The orthopedics and sports medicine practice affiliated with Goshen Health in Indiana last year piloted a secure text messaging system that allows patients to contact doctors during recovery, and almost 80% of patients who tested the app the system improved their care, Jessica Cohen reports for Modern Healthcare.
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Texting with patients
About three years ago, David Koronkiewicz, an orthopedic surgeon and then medical director of quality at Goshen Health, was tasked with establishing a systemwide text messaging system for clinical staff and supervisors.
As Koronkiewicz worked on the project, he realized that secure text messaging could also improve communication between clinicians and patients, Cohen reports. Koronkiewicz began testing secure messaging with his surgical patients at Goshen Orthopedics & Sports Medicine, the hospital-employed orthopedic group at Goshen Health. He relied on the secure message app Blackline, and enrolled patients and their caregivers in the app on the day of surgery.
During operations, Koronkiewicz used Backline to update patients' caregivers on the procedure. In the days after the procedure, Koronkiewicz would use the app to message patients for updates on their recovery. The app alerts patients to an update from a physician via a text that contains a link to a secure webpage. Patients can send questions to their clinician for up to 72 hours after the clinician first contacts them on the app.
"I've had patients text us that say, 'I need new pain medicine,' or 'I'm nauseated,' or 'Can I (take) a shower,'" Koronkiewicz said.
Implementing the system across Goshen Orthopedics & Sports Medicine
The app "was a hit" among patients, Cohen writes, so in January 2019, Koronkiewicz launched a formal pilot to test the messaging app at Goshen Orthopedics & Sports Medicine.
The one-month pilot study enrolled 38 patients into Backline's messaging system and found that the majority of patients felt the app improved their care experience.
Seventy-eight percent of patients said the messaging app improved the overall care process, while 83% said having the ability to message their clinicians made them feel more at ease. Overall, about 90% of patients said they would recommend the system to others.
Initially, clinicians at Goshen expressed concerns that the patients would abuse the app and contact them too often, but over-communicating did not seem to be a problem during the pilot, according to Koronkiewicz.
According to Koronkiewicz, only two patients messaged their clinician four or more times, and only one clinician complained that a patient texted them multiple times in the middle of the night.
How others can implement a direct messaging system
When implementing a messaging system like this, hospitals should have other clinical staff, including nurses and physician assistants, triage messages and respond to those that don't require a physician's input, Cohen writes.
Lew Schon, director of orthopedic innovation at the Institute for Foot and Ankle Reconstruction at Mercy Medical Center, has used direct messaging to communicate with patients for at least five years. But to manage his workload, Schon said he only offers the option to patients who are out of state, international, or have more complex care needs.
While Schon said his patients have never misused the direct messaging system, he said it's important that clinicians set expectations regarding response time as well as the types of questions patients can ask.
But what's most important is that hospitals implement direct messaging at a manageable pace, starting with certain patients and conditions according to Schon. "[B]ecome more comfortable with it, test drive it, and figure out what’s best for your unique set of doctors and your hospital" (Cohen, Modern Healthcare, 8/17)