Health care providers are looking for ways to cut the amount of time their practice spends in calling patients to confirm and remind them of appointments, lab calls and follow-ups. Text messages can also be used for "outreach" messages reminding patients of needed mammograms, Pap smears and cardiovascular disease lab tests. They can also be used for other reminders such as: "You have a physical at 9 a.m. tomorrow. Please do not eat or drink anything after 12 p.m. midnight."
They can also be used for billing reminders: "You have a balance of $55. Please remit." Daily reminders can also be set up for patients in reminding them to put on sunscreen or other reminders to help patients be compliant. They can also be used to develop patient relationships such as "happy birthday" greetings. Many providers report that patients like it and do not find it overly intrusive.
Although we have written this to address health care providers, many other professional practices can use the ideas in this article and adapt for their business. For example, in our own practice we are sending text messages to confirm the time and place of appointments and court or hearing appearances. This helps confirm that the person will receive and see the message without checking home answering machines, cellphone voicemails or emails. All professional practices that rely on appointments could benefit from the idea although it is usually medical practices that have the volume of patients to justify using a web-based text messaging program.
There are many Web-based text messaging options. Most are free to set up, with users billed a set fee for the month, generally in the $200 range. Also available are physician-specific systems that can mine data from a practice management or electronic medical records system, which means the messaging is all done automatically. For other systems, cell phone numbers would need to be entered manually each day. Some of the text messages can also be sent to a phone as a voicemail.
Since many people have cell phones with text-messaging capabilities, some health care providers (including test programs by Kaiser Permanente) have decided that texting is the way to go. These providers are saving numerous staff time hours per week by using a text-messaging system that automatically sends the reminders. Some practices are reducing staff time from one hour, per doctor, per day to less than 10 minutes by using text messaging systems for appointment reminders, lab calls and follow-ups. They are also able to better predict the number of "no shows" so that revenue can be increased by filling that time with additional patient visits. This can boost the bottom line of practices significantly.
Many providers have enthusiastically adopted texting. However, to make sure texting is effective for your practice, it takes some groundwork and preparation. to make sure texting is effective for your practice.
First, determine what the texting system will be used for which will help make it easier to decide which system to buy.
Second, the practice should draft the outgoing messages that will be sent and have them cleared by the practice's attorney for possible HIPAA security rule violations. Our opinion is that in general, the use of text messaging is permissible on the same basis that telephone messages have been permissible under current law. However, there should be guidelines to ensure HIPAA compliance.
Third, patients need to be given the option of whether to use the communication mode. The patients should also be given instructions on how to opt out of receiving text messages. Senior patients may need instruction on how to check their text messages. Some text messages allow you to opt out. For example, in Kaiser's case, each message ended with, "Txt STOP to end msgs."
Fourth, your practice should start collecting cell phone numbers if they have not already been collected. For physicians just getting started it might be a slow process before the system reaches its fullest potential, as it might take several months for the databases to be populated with cell numbers.
Fifth, practices need to be vigilant about making sure data fields are updated regularly to avoid invalid numbers or bounced-back messages.
Sixth, if your practice sets up a two-way system, the staff must be equipped to deal with the return messages. Some providers' systems allow patients to respond to the text message to confirm appointments, for example. The messages are sent back as an e-mail that the staff must receive. Then, the staff manually enters any schedule changes or confirmations into the practice management system.
Finally, determine in advance the format and content of the messages so the staff has little discretion in what they write. To further protect yourself, it may be that the less specific the messages, the better. Messages about test results, for example, could say something like, "Everything looks normal," or in the case of a positive result, "UR lab results are in. Call 2 discuss."
Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals and businesses in civil, business, administrative and criminal proceedings, with a specialty in health care providers.
