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Why Secure Text Messaging Is So Much Better Than SMS

Posted on January 14, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my most popular articles of 2013 was titled “Texting is Not HIPAA Secure.” Certainly HIPAA compliance is good enough reason for every healthcare organization to implement a secure text messaging solution in their office. Considering the number of organizations I hear are recklessly sending PHI over SMS, I expect this is going to come back and really hit some organization where it hurts. Plus, you won’t be able to hide since the carriers often save the SMS messages for easy discovery by a legal team (which is another reason why SMS isn’t HIPAA compliant). It might take a major HIPAA violation for the industry to wake up.

HIPAA violation issues aside, there are so many other reasons why a healthcare organization should consider using a secure text messaging solution as opposed to insecure SMS as many do today.

As most of you know, I’m adviser to secure messaging company, docBeat (Full Disclosure). As I’ve worked with docBeat, I’ve been amazed at how much more a secure messaging platform can do beyond the simple messaging that you get with SMS. All of these features make a secure messaging option not just a way to avoid a HIPAA violation, but also a better option than default SMS.

Here’s a look at some of the ways a secure messaging solution like docBeat is better than SMS:

Message Delivered/Read Status – I think this is one of the most underrated features of a secure message solution. With an SMS message you have no idea what’s happening with the message. You have no idea if the message has even been delivered to the recipient, let alone read. We’ve all had times where we receive a SMS message well after it was sent. In the case of docBeat, they have a status indication on each message so you know if the message has been delivered to the recipient and if it’s been read. A simple, but powerful feature.

Secure Text to Groups – While SMS is great for sending a message to one individual, it fails when you want to include an entire group in a conversation. The concept of group messaging is really powerful in so many areas of healthcare. Much like the reply to all in email, you have to be careful not to abuse a group text message, but it’s easier to manage since they’re usually short messages that are easily consumed. In docBeat, they offer this group text messaging to a predefined group of users or to an adhoc group that you create on the fly. I especially like this feature when you need help from any one of many doctors, but you’re not sure which is available to help.

Controlled Message Storage – While this has HIPAA implications, the ability to control and audit the messages that are sent is really valuable for an organization. In the wild world of SMS you have no idea what the carrier is doing with those messages. Once they’re on the phone, there’s not an easy way to wipe them off if something happens to the device. With a secure message solution you can control and audit the secure messages. This might include knowing how many messages are sent, how quickly the messages were read, where the messages are stored, etc.

Mobile and Web – In a healthcare organization there are often a lot of people you want to message who don’t have a mobile phone issued by the organization. This often means those people start using their personal device to SMS providers (not a good thing) or they just can’t participate in the messaging. docBeat runs on the iPhone, Android and the web. In most cases, the web option is a perfect way for the non mobile staff to participate in the messaging. Try making that a reality with SMS.

Quick Messages for Common Responses – While many people have gotten very fast at typing on their cell phone, it still takes some time. One way to streamline this is to use quick canned messages for responses you give all the time. It’s much easier to one click a message like “I’m on my way. Be there in a minute.” than to try and type that message into the phone.

Scheduled Messages – Considering the 24/7 nature of healthcare, there are often times when someone is working late at night, but the message doesn’t need to be read until the next morning. Scheduled messages are a perfect solution for this problem. You can create and schedule the message to get sent at a reasonable time rather than waking the doctor up needlessly.

Secure Attachments – While MMS mostly works, I’ve seen where some telcom providers don’t support attachments using MMS. Unfortunately, the telcom provider doesn’t tell you this and so you have no way of knowing that the attachment you sent never made it to the recipient. Plus, MMS works best for pictures. It doesn’t support the wide variety of document formats that a secure messaging provider can support.

Ability to Send Location with Text – While you have to be careful with this feature, it can be a really nice added value to your organization to know their location. Are they sending you a message at your hospital or at their kids soccer game? Knowing this little piece of information can change your workflow so the patient gets better care.

Message Expiration – We could call this feature the snapchat feature. As we saw with the popularity of snapchat, there are times when you may want a message to only live for a certain duration. As is the case with most data retention policies in healthcare, some organizations love this feature and some hate it. Of course, each institution can choose how they want to use this type of feature. In the SMS world, you don’t have a choice. You’re at the mercy of the telcom providers decisions.

Automatic Message Routing to On Call Individual – One of the great features of docBeat is the ability to identify the On Call individual in a group. This was originally applied to docBeat’s call forwarding functionality, but they recently applied it to their secure messaging as well. Now you can message a provider and if they’re not around it can be auto routed to the on call provider. A powerful concept that wasn’t possible before.

One Messaging Platform – This is going to take a while to see fully fleshed out, but those in healthcare are starting to get messages from a variety of sources: SMS, phone, EHR, HIE, Patient Portal, medical devices, etc. As it stands today, those messages have to be checked and responded to in a number of different ways and locations. Over time, I believe each of these messages will be integrated into one messaging platform. The beauty of a secure messaging platform like docBeat is that it can handle any type of message you throw at it. We’re not far off from the day where a doctor can check her docBeat message list and see messages from all of the sources above. The idea of a unified messaging platform is really beautiful and can’t come soon enough.

I’m sure I’m leaving off other examples that I hope you’ll share in the comments. As I look through this list of secure text messaging benefits over SMS, I think we’re at the point where many will choose a secure messaging solution in healthcare because of the added features and not just to try and avoid a HIPAA violation.

Why Accepting Patient Email is a Practical Requirement of the Affordable Care Act

Posted on July 31, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Zachary Landman, M.D., Chief Medical Officer for DoctorBase.
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With the infusion of 30 million patients into the U.S. healthcare system in the coming years, the physician shortage is only going to worsen. In Massachusetts, which has had a similar healthcare legislation enacted since 2006, improvements in healthcare coverage and access are highly associated with physician shortages. Prior to the implementation of the health law in Massachusetts, internal medicine and family practice physicians were in deemed to be in “adequate” supply. Almost immediately following the legislation and in nearly every year since, however, the specialties have listed as “critical.”  While the percent of covered patients in the system has reached upwards of 95%, the result has been that physicians are increasingly difficult to visit. Appointment wait times have soared into weeks and months for some specialties and there has been frustration from both patients and providers regarding access.
MMA workforce 2006 and on
An even direr scenario is expected to play out on a national scale when 55 million people currently without insurance enter the healthcare market through subsidized exchanges. Economists predict that the current shortage of physicians will balloon to 63,000 by 2015 and escalate to 130,600 by 2025, due to both increasing demand and dwindling supply. To add salt the wound, a 2012 Physicians Foundation survey demonstrated that nearly half of the 830,000 doctors in the U.S. are over 50 meaning that as the number of patients swell, the supply of physicians will conversely retract.

Clearly, the way healthcare is provided will need to fundamentally change in order to accommodate the three main tenants of the Patient Protection and Affordable Care Act: Access, Quality, and Cost. One potential way is to simply force physicians and healthcare providers to see more patients in the current set of time or work longer or more frequently to maintain their level of reimbursement. Physician time, however, especially for chronically ill and complex patients has become a relatively “inelastic product.”

Physicians already experience significant rates of burnout, are feeling overworked, and have increased the frequency of patient visits to between and 6 and 9 minutes per encounter. Some studies suggest that trying to reduce this amount of time further may actually cause an increase in costs due to inadequate care, counseling, and increased frequency of complications. I would therefore argue that we have reached a point at which physicians cannot increase the volume and frequency of patient care without a fundamental alteration to the paradigm of healthcare.

Secure email may just be the answer. Securely messaging patients can provide a way to fundamentally alter the type and scope of care provided remotely leading to a maintenance or even reduction in the amount of patient care conducted in the office. The fundamental “if” in this scenario, however, is that it must save physician time. For example, physicians have known the value of hand hygiene in patient care for nearly two centuries, but only recently has widespread adoption been shown in an inpatient setting. What led to the main change? Time.  It takes considerable time to cleanse hands thoroughly between each visit. Only when the practice became a time-neutral or time saving event were physicians keen to alter practice behavior. With the inclusion of quick, visible, and easy to use dispensers outside each patient room, these two principles finally coincided.

It’s the same with email. Many physicians worry that by accepting patient messages, their already inelastic time will continually be stretched, forcing them to work longer and harder for a non-reimbursed activity.  After studying more than 11,000 physicians over three years, I have found that the effective use of secure messaging saves physicians on average 45 minutes per day.

Three hours and forty-five minutes per week. That’s a lot of time. And here’s where it comes from.

#1 – Triage. Physician messages should be directed to a practice manager or physician extender who triages the messages and forwards to the appropriate individual. In our case, we found that nearly two-thirds of “physician” messages could actually be handled by office staff. These messages were typically related to hours, availability, insurance coverage, consultant phone numbers, or other back office functions. Our surgeons found that by including a nurse practitioner or physician assistant could also further reduce the number of “MD-level” messages.

For example, minor concerns regarding wound or incision appearance, follow-up timing, suture removal, or questions from visiting nurses were all routinely and commonly handled by the midlevel provider. The exact nature of each question was handled in accordance with physician comfort and expectations. Ultimately, the number and quality of the messages that were directed to physicians were important, timely, and appropriate which led to fewer ED visits, sameday appointments, and phone calls.

#2 – Mobile. Physicians who are able to read, review, and send messages from their mobile device were able to find a considerable amount of “lost” time in their day. Physicians are constantly on-the-move: between patients, rounding, to the hospital and back, to lunch and back, on the elevator, etc. We found that these “micro-minutes” in each day added considerable effectiveness to mobile messaging. As discussed in #1, physician messages were already screened to be important and relevant and so a timely response is indicated. Physicians were able to answer these questions on-the-fly, leading to further confidence in the system on behalf of the patients and fewer voicemails or messages to return at the end of each day.

#3 – Voicemail. Voice messages are the bane of nearly every provider’s life. They are difficult to understand, slow, and take considerable time to review, record, and answer. Through points #1 and #2, the volume and frequency of voicemails decline considerably. The top competitor to patient portals and secure messaging is the phone. It’s universally understood, easy to use, and an immediate response is obtained. Only when patients have an easy to use portal that they can easily access anywhere (and from any device), send a secure message with confidence that it will be reviewed by the provider in a timely manner, and rewarded with a response will patients choose a new system. That’s exactly what our experience has been and there’s absolutely no reason that this cannot be replicated on a national scale.

Whether secure patient email (and ultimately our healthcare legislation) is a failure or a success relates to the patient and provider experiences and our ability to create a harmonious interplay of accessibility, ease of use, and time.

Zachary Landman, M.D. is the Chief Medical Officer for DoctorBase, a San Francisco mobile health technology company considered to be the leader in mobile cloud-based health messaging services that serves more than ten thousand providers and nearly five million patients. Landman is a former resident surgeon at Harvard Orthopaedics and graduate of University California San Francisco School of Medicine. During his career at the intersection of healthcare, technology, and industry, he has developed interactive online musculoskeletal anatomy modules for medical students, created industry sponsored resident journal clubs, and published numerous peer reviewed articles on imaging and outcomes in spine and orthopaedic surgery. Currently, he is leading the development of DoctorBase’s pioneering patient engagement and automated messaging suite, BlueData.