Membership & Fellowship: OMG! Texting in Health Care Is Here to Stay

By Stephanie Stephens

This article reprinted courtesy of HealtheCareers, the providers of ACOG’s Career Connection online job board. Find your next job and career resources at ACOG’s Career Connection 

With more than 20 billion texts sent every day worldwide, there's no question that we’re a planet of texters. And we aren’t just texting our family and friends. We also choose texting over calling for customer services, especially scheduling or changing appointments. Texts get to the point and get read in less than five seconds.

"If you want to get your message to your patients, your best bet is to send it in a way they will see, through a text," says Lea Chatham, director of content marketing at patient relationship management firm Solutionreach. She also notes that texting isn’t just for millennials and says profiles of the age 65+ group who text aren't too dissimilar from those of all age groups — surprising to many.

Because of the popularity of text messaging, professional organizations — including the American Medical Association (AMA) — have addressed it head-on, acknowledging that the issue is still a work in progress.

At its June 2017 meeting in Chicago, the AMA recommended that it work with the U.S. Department of Health & Human Services' Office of Civil Rights “to develop guidance on text messaging to facilitate the appropriate and safe use of this technology when communicating patient information."

In the meantime, this guidance from AMA Wire should help cover the bases until the AMA issues an updated message. The association suggests you:

  • Remind patients that there are privacy issues involved with text messaging
  • Establish a clear understanding of time frames for communications
  • Maintain a cordial yet businesslike tone in your exchanges
  • Refrain from using patients' identifying information
  • Proof your texts carefully before sending to ensure accuracy

You can also take advice from basic tenets provided by HealthIT.gov that address privacy and security with use of mobile devices.

Texting in this decade is what email was to the last, says the Healthcare Information and Management Systems Society in a recent policy statement. The society says that "through the implementation of the text messaging policy, services will improve health, be efficient and not increase spending, while addressing needs of the health care consumer. Those needs may be a decrease in anxiety related to waiting for a return call from the office, or guidance needed to seek emergency or urgent care."

Docs Who Text

Psychologist Marie Fang, Psy.D., with practices in both San Francisco and San Jose, texts with her clients regularly. And she’s created some guidelines that other physicians might consider employing.

"I never send the first text," says Dr. Fang. "If a client chooses to text me, it's usually because they're going to be five minutes late for an appointment. It feels so benign — so much easier than phone tag."

Obviously, that kind of message is of lighter weight than one that's more clinically focused, she says. "If a client sends one like that, more specific, I'll respond with 'Let's set up a time to talk on the phone or in person.' Too much can get lost in other kinds of communication."

Karen Jacob, a psychologist at McLean Hospital in Belmont, Massachusetts, uses text message discussions to map her patients' crises and better understand their emotional patterns. She calls texting "therapeutic," but admits patients can become too reliant on her responses and says she ultimately had to sever one relationship because of that.

"I would never initiate a text to a patient with any personal health information — nor in an email," says Joseph C. Kvedar, M.D. and vice president for Connected Health at Partners HealthCare in Boston. "If a patient contacts you first, it's their decision and you aren't bound by HIPAA to answer them."

Patient-provider communication is by its nature asynchronous, he says. That means it's not a steady stream of exchanges, but more stop-start in nature.

Text messaging carries a sense of immediacy that's fascinating," says Dr. Kvedar, a dermatologist in practice since 1988. "We tend to respond more in the moment, shorter and more succinctly. Both patient and provider can leverage that in an effective way, such as 'I need to reach you and I want you to pay attention to it.'"

He acknowledges that most doctors don't love the texting idea, especially if they've been "really pestered" by a patient. "I'm a very service-oriented person and it's a way for me to provide extra support — and I'm comfortable with that."

His colleagues in concierge medicine know texting is an expected part of patients' amenity package. They are, after all, paying for enhanced communications with their providers.

Texting has even found its way into the literature. The Journal of the American Heart Association found that for patients at risk for developing heart disease, physicians who texted positive messages actually increased those patients' physical activity levels.

How to Make Texting Work for Your Practice: Your Texting Toolkit

Many health care professionals aren't watching or waiting, but have taken their own texting reins.

"We moved to a system that not only sends email reminders but also text messages to all of our clients," says the clinical director of Darien Wellness, David Ezell, M.A., M.S., L.P.C. and L.M.H.C. of Darien, Connecticut. At his counseling and wellness practice, "clients can opt out at any time but rarely do. We advise them that we use electronic communications in their consent paperwork and have so far had no problems."

For the past year, he's been using TherapyNotes, an integrated practice management software platform that offers a texting option. "We know cell phones are an integral part of people's lives, and that we need to find people where they live," Dr. Ezell says of his totally digital, paperless practice. The system may have made worrying about appointment compliance a moot point, he says.

It's been an added perk to motivate a growing business of 14 practitioners. "When prospective staff interview here they ask, 'What is your compliance like?' They moan and groan about theirs. When we tell them about ours, it's an extra incentive to want to join us."

Texting works because it's difficult to ignore, he says. "Sure, sometimes people say they forgot an appointment," he says. "But part of my job is to be a skeptic, and I feel texting puts the appointment more 'in their face.'"

Darien Wellness also treats a lot of adolescents, says Dr. Ezell. "We're very pleased with this service. We can send a text message to the adolescent and an email to the parent all at once."

From a technology standpoint, for both physician practices and hospitals, it's all about how to fit in with workflow, says Amelia Coleman, vice president of business development for OhMD. An idea approximately five years in the making, it's a HIPAA-compliant texting app for doctors and providers.

Right now, the basic texting platforms of patient-to-practice and doctor-to-doctor are both free. The company charges if it performs an integration with the practice's EMR, she says.

"There's a strong case to be made for creating simple solutions that have really clear value propositions," says Coleman, noting Uber and GrubHub in the non-health care space. "Still, this will take time for widespread adoption. Remember, some medical practices still use paper charts but we're definitely moving in the right direction."

In contrast with SMS or regular cell phone texting, OhMD offers a secure, end-to-end encrypted channel. "Here, you can share clinical information without risk of a HIPAA violation or of having data compromised," says Coleman.

With OhMD on both the provider and patient's phones, data basically goes back and forth via the OhMD channel — there's no cell phone number involved. Both parties obtain an OhMD account via mobile app or web portal.

Patients use mobile, while physicians use either mobile or web. "Patients may text as many doctors as they want, and providers can freely communicate with each other," she says. "We currently market to physicians, who invite patients to sign up."

The exchange "feels like" a patient is actually texting the doctor, but they're texting the practice, where a staffer determines which texts of an urgent nature the doctor should personally respond to.

 

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