In a 5/16 Physician’s Practice blog post, the author, Erica Adler writes about the benefits and considerations of physician’s text messaging with their patients. Some of the concerns Adler cites in her article include:
1. Physician Contact – If patients are texted from a providers cell, one risks patients’ obtaining access to the provider’s cell number, which, beyond physician privacy, could compromise care when patients attempt to contact a physician who is not on call or unavailable.
2. Patient Consent – Even though medical practices may have a patient’s cell phone number in the patient record, that does not mean the patient has consented to be contacted via text message. Not all patients have texting in their cell plan, and some don’t even look at messages on their phone. I agree with Adler, who suggests that practices have clear patient consent to be contact via text messaging and that patients have an understanding that additional text message charges may be involved.
3. HIPAA – Once you start contacting a patient via text messaging, there are all sorts of security and privacy implications that you may have not been addressed. Is the cell phone only used by the patient? Is the number you are texting to still registered to the patient? How secure are the devices? Are the devices password protected on both ends? How are cell phones decommissioned when they are no longer in use? HIPAA compliance includes a patient’s right to access all information used in deciding patient care. Is there a process that ensures that both ends of a text conversation are noted the patient’s record? If not, are you at risk for noncompliance with the law?
While all of the aforementioned issues should be considered prior to text messaging with patients, there is an additional topic that Adler has not addressed. That topic is patient expectation.
Patients need to understand that texts received from healthcare providers are not like those they have received from their friends. Often times they are one way informational notices. Unless a provider has initiated an obvious 2 way conversation, the that provider will not be looking at their phone for a response. Health care professionals cannot be responsible for monitoring their phone 24/7. They sleep, share coverage, and have days off (even residents).
Further, if text messages are sent from a computer, office phone, or automated service, patients as message recipients might respond thinking that their response will be received by their doctor or healthcare provider. In actual practice, many texting services are not set up to or choose not to accept incoming text message. The patient is not aware of this black hole and may perceive their healthcare provider as non-responsive.
If practices want to avoid misunderstandings, a process should be implemented to inform patients about the practice’s texting communications policy including whether, how to, or not to, respond to texts.
This patient communications “policy” does not have to be overly complex or steeped in protective legalize, just something that explains, in plain English, the different paths you and your patients can best use to communicate with each other.
A well designed plan can support you in guiding patients to particular venues for various situations. Let patients know which types of messages you will respond to, and which type you won’t. And if you use social media, be sure to include your boundaries, i.e. if you will accept friend requests, follow, or what expectations you have for engagement on your social media sites.
Texting is just one more communication pathway in your toolkit. There is no reason it should not be integrated into healthcare, in fact, there may be an immediacy issue that provides great value. Providers just have to make sure that the users on both ends understand the rules, risks, and the best use of this technology in connecting with each other.
