SMS, Mobile, and Digitizing Healthcare

How much time do you spend texting per day? Perhaps a more accurate question would be, how much time do you NOT spend texting per day? Texting has become an integral part of our lives. It is perhaps the second most common method of communication between us, after face-to-face contact. For some people who don’t see each other, texting comes first on the list. Texting, for instance, keeps people together. Twenty years ago, the odds of staying in touch with a loved one who lived in another country were very slim; phone calls were too expensive and regular mail takes too long.

Texting is easy and incredibly fast. It’s also really convenient, especially for people who aren’t fans of phone calls. When I pick up a call from a friend, the first thing I say is, “What’s wrong?” It has become natural to me that, when someone calls, there’s an emergency. What’s the point of calling if you can just text?

Medicine is being influenced by technology every day, and that doesn’t just include diagnostic and therapeutic technology. Communication technology is starting to assume its role in healthcare. Beepers were, and still are, greatly involved in medicine, but now we have the opportunity for much more. Let’s take a look at some of the ways SMS and technology are influencing medicine and the pros and cons of this.

Who still uses web portals? Barely anyone does these days. So, how are people in the healthcare system supposed to stay in touch with patients? Phone calls are too time-consuming, and emails are unreliable. Some people don’t check their email at all while others have schedules for doing so, which means that by the time they see an email, it may be too late. For these reasons, texting becomes the most convenient method of staying in touch with patients. Almost everyone knows how to send and receive text messages, and the service is available at all times.

An internist and pediatrician in Laurel, Maryland says that his practice has used web portals since 2006, but he feels like they lost their functionality because people prefer SMS. He says now it’s just easier to text everyone. The platform used for texting is the practice’s eClinicalWorks EHR. Reasons to text patients include asking them to call back for more information, to tell them their lab results are normal, or to make appointments. He says people are responsive and they do call back when asked.

Another doctor in Georgia uses an application called Twistle, which is completely secure and allows his patients to text him without having access to his personal phone number. The app also sends copies of the texts he receives to his nurses so they can deal with routine issues straightaway without his interference. He says the perks of texting include being able to reply quickly, when convenient, and automatically saving the interaction for future reference.

Texting lab results is another cool utilization of texting. Instead of saying results to patients and risking them hearing the wrong thing or misinterpreting what you’re saying, you can just text the results. This also saves time which staff members would normally use to spell out results over the phone. It’s also possible to create protocols or scripted responses to expected and easy questions from patients.

One physician says he texts about four to six lab results per day and this takes a total of about ten minutes. He also adds certain notes to the results, such as telling a patient what to do next and how to best take care of themselves. On the other hand, he receives about twenty texts per day. Some of these are from patients asking if they should be taking an over-the-counter drug in case it interferes with their prescription. Other texts are simply from patients saying their sciatica pain was relieved thanks to a certain injection, for instance. Another great use was found when one patient texted him when she was about to be discharged from the emergency department because she felt she shouldn’t be. In return, he then texted her some information for her to show the emergency physician who admitted her.

There’s no reason to worry about receiving too many texts or that the process will become time consuming, because this rarely happens. Patients usually ask simple questions or share minor information between visits, which eliminates the need for repeated short ones. This frees up time in a doctor’s schedule for same-day appointments, making him/her more available and accessible.

Other applications include increasing patient adherence. Patients who have chronic illnesses require constant follow-ups to make sure they’re doing okay. Studies have shown patients who receive text messages from their healthcare providers are more likely to adhere to their instructions.

Another study showed the relation between smoking cessation and receiving text messages. One group received 157 texts over a period of 12 weeks, while the other received one text every two weeks. The first group that received lots of texts showed 25% of its members abstained from smoking eight weeks later, while only 14.6% of the members from the second group did.

A group of patients also stated that receiving texts to remind them to take their medication greatly increased their compliance. This is especially useful for patients with chronic diseases who take several medications throughout the day and for the rest of their lives. This includes diabetics and hypertensives.

There are, of course, some issues with texting medical information. A major issue is security and confidentiality. For starters, someone else might have access to the patient’s phone and might see their medical information. Someone might also hack or decrypt messages sent between a doctor and his or her patients. The risk of information getting into the wrong hands is also increased when texting is done via public wifi networks.

Some information should definitely be excluded from texts. This includes numbers such as account numbers, medical record numbers, serial numbers on medical devices, social security numbers, IP addresses, health plan numbers, license or birth certificate numbers, and any other number unique to an individual. These are all very private numbers and may lead to sensitive data, so they should be protected at all costs. Adding full-face photographs or pictures that are specifically identifiable should also be avoided. Names (including initials), locations more specific than state, and most dates are things that should be avoided as well.

These data, if intercepted or decrypted by someone other than the patient and the service provider, can lead to severe consequences. Confidentiality is very important in medicine and its breach is a serious issue. It’s a lot easier to exclude this kind of data than to lose it to a third party, then try to fix the issue. Generally, the rule to follow is “when in doubt, take it out.” If you’re wondering whether something should be included in a text message, you’re probably better off not including it.

Technology is a major part of our lives now. To say that it is invading our lives would be incorrect, because we’re already past that point. I’m not saying it’s a bad thing, because it’s definitely not; technology makes life more convenient and much easier. Right before you read this article, you were probably texting and you’re likely to get back to it in a few minutes. It’s no surprise that medicine is being influenced by texting as well; digitalizing healthcare is something that has been happening for a long time.

It has perks such as reminding patients to take their medications, reminding them of appointments, answering their questions, and following up with them. This has a lot of benefits for both doctors and patients. To get the most out of this without getting any of the bad, make sure to text your patients through a secure connection.

What other ways do you think technology can affect medicine and communication with patients?