how sms can be used to to increase dental appointments

While you may think your dental practice is following all HIPAA rules, is it really? Check these seven rules from an attorney who has represented dental practices who have missed something regarding HIPAA, and paid for it. 

SEAMLESS INTEGRATION OF HEALTHCARE MESSAGING

 

If you’re a dentist, you know about HIPAA. You know that HIPAA creates rules and restrictions on the way you keep, use, and disclose patient information. However, many dentists don’t realize that HIPAA also restricts the way they and their staff can use email and text messages to communicate with patients and other providers about patients.

HIPAA applies to emails and text messages

HIPAA applies to emails and text messages sent to a patient, such as for scheduling or appointment reminders. HIPAA also applies to emails and texts sent to another provider about a referral, with diagnostic images, or to discuss treatment. Here’s the kicker—HIPAA applies when a dentist emails patient records or information from a work email account to a personal email account, even if the dentist is doing so simply to finish up work from home later that evening.

HIPAA doesn’t completely prohibit using emails and texts to communicate with patients or other providers about patients. But HIPAA does require dentists to use security measures when doing so, such as encryption or secure messaging platforms. Alternatively, dentists need to obtain consent from patients to send protected information via unsecured email or text. Sending protected information over unsecured emails or texts without a patient’s consent can violate HIPAA.

Why should dentists care about this?

Failing to comply with HIPAA can have severe consequences. If protected health information is used or disclosed in a way that does not comply with HIPAA, a dentist may need to give notice of the impermissible use to the affected individuals, the federal government, and, if more than 500 individuals are affected, the media. The federal government has stepped up HIPAA enforcement, conducting more compliance audits and seeking more financial penalties from HIPAA violators.

What does this mean?

Dentists and their staff need to know and follow the rules with emails and texts to remain HIPAA compliant. Before getting to the rules, here’s some terminology:

First, HIPAA applies to the storage, use, and disclosure of a patient’s individually identifiable health information, which HIPAA calls protected health information (PHI). PHI is generally defined as any information about a patient,—name, demographic information, past, present, or future physical or mental health condition, treatment, x-rays, pictures, and payment information—that can reasonably be linked to a specific, identifiable individual.

Second, “password protected” is not the same as “secure” or “encrypted.” To understand the difference, think of a padlock and a code. A padlock (like a password) protects against unauthorized access. But once a person unlocks the padlock (gets past the password), the person can see and make sense of everything inside. Encryption, on the other hand, is like a code. The information gets jumbled so it cannot be used or understood by a person who sees unless that person has the “key” to decode the jumble (the “encryption key”).

What are the rules for emails and texts?

1. Emails to others inside the same practice—Most practices have a secure server and network, and emails between people inside the same practice, even if located in different offices, are sent over the secure server and network. If an email is sent to another person inside the same practice over a secure server and network, the email can include a patient’s PHI and does not need to be encrypted. However, if the in-practice email is not being sent over a secure server (e.g., if the practice uses Gmail or another web-based email service), the email should not include information about a patient that can be linked to a specific, identifiable individual.

2. Emails to persons outside the practice (other than the patient)—Emails to people outside the practice other than the patient should not include a patient’s PHI unless the email is encrypted or sent via a secure messaging system. This generally means that dentists should not use emails to communicate with other providers about an identifiable patient unless special security measures are taken.

3. Emails to personal email accounts—Emails from a work email account to a personal email account should not include PHI or attach patient records or other documents with PHI. If work needs to get done from home, consider using a secure remote connection (such as GoToMyPC) to connect from home, or take the minimal amount of needed information home on an encrypted flash drive.

4. Text messages to persons other than the patient—Unless a provider or practice has a secure text messaging platform, text messages are not secure or encrypted. They are easily intercepted, often sent to an incorrect number, and usually stored indefinitely on third-party devices, such as the wireless carrier’s servers. Thus, text messages should not include a patient’s PHI. This is true even for texts to staff or other providers inside the same practice; these should not include identifiable patient information.

5. Emails and texts to patients—More patients want their dentists to communicate with them by email or text. Dentists who want to do so must do one of two things. Option one is to use an email or text messaging system that encrypts messages or requires patient login, such as a patient portal. If a secure messaging system is used, messages sent to a patient can include PHI.

Option two is to obtain the patient’s consent for using unencrypted email or text messages to communicate with the patient. This is after advising the patient of the risks of doing so, including the risk that the message could be read by a third-party. A good way to do this is by giving the patient a well-written consent form as part of his or her new patient paperwork, or to existing patients at their next visit. If a patient consents to the use of unsecured emails and texts after being properly warned, a dentist may communicate protected PHI to the patient in that way.

6. Emails and texts from patients—The above rules do not apply to emails or texts sent by a patient. HIPAA applies to health-care providers (and other “covered entities”), not patients. Patients can use unencrypted emails and texts to communicate with providers.

If a patient initiates an unsecure email or text and sends it to his or her health-care provider, the Health and Human Services Office of Civil Rights (OCR), which enforces HIPAA, explains that the provider may assume that using unsecure emails or texts are acceptable to the patient, unless the patient has explicitly stated otherwise. However, OCR has also advised that if the provider believes the patient might not understand the risks of using unencrypted email or texts or if the provider has concerns about potential liability, the provider may want to alert the patient of those risks and let him or her decide whether to continue with unencrypted email and text communications. So, if a dentist doesn’t have a signed consent and preference form from the patient, the dentist may want to get one before replying via unsecured email or text.

7. Email confidentiality notices and disclaimers—There’s a myth that including a confidentiality notice or disclaimer in an email makes the email compliant with HIPAA and allows a dentist to send PHI via unencrypted or unsecure email. The myth is false. Even the best-worded notice or disclaimer will not make an unencrypted email comply with HIPAA. The rules here still apply.

Best practice: Get consent and preference forms from all patients

All dental offices, even those that use encryption or secure messaging systems, should consider having all patients complete an email and text message consent and preference form that confirms their preferences about emails and texts. Doing so would allow dentists to communicate with their patients consistent with their desires. It would also give patients a chance to consent to the use of unencrypted emails or texts.

Consent forms would also help dentists with another significant hazard that comes with calling or texting a patient’s cell phone—the Telephone Consumer Protection Act (TCPA). TCPA is the federal law that protects consumers from unwanted telephone calls and faxes. TCPA prohibits making auto-dialed and pre-recorded calls and texts to cell phones (e.g., auto-generated appointment reminders) without the prior express consent of the called or texted party. Sanctions for violating the TCPA can be huge—$500 per violation (per call or text message).

For all of these reasons, having every patient review and sign a well-written consent and preference form, and then following the patient’s preferences, is a good idea that will keep your dental practice HIPAA compliant.

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how text messaging boosts to engagement and patient outcomes

Texting can keep patients motivated, engaged, and on the road to better health 

 

Deliver better healthcare through effective use of secure mobile messaging

Text messaging has become a critical and strategic tool for healthcare providers. Innovative healthcare organizations and clinics are leveraging SMS as a communications channel to make the patient experience easier and more convenient. Further, text messaging is playing a pivotal role in keeping patients motivated and engaged with their providers about their well-being and treatment plans. Knowing where to start can be a challenge with implementing an initiative like this — especially given industry-specific regulations and compliance requirements.

A recent Flowroute survey found more than half of consumer respondents prefer receiving notifications — such as appointment reminders and prescription updates — via text rather than email. In fact, the study found 82 percent of all text messages are read within five minutes, therefore increasing the likelihood of interaction. Meanwhile, consumers open just 25 percent of the emails they receive.

While businesses are increasingly using SMS as a communication channel, healthcare is outpacing all other industries. In healthcare, SMS messaging is used particularly for appointment reminders and prescription refills.

A study conducted by researchers from the Perelman School of Medicine at the University of Pennsylvania found text messaging systems can also benefit hospital systems and boost patient recovery times as well, as Health IT Outcomes reported. Introducing the use of a text message based hospital communication systems in place of traditional paging systems benefits not only staff but also the patients in the hospital.

According to Flowroute study the benefits of SMS include:
 

• Convenience and cost reductions: Being able to manage appointment cancellations and rescheduling via text is convenient for patents and also has a direct impact on a provider’s bottom line. No-show appointments cost U.S. providers more than $150 billion annually. The problem affects urban hospitals and small specialty clinics most, where no-show rates are between 10 and 20 percent.
• Motivation to stay engaged: Text messaging can also play a key role in improving patient engagement and involvement with their treatment plans. Reminders for prescription refills, for example, could help boost medication adherence rates and subsequently impact patient health outcomes.
• Communication on your terms: Text interactions also give patients flexibility to interact with their providers in the manner they feel most comfortable, which could enhance the patient-provider relationship and foster patient loyalty, making it more likely they will seek regular preventative care as well as treatment for chronic conditions with their healthcare professional.

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how the health industry is using SMS to improve patient care

The growth of text messaging (SMS) has matured over the last several years, and the potential for businesses across all industries to incorporate texting into business operations and customer communication is vast. Companies in the restaurant delivery, banking, transportation, and ride-sharing industries have been successful in using SMS as a communication channel because it provides their employees and customers with an efficient, private and convenient way to interact.

Text messaging has also emerged as a popular and effective way for many organizations to improve customer experience. According to a national survey, alongside email and phone calls, SMS ranks in the top three communication methods consumers prefer when interacting with businesses. In fact, over half of survey respondents indicated they would view a business more positively if it offered SMS capabilities.

Deliver better healthcare through effective use of secure mobile messaging

The healthcare industry in particular is outpacing others in its use of SMS. Physician's offices are leveraging texting as a strategic tool to improve the patient experience and their own internal processes. Common use cases for SMS include notifications around appointment reminders, prescription refills and test results, as well as managing wait times.

Independent and hospital-owned practices that employ SMS for the processes listed above, can realize a number of benefits pertaining to internal and external procedures.
 

The following are three examples of how healthcare providers are using SMS as a communication channel to their benefit:

 

Optimized appointment schedules.The ability to manage appointment schedules by sending reminders, cancellations, and reschedule-requests via text is not only convenient for patients, it also has direct implications on the physician office's bottom line.

For example, if the office has a waitlist and the ability to text patients when there is an appointment opening - especially a last minute opening - they are able to fill the appointment slot and utilize the staff present where there would have been a no-show appointment (a major expense costing the U.S. healthcare system more than $150 billion each year).

Being able to mitigate no-shows via text alerts is a definitive way to optimize the appointment schedule and minimize operational costs such as overstaffing, improper booking of machinery/lab equipment, etc. A more organized schedule with accurate wait times results in a more relaxed environment and happier patients.

Increased flexibility for customers. SMS also gives patients the freedom to communicate with their healthcare providers in a way that is intuitive and easy for them. By giving patients the choice of how to interact with their healthcare providers, SMS has the potential to enhance the patient-provider relationship and strengthen patient loyalty, increasing the likelihood that the patient will reach out for preventative care, as well as ongoing treatment for chronic issues. In addition, offering the flexibility to communicate via text reduces much of the hassle associated with listening to voicemails or making phone calls about test results at an inconvenient time or place.

Improved treatment and patient care. Physicians' offices have also begun to use SMS in innovative ways such as reminding patients to take their medication, checking insulin levels, and sending motivational text messages that encourage positive behaviors (i.e. eating healthy and increasing activity) and reduce negative behaviors (i.e. smoking). These alerts demonstrate a level of care and involvement from the healthcare provider, while also improving the patients' health and quality of treatment.

In fact, a recent study from the American Heart Association hypothesized that using automated mobile health notifications with tracking and texting components may increase physical activity. The results showed that patients who received these motivational and informative text messages walked an additional 2,500 steps each day, compared to individuals who did not receive the messages. This strategy, although not yet widespread, has great potential to become a common and successful practice among healthcare providers due to the huge popularity of wearable activity trackers on the market today.

Together, these strategies have the potential to make a significant difference in enhancing the patient experience with a provider, as well as their engagement with a treatment plan. Healthcare providers looking to incorporate SMS as a communication channel not only have the potential to further benefit a patient's well-being, but also establish themselves as a trusted partner with a deep level of emotional investment in their patients long-term health plan.

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study shows patients like remote monitoring via mobile app for follow-up care

Dive Brief:

Access to a mobile app that allowed ambulatory breast reconstruction patients to submit photos and report information to physicians resulted in fewer post-surgery follow-up appointments, according to a study published by JAMA Surgery.

Out of 65 women treated between February 1, 2015, and August 31, 2015, 32 women with access to the app attended a mean of 0.66 in-person visits while 33 women without the app attended a mean of 1.64 in-person visits.

There were no significant differences in telephone calls with physicians, satisfaction scores or complications between the two groups, although women with access to the app sent more emails to their physicians and reported higher convenience scores.
Dive Insight:

One obstacle that has hindered adoption of technology in healthcare has been doubt over its ability to replace in-person care. However, results such as these are slowly helping to break down barriers holding technology back, especially as patients increasingly indicate their preference for more consumer-friendly services.

Out of 32 women in the study who had access to the app, 30 (97%) agreed or strongly agreed that their follow-up care was convenient. Meanwhile, only 16 of 33 (48%) women without access to the app agreed or strongly agreed that their follow-up care was convenient. This response lends credence to surveys that suggest patients would appreciate digital tools that allow communication with their physicians.

For instance, 62% of those surveyed for a report published June 2016 by Salesforce said they would consider virtual appointments with physicians. Another 61% who had been hospitalized or knew someone who had been hospitalized reported that post-discharge communication with physicians could be improved.

Some healthcare providers have begun to experiment with new care delivery systems that rely heavily on technology. For instance, One Medical, which operates a network of retail clinics, allows patients email and video chat with physicians, send photographs, refill prescriptions and schedule appointments via a website and mobile app. These tools are not only convenient for patients, they also streamline administrative tasks for One Medical physicians and employees.

While the potential for technology to transform healthcare is there, the transformation has not occurred as quickly as some might have hoped. Former CMS Acting Administrator Andy Slavitt, in a recent Q&A with HIStalk, expressed frustration with health IT vendors for engaging in self-congratulatory behavior even though their products arguably make physicians jobs more difficult. A study published September 2016 by Annals of Internal Medicine found physicians spend about half of their workdays on EHR and administrative tasks.

Despite frustration with the slow pace of progress that technology is making in healthcare, the potential is still there. “I don’t think anybody should lose promise in the power of what technology can do,” Slavitt said.

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how healthcare organizations can benefit by using messaging for cancelled appointments

How Healthcare organizations can save money and time by using messaging for cancelled appointments

A recent report states that 8% of patients miss appointments with their doctors and hospitals . And for hospitals loses and delay in managing effective handling of missed patient appointments means impacting their productivity as “ reallocating and rescheduling “ appointments across medical staff and doctors involves considerable time waste . For doctors and medical staff who runs a strict schedule each delay involves changes in their workflow. How can hospitals ensure that “ this time is actually allocated for more urgent and important tasks.

One of the ways Hospitals can automate this is by mobile messaging According to Quarterly Hospital Activity Data 2015, between 2014-15 around 9%, or 5.6 million, NHS outpatient appointments were missed in England, although the rate at some hospitals and for some clinics is much higher.

Of late mobile messaging including text messages and emails have been increasingly being used by Healthcare Organizations and hospitals to remind patients of their appointments by sending out Application to Personal ( A2P messages and also soliciting P2A ( person to application messaging ) in case patients wants to cancel their hospital appointment. A new research trial run by a team from Imperial College London, the Department of Health (DH) and the Behavioural Insights Team in collaboration with Barts NHS Trust and text message provider, iPlato.show that mobile messages and the wording of SMS reminders significantly affects the extent to which patients miss, attend or cancel outpatient appointments Given the scale of SMS usage, this is a significant opportunity for service improvement.

A recent data shows that 52% of smartphone users gather health-related information on their phones. That includes information about a specific medical problem or procedure, or diet, nutrition, and fitness-related information.