COMMENT: The text effect - transforming two-way patient communication

NOW, more than ever, the health sector needs to drive out cost – the challenge is how to do it affordably and with a positive impact on patient care.

It is in this context that the humble SMS (text) message is now coming to the fore, bypassing the complexity and expense of fancier technologies to tackle one of healthcare’s most-costly burdens - patient communications.

The humble SMS (text) message is now coming to the fore, bypassing the complexity and expense of fancier technologies to tackle one of healthcare’s most-costly burdens - patient communications

Every time a patient fails to turn up for a hospital or clinic appointment, huge costs are incurred. There’s the practitioner’s time that has now been wasted, the waiting list which now grows longer, and the additional administration as follow-up actions are taken, schedules re-organised and new appointments booked. The annual toll on the health service of these so-called did not attends (DNAs) is estimated to be around £600m - of pure waste. At a time when cuts threaten even the most basic standards of care, this kind of cost cannot be afforded or morally justified. Yet, as UK NHS healthcare is free at the point of use, it’s hard to encourage more conscientious behaviour among patients.

The IT industry’s response to the health sector’s financial woes traditionally has been to offer complex, tailored solutions involving huge capital investment, substantial retraining and a lot of upheaval. Yet, when it comes to eliminating the colossal waste of DNAs - quickly and painlessly, while producing a number of additional benefits - there is no solution more affordable and natural than the simple text message.

Whether for automatically issuing appointment reminders, or reminding patients to take medicine at prescribed times, an SMS is immensely powerful. Unlike the phone or emails, a text message to a mobile phone is rarely ignored, or screened by someone else. Indeed, it has been proven time and again to be the single most effective and timely way to reach a particular individual at any given time.

Ofcom figures suggest that 97.5% of all text messages are read within five seconds of being received

Almost everyone aged 16 and over carries a mobile phone with them at all times which, however basic, is likely to support text messaging, a medium that commands instant attention in a way that even a ringing phone does not. Ofcom figures suggest that 97.5% of all text messages are read within five seconds of being received!

Is anybody there?

To date, where SMS has been trialled as a medium for patient communications, it has had a positive impact, but the facility until now has been limited to restricted options because automated systems have had no way of capturing and processing the patient’s response.

A one-way reminder to a patient may jog their memory, but without the facility for the recipient to reply and thereby close the loop, there has been no scope for the patient to indicate that they’d like to reschedule, or that the appointment is no longer required. Rather, this kind of notification has relied on the patient pro-actively telephoning the hospital, surgery or clinic - a process which in any case would tie up staff time, something the cost-cutters are keen to avoid.

The IT industry’s response to the health sector’s financial woes traditionally has been to offer complex, tailored solutions involving huge capital investment, substantial retraining and a lot of upheaval

A far more efficient solution, available now, is one where traceable two-way communications are facilitated between an automated administration system and an individual patient. This enables the patient to be given options to choose from – for example ‘Yes I will be there’, ‘I no longer need the appointment, or ‘Please send me a new date’ – because the reply has been matched with the outbound message, allowing the patient’s response to be registered back to the appointment scheduling system. Where a patient rejects the allotted time, new actions can then be triggered, automatically, for example the issue of a new date and the reallocation of the now-free appointment.

This opens up all sorts of possibilities in removing significant cost from the patient administration process, while significantly cutting DNAs and reducing patient waiting lists. Early estimates suggest that implementing a simple two-way text facility as an extension to an existing patient appointment administration system could more than halve DNAs.

Patient, heal thyself!

In addition to the cost benefits of eliminating human intervention from a routine process, the patient is encouraged to better manage their own health, minimising the need for expensive acute care

SMS has great potential for other patient communication applications, too, such as reminding vulnerable patients to take medication on time. In the US, the University of California’s medical clinic uses SMS to remind HIV patients to comply with a complicated medication regime three times a day. The SMS provides a simple communication interface between a complex medical system and the patient. This then enables multiple outgoing SMS texts to be intelligently matched to their replies and passed back to the medical database, thus supporting patients in their medication regime.

In addition to the cost benefits of eliminating human intervention from a routine process, the patient is encouraged to better manage their own health, minimising the need for expensive acute care. The same approach could be used in the management of other chronic patient conditions including diabetes.

Unlike the phone or emails, a text message to a mobile phone is rarely ignored, or screened by someone else. Indeed, it has been proven time and again to be the single most effective and timely way to reach a particular individual at any given time

Other potential applications extend beyond patient communications, to staff resource scheduling, for example, where medical teams need to be scrambled at short notice to respond to an emergency. Again, all that’s required is simple integration of SMS with existing operational systems.

Responses to SMS alerts like these average at 82%, which is a phenomenally successful take-up rate compared to alternative media. There’s no downside to using SMS either – there’s no new equipment to buy and no special training needed, while patients are not inconvenienced. The benefits, meanwhile, are huge: considerable cost savings and no capital investment, higher staff productivity, reduced waiting lists, and a higher quality of patient care.

At a time of poor national and economic health, that’s a medical miracle.