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Some electronic health record (EHR) systems do not offer integrated texting apps, which can lead to the use of texting apps that require a separate process to transfer texts to the patient record. Unfortunately, text messages frequently do not find their way into the record.

Texting can blur traditional patient-physician boundaries. The loosening of social inhibitions in the online environment often allows people to behave differently than they would in person, a phenomenon known as the online disinhibition effect.

The reporting of unusual occurrences and adverse events has been a staple of the risk management plan in hospitals and healthcare facilities for many years. Incident and event reports, whether written or oral, are a means of alerting hospital leaders to potential or actual patient harm. These reports are critical to the ongoing identification of risk and the investigation of the circumstances that led to an adverse event. The reports, too, are key to the development of risk mitigation strategies designed to create a safer environment for patients, physicians, and staff. Additionally, the incident report, and the information it contains, is a valuable alert to potentially compensable events and the need for disclosure discussions.