5 FAQ's on SMS (Short Message Service) Text Messaging Implementation in Healthcare

1. What technology do I need to have in place to begin deploying SMS? At a minimum, you need a gateway service to send the messages. This type of service, provided by numerous vendors such as Mobile Commons, Mobile Storm, TigerText and Twilio, will take your message and the text number and distribute the information to the various carriers (AT&T, TMobile, Verizon, etc.) for actual sending to the user. There is also an option that allows users to send an SMS message to an email address, comprised of the text number and carrier, but all carriers do not have the email option and it does require you to maintain information on which carrier your recipient has. This can be problematic given the frequency in which consumers change carriers. There are also workflow management tools that integrate with these gateways that you can use to manage your SMS distribution. For example, Epic Corporation offers an SMS module as part of its electronic medical record software. You can use the module to plan your SMS messages (i.e. send a daily reminder text to all patients with an appointment the next day) and then have the gateway handle the actual distribution. If you are planning to use SMS extensively, you will want a workflow management tool or very strong import integration with the gateway so that you do not have significant daily manual effort to send the SMS messages. 2. What standards do I need to follow with my SMS message? The Mobile Marketing Association (mmaglobal.com) publishes standards and best practices for the use of SMS. There are very clear guidelines regarding ensuring you have the recipients permission to text them. This needs to be an opt-in program. Each SMS message has to be 160 characters or less, so you need to learn to abbreviate. You also need to include a HELP option and a STOP option. The STOP option can be within the response you send when a recipient texts 'HELP'. 3. What is a short code and why do I need one? Short codes are special telephone numbers, significantly shorter than full telephone numbers that can be used to address SMS messages. Short codes are meant to be used for commercial volumes of SMS messages. You can get started using a standard line (and purchasing one of these is significantly less than a short code), however, a standard line is meant for consumer use and the carrier will cancel your line (without notice) if they find your use to be consistent with commercial volumes. The short code will be unique to your organization, and will serve as an identifier when you get a response to your SMS message. As short codes are expensive (in the $1,000/month range), you do not want to purchase them for every type of text you send (appointment, education program, medication reminder, etc.). But having just one may create problems in terms of tracking to what message the recipient is responding. A short code for each category of SMS, such as appointment-related SMS, may be an effective way to address the costs and tracking concerns.

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4. Can I send PHI via SMS? The debate is still raging regarding PHI via SMS, but to be on the safe side, you want to avoid it. SMS is an unsecured platform so if your message is intercepted, you are at risk for a HIPAA violation. If you need the message to include or reference PHI, an option is to include a link to a secure site in the text. For example, if you have a patient portal, you could text a patient that he/she has a message from his/her provider and to login to the portal to retrieve it. There is also some discussion on whether you should use the first and last name of the recipient. Consider whether first name is enough to personalize the message for you. 5. Who responds to HELP messages? In general, you will want to incorporate your technical assistance for SMS into your normal help desk structure. However, you have flexibility in your response to a user text for HELP and do not necessarily need a one size fits all answer. For example, if you have setup a short code that you use for all appointment-related texts, your HELP response should probably include a number for your scheduling department as well as your help desk. A good number of user calls are likely to be about the appointment, needed information or a desired change. Sending everyone to the help desk will just make the resolution of the users question a two-step process. Including an opt-out option commonly texted as 'STOP' in your HELP response will free up some characters in your original message, since you will not have to list instructions for both HELP and STOP. Whatever path you choose, do ensure that you provide adequate attention to the processing of STOP requests. Text messages have a cost to the user. An organization could quickly become overrun with very angry users if you text them when you they have asked to be removed from the list. Also, as you may be using more than one short code, training for help desk or other support staff should be clear on what each short code covers, both for questions and opt-out requests. A user may be willing to receive texts in one area (e.g. appointments) but not another (e.g. marketing). About the Authors: Keith Weiner is the Ambulatory and Outreach Applications Manager for New York Hospital Queens. Chanin Wendling is the Manager of eHealth at Geisinger Health System. She has responsibility for Geisingers patient portal, SMS patient strategy and patient activation efforts (outside of the office visit) using electronic communications and tools. Karen Kimbro is a Senior Consultant at CGI Federal's Health Practice; she has 10+ years of experience in private and public sector health.

Disclaimer: The inclusion of an organization name, product or service in this document should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval.

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