The Benefits and Risks of Text Messaging in Healthcare

To optimize patient communications, hospitals and healthcare facilities are harnessing the convenience and effectiveness of text messaging.

According to Pew Research Center, sending text messages is the most common cellphone-related activity, and 97% of American adults text weekly. Throughout the world, billions of texts are sent each day.

The Benefits of Text Messaging in Healthcare

In a recent News Medical article, Liji Thomas, MD, explains texting has particular utility for health messaging due to its low-cost scalability, personalization options and interactive potential. “[Texting] to communicate health-related data may represent an excellent and inexpensive manner of helping patients take better care of themselves,” she explains.

She says healthcare providers can use text messaging to support patients in a variety of ways, including:

• communicating appointment reminders with patients in advance of virtual or office visits to reduce cancellations and absentees while minimizing wait times;
• sending prescription reminders to encourage patients to collect medications from pharmacies;
• encouraging management of chronic conditions;
• sharing information about health initiatives, such as campaigns to reduce disease spread or substance abuse; and
• supplementing mental health services.

A study conducted by the University of California-San Diego indicates that text communication can positively impact patient satisfaction. The research explored how texting a link to telehealth patients when their provider was ready for an appointment could replace the need for a virtual waiting room. “Wait times and lack of timely communication both correlate with patient experience,” explains study co-author Emily S. Perrinez, RN, MSN, MPH. “Real-time text notification that the provider is ready improves patient satisfaction.”

Penn Medicine has also explored the benefits of text messaging in patient care. In the early days of the pandemic, Penn Medicine launched COVID Watch, an automated text-message system  that monitored COVID-19 outpatients. Backed by a team of nurses, the program used algorithmically guided conversations to evaluate patient condition. If patients revealed worsening symptoms, they were directed to human care-team members who could provide more personalized information and refer patients to hospitals. Patients who were enrolled in the system were 68% less likely to die than those not enrolled. “Our evaluation found that a small team of five or six nurses staffing the program during some of the most hectic days of the pandemic directly saved a life every three to four days,” explains the study’s co-primary investigator Krisda Chaiyachati, MD.

The Risks of Text Messaging in Healthcare

Dr. Thomas cautions that risks are associated with text messaging in healthcare. For example, information sent via text could be confusing or misleading due to brevity or lack of verbal and nonverbal cues that often support communication.

Furthermore, although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) does permit text messaging in healthcare settings, privacy issues remain a concern. Messages could jeopardize patient privacy if they are sent to the wrong recipient, intercepted by hackers or uncovered by another user. To address these issues, HIPAA requires the use of safeguards, such as encrypted messaging and other controls that prevent unauthorized access to protected health information.

For healthcare organizations looking to incorporate text messaging into patient communications, Dr. Thomas advises selecting a system that provides privacy, confidentiality, secure storage and accurate contact information.

Text messaging can lead to major legal issues if they are not incorporated into patients’ records. Information relative to diagnosis and treatment is considered protected health information. All communications between physicians and patients which contain clinically significant information should be added to records in a timely manner. Communications via texts are just as important to retain as any other exchanges of patient information via all other mediums. 

For additional guidance on this technology, we recommend consulting MLMIC’s Risk Management Checklists on technology in healthcare, specifically, the checklist on security of patient information and health IT.