The use of text messages for recalls and reminders has
increased in medical practices due to:
- Patient demand – patients find it convenient to receive messages on their phones and are more likely to respond to a recall or reminder SMS message than a letter1.
- Cost – the cost of a text message is lower than the cost of a letter.
- Technology – many electronic health record and online appointment systems provide an easy way of sending and recording SMS messages.
As with any form of patient communication, medical practices need to take reasonable steps to protect personal information when using SMS messaging2. The RACGP’s standards provide the following useful guidance that can be used by all specialists3:
- Since there is a higher risk of information inadvertently being seen by another person, conduct communications with particular regard to the privacy and confidentiality of the patient’s health information.
- Consider whether it is appropriate to communicate particular information by electronic means or whether other methods would be more suitable (e.g. for sensitive information such as HIV status or pregnancy results).
- Obtain and document patient consent before health information is communicated by email or SMS.
- Confirm a patient’s identification and verify the patient’s contact details before any information is sent.
Is the “reminder” an offer to supply goods or services?
If the whole or part of the purpose of the reminder SMS is to advertise or offer goods or a service at the practice, you must comply with the Spam Act (Cth) 2003.
The SMS message must:
- clearly and accurately identify the organisation that authorised the sending of the message
- include accurate information about how the recipient can readily contact the organisation
- contain a functional and clearly presented unsubscribe facility.
Have a text messaging policy
Your practice should develop an SMS messaging policy to encourage consistent use of the system. The policy should cover:
- who is authorised to send/receive and respond to SMS messages
- how messages are included in the electronic health records
- what information may be included or not included in an SMS message
- how patient consent is obtained and documented
- whether SMS messages are sent offering goods or health services
- what checks are made to verify the patient’s mobile telephone number is up to date and accurate.
Tips for sending SMS messages
1. Obtain and document consent to send an SMS message
messages. Your practice can obtain the patient’s consent to receive SMS messages and the mobile number to use for the messages:
- in the patient registration form for new patients
- when confirming an appointment for existing patients
- through an online appointment or registration portal.
An example of wording in a patient registration form:
Would you like to be contacted via SMS (mobile text
message) for: appointment reminders, recall and other test
reminders or medical services we offer? Yes/No
The mobile phone number should be checked on a regular basis to ensure it has not changed.
Where patients do not consent to be contacted by text messages this should be clearly documented to ensure that SMS messages are not sent.
2. Limit the information contained in SMS messages
To reduce the risk of sensitive information being accessible, the SMS messages should not contain sensitive health information such as a description of particular test results that need to be followed up or the results of such tests (unless the patient expressly consents to this). The message should simply request that the patient contact the practice, as well as indicate (where appropriate) the level of urgency.
It is reasonable to send reminders about generic preventative screening tests (e.g. pap smears, skin checks, flu vaccines) as part of a practice’s preventative care role.
3. Implement a system for following up patients who do not respond to recall SMS messages
When recalling patients for test results, the same principles apply to SMS messaging as for following up any test results. The extent to which patients are followed up will depend on the level of urgency and the clinical significance of their test results.
In the case of routine preventative health reminders, it is generally not necessary to follow up patients as they may have decided not to have a test performed at the practice.
4. Store the SMS message in the patient’s record
An SMS message – to and from the patient - forms part of the medical record and needs to be included in the patient’s record. Some electronic health record systems do this automatically.
1. Use of SMS Text Messaging to Improve Outpatient Attendance – Med J Aust 2005; 183(7) 366-368
2. Australian Privacy Principle 11 requires practices to take reasonable steps to protect personal information from misuse, interference, loss and unauthorised access, modification or disclosure
3. RACGP Standards (4th edition criterion 1.1.2 – telephone and email communications found at http://www.racgp.org.au/standards/112)
For more advice, call Avant’s Medico-legal Advisory Service on 1800 128 268.
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