messaging clarity
If a messaging thread is exhausted in its clarity, escalate to a verbal conversation.
Traditional texting puts all messages from one user under the same thread, which can be dangerous, especially when communicating about different patients. SafeText provides users the option to start new threads with a recipient or continue with an older message thread. Colleagues should relegate content about one message per thread. For example, if Nurse and Doctor are communicating about Patient A, they should begin an entirely new messaging thread to begin communication about Patient B.
4.6 Urgent Messages
Colleagues must be sensitive to utilizing the urgent functionality and only employ in true clinical emergencies.
5. PERSONAL DEVICE
5.1 Optional Use
Personal cell phone use is an option. Advanced Medical Imaging will not reimburse staff for the device, data, or battery (Appendix B). As such, Advanced Medical Imaging is not liable for the loss or damage of personal cell phones or electronic devices that are brought onto facility property.
In order to gain access to Halo from your personal device, Advanced Medical Imaging does enforce a passcode be used for secure access into your cell phone or other electronic device.
5.3 Personal Information
All information transmitted via Halo is secure and encrypted. In addition, all information transmitted via Halo is kept within Halo—not anywhere else on the personal device. As such, in the event of legal action, all relevant medical information may be extracted from the Halo system, protecting personal device information unless otherwise noted (see Appendix C).
Appendix A: Sent Date, Delivered, and Read in Messages Reports
Halo Message Report, Message Status
Halo Message Reports display three different times in the message delivery process:
When the message was sent
When the message reaches the user’s web browser or mobile device (when the first notification is visible on the recipient’s device)
When the user clicks or taps on the message (blue dot is removed – new message count indicator changes)
Halo Message Reports – Sent, Delivered and Read Status
WHEN IS THE MESSAGE SENT?
The message is sent by Halo within a few seconds if not immediately.
The Halo system will immediately start sending notifications to the recipient’s mobile device.
WHAT CAUSES A DELAY IN SENDING?
A delay in sending would be caused by a weak or unavailable Wi-Fi or cellular connection.
If the message fails to send on the mobile app the user will immediately see a pop-up stating: Send message failed. Check network connection
The failed message will be indicated by Not delivered – Retry. The user can then tap Retry to re-send the message when a connection is available.
WHAT CAUSES A DELAY IN DELIVERY?
Recipient has disabled notifications for the Halo app in their device settings.
Recipient has a weak or unavailable Wi-Fi or cellular connection. Connection strength can be determined on the mobile app using the Connection Status located in the Settings tab.
Web users: Recipient is not logged into their account on the mobile app or the Halo Notifier.
WHY ARE SOME MESSAGES DELIVERED, BUT NOT READ?
A recipient may be able to view a shorter message without having to tap the message to open the thread and display the complete message.
Appendix B: Halo Communications Data and Battery Explanation
Halo works on both Wi-Fi and cellular networks. When users are connected to Wi-Fi, no data is used. Alternatively, when the device is set to cellular instead of Wi-Fi, under average usage (defined as sending and receiving 25 messages a month), the app consumes only .0185 megabytes of data. Attachments use more data: photos average about 250 kilobytes per photo, voice memos average about 58 kilobytes per 10 seconds of recording, and videos average about 850 kilobytes per 10 seconds of recording.
Most users have network consumption from our app of less than 1 megabyte per month. To keep this in perspective, there are 1,024 megabytes in 1 gigabyte of data.
The Halo mobile app only runs in the background briefly when a new message is received. The Halo Communications team frequently runs the app in simulated environments for testing processor and battery load to ensure that the app is efficient.
Users can check their battery usage by going to the mobile device’s Settings > Battery (or Power) page. From here, users can see a list of apps the device is running and the percentage of battery that each is using. The Halo app may not appear in this list, since it often uses less than 1% of the device’s battery.
If your battery is negatively impacted when you’re at the office or hospital, other apps or functionality could be running in the background. This may include home and lock Screens, SMS messages, Facebook Messenger, social media sites, etc. Remember, Halo does not run in the background.
Appendix C: Halo Comunications’ Legal Explanation for Discovery on BYOD
Halo is a HIPAA-compliant secure messaging system for physicians, nurses, and other staff. Halo has an exclusive professional contact list that is integrated from the health organization and is completely independent of users’ personal phone contacts, as it does not allow for personal contacts to be imported or exported into our system. Our communication functionality cannot be accessed from anywhere outside of our web and mobile apps. We do not allow content to be shared outside of our system and our system does not allow photos, videos, or other information to be exported to the user’s device or photo gallery. Halo is an all-inclusive system that keeps and encrypts Protected Health Information within the application. Messaging content, critical labs, photos, videos, voice memos, imaging studies, Clinical Team information, and schedule data are not exportable to a user’s personal device.
Regarding the use of Halo on personal devices, we do not believe there is any material increase in risk that employee’s personal data might acquire into medical litigation. In general, before courts order the production of an individual’s personal data, there needs to be some evidentiary basis for a court to conclude that a personal device may contain evidence relevant to the medical claim. Halo usage should not increase such a likelihood and, in fact, should reduce it.
Because of HIPAA and related laws, most medical providers already routinely prohibit their employees from using unsecured personal devices to transmit medical information. Halo app usage does not violate such policies, because all information transmitted in Halo is secure and encrypted. In addition, as described above, there is no basis for any party to conclude that any information transmitted through Halo might migrate anywhere else in the device. All information is kept within the Halo platform, and all information may be extracted from the Halo platform when and if required for legal proceedings. There is no reason for anyone, including a court, to conclude that any other relevant medical information might be found on any personal device, especially those where the Halo app is installed.