Increasing Patient Engagement | Text Messaging

Texting is a powerful communication channel that, when used properly by medical practices, can improve patient engagement, improve health outcomes and decrease no-shows. Texting is instantaneous, convenient, direct and less intrusive than phone calls. According to a 2015 report by Pew Research, nearly two-thirds of Americans own smartphones and 97 percent of smartphone owners use text messaging, making it the most widely used basic feature.

With all of the potential benefits of engaging with patients through this communication channel and with such wide-spread use of this feature, why are medical practices so hesitant to use text messaging to communicate with their patients, even if it is the patient’s preferred method of communication?

Text messages are not inherently secure forms of digital communication. Even if sent over secure and encrypted systems, text messages have to travel over mobile networks and the mobile phones themselves could be lost, stolen or left out for others to view. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rules protect the privacy of individually identifiable patient health information (PHI). However, medical practices can still take advantage of this powerful, convenient channel of communication by following these three important steps.

1. Create messaging policies for your medical practice. For example:
   1. Only send text messages through secure automated communications systems or encrypted text messaging systems
   2. Determine what types of text messages the practice may send—appointment reminders, payment reminders, scheduling changes, office announcements, recalls, educational information for chronic conditions, etc.
   3. Verify patient’s mobile number on each visit to ensure messages are being sent to the correct number
   4. Make it easy for patients to opt out
2. Obtain explicit, written consent from patients. Even though the U.S. Department of Health and Human Services (HHS) states that appointment reminders are allowed without authorization from the patient, Vital Interaction recommends medical practices require patients to opt in to receive text messages and select the types of messages they agree to receive via text, even appointment reminders.
3. Define what information your practice will allow in a text message to patients. For example:
   1. Will the name of the practice expose PHI? If so, consider using the doctor’s name instead.
   2. Will the name of the patient expose PHI? Even though personalization is one of the most effective ways to reach people through texts, consider eliminating the patient’s name in order to protect PHI.
   3. When sending out recalls, will the needed treatment expose PHI? Consider creating a more generic message that could apply to anyone.

The HHS Office of Civil Rights, which oversees the administration of HIPAA, announced they will begin working closely with mobile health companies to make sure HIPAA rules for communicating with patients digitally are clear and explicit. Areas causing particular confusion include texting, emailing and transmitting data from health wearables. In the meantime, by following some basic recommendations, medical practices can take advantage of this powerful communication channel today, resulting in increased convenience and satisfaction for patients.