Calculating ROI on text message reminders

By: Brian Dolan | Feb 6, 2009        

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During the final presentations at an mHealth Workshop at TEPR this week, Barry Greene, President & CEO, Libertas.md & Med Practice Informatics outlined the return on investment for deploying a simple text message-based communications tool in a hypothetical one doctor practice. Greene showed significant costs saving and revenue boosting opportunities can be leveraged by using text messages to send patients appointment reminders, simple lab results and other “good will” messages like “Happy Birthday” or “How are you feeling?” 48 hours after a visit.

Greene’s hypothetical practice only had to ensure that it added an initial item on admittance forms that read: “Check here if it is OK to use your cellular phone for patient communications.” It would be even better to have a box for green lighting communications via text message, but the first option alone should put you square with HIPAA, Greene said.

Many text message systems like the one needed for these three use cases are free online. They are simple and free to use and are compatible with all of the major wireless carriers in the U.S.–no worrying about what kind of phone or service provider the patient has–they all have text messaging capabilities. 

Greene estimates that making calls for patient reminders, the way most practices operate today, costs about one hour of staff time per day per doctor (at the very least). At $12 an hour, that translates to about $3,000 a year per doctor per practice. Green says a free, text messaging portal online have a hard cost of zero and a soft cost of about 12 minutes per day per doctor, or about $600 per doctor per year. That’s $2,400 less expenses per year, if true. The same soft costs that are associated with making patient reminder calls are associated with informing patients of lab results. By implementing a simple text system that could let patients no as soon as possible that “All results look fine” or “Please call us immediately to discuss” when appropriate, would also save practices about $2,400 a year per doctor, Greene said.

Finally, Greene noted that all these lowered costs are the result of less time on the phone, so in the case of lab results that could translate into more time for doctors (no longer on the phone as much telling patients they are fine) to bill more hours by seeing more patients in-person at their practice.

 ”I’m sick and tired of people saying that there is no money to be made in these mHealth applications,” Greene said during his presentation. So, what do you think–is Greene’s math fuzzy, should every practice be offering text reminders or are there other privacy concerns and technology adoption concerns out there?

  • http://www.diversinet.com David Annan

    “FREE” SMS, A Comment

    Text Messaging is broadcast over insecure public network facilities.

    Most North American text messaging does not have actual delivery notification so the doctor has no way of knowing if the information actually gets to the patient. Using ‘free’ 3rd party SMS delivery schemes implies no assurance about the posted web side information security, timelines, delivery and is designed for casual, non-commercial and non-critical use.

    Honestly, we believe that patient information, even appointment reminders must maintain patient trust and confidentialty if HIPAA is to be honored. Opening up patient contact in an attempt to save a few pennies when secure methods are available does not seem prudent.

    What happens when some nefarious person figures out that Dr. X is a cardiologist or worse a physician working on HIV? If they can crack the ‘free’ site there are records of all the sensitive appointment reminders targeted by individual cell phone numbers. The site workers have complete access to messages sent through their site. Health Insurance or employment could suddenly become problematic if this information was leaked to employers or insurers.

    We believe all communication between physician and patient should reliable and protected.

    David Annan
    CTO
    Diversinet Corp.

  • http://mobihealthnews.com Brian Dolan

    I agree with you, David. Cases abound of text messages that arrive hours after they’re sent (or never make it at all). More interested in the security side of it though:
    Given the security concerns, does this preclude SMS altogether then? You directed most of your criticism toward free, 3rd party solutions, but I’m curious if a platform like Diversinet/AllOne Mobile’s, which is steeped in security measures, enables secure SMS appointment reminders or a comparable, secure, IP messaging service.

  • http://mobihealthnews.com/2009/02/text-message-reminders-sans-sms-wireless/ mobihealthnews » Blog Archive » Text message reminders sans SMS, wireless

    [...] A recent reader comment about SMS security and reliability issues, dovetails nicely with the presentation that Barbara Rapchak, CEO of Leap of Faith Technologies gave last week at the TEPR conference in Palm Springs. Her company conducted a medicine compliance pilot study that sent text messages reminding users to take their medication on-time–but the texts were not sent over a wireless carrier’s network. They weren’t sent at all. [...]

  • Arthur James Nelson

    David everything you say is quite correct. Your risk example is real. But I am not sure if it will matter. I have two teenage sons…and I can tell you that the culture has already shifted to a reliance on text messaging as the primiary method of direct communication. (not phone calls). I think customers (patients) will force this change on us. Perhaps sometimes good enough…is good enough for limited purposes.

    Besides we are talking about point to point communication between two individuals. Just like a phone call, it is between two people. Once the patient has signed a release for limited purposes. HIPAA is largely irrelevent for text messaging. The patients’ demands should prevail.

    I was doing a training in 2007 about wireless emergency notification procedures at a large university. I went into some detail about how everyone will get email notifications (as well as phone calls) should there be a campus incident. I asked the group what they thought. An entering Freshman raised her hand and said, “Email is for old people. …What about text messages?” Boy did I suddenly feel old.

  • http://mobihealthnews.com Brian Dolan

    Arthur, Funny you bring up the use of SMS in emergency situations at large universities. This string reminds me precisely of that same use case–many vendors in that space will argue against SMS for the same reasons of reliability (not security). As you said their fears have been generally assuaged and SMS has largely prevailed.

    For example, I heard students at my alma mater, Boston University, recently received just such a text about an armed and potentially dangerous person on campus. I think security is the bigger issue, but I hope you are right and the younger generation pushes for this technology. It’s so simple and looks as if it could save providers substantial $$ over time.