During the second morning session of the mHealth track at TEPR today, Kaiser Permanente's Manager of Solution Consulting Nardo Manaloto outlined best practices for using text messages to send appointment reminders to patients. Manaloto recently completed a successful trial of such reminders at one of Kaiser's clinics. KP teamed up with text messaging application service provider Mobilestorm to handle the delivery of the text message reminders.

During the one-month pilot, Kaiser gave Mobilestorm 87,950 cell phone numbers from Kaiser's database of patients. Of those, many phone numbers were either not cell phone numbers or invalid altogether. As a result, Mobilestorm ended up sending 32,864 messages total. At the end of the pilot, Kaiser lost 1.8 percent of their user group, which opted out, or asked not to receive future text reminders. Manaloto also noted that overall, the program showed an improvement of 0.73 percent fewer "no shows" for appointments or 1,837 fewer "no shows". 

Kaiser Permanente's CIO was impressed enough to greenlight the program as an upcoming national initiative, Manaloto said. Given some of the lessons learned and stated "failures" from the pilot, Manaloto admitted Kaiser was going back to square one to pick a new vendor partner. A national, commercial rollout would also include branding, sales/marketing and more complex opt-in and opt-out mechanisms, he noted.

Update: Just to be clear: As Manaloto noted in the comment section below, Mobilestorm is not necessarily out of the running. 

Read on for a few of the best practices and lessons learned from Kaiser Permanente's text message-based appointment reminder program:

- Generic appointment reminders are more effective than specific ones: Mammogram appointment reminders that specified the test had a 2.96 percent unsubscribe rate, for example.
- Females are more likely to opt-out than males
- Patients aged 13 to 17 years old and 18 to 24 years old have the highest opt-out rate probably because they know how to opt-out.
- Be sure to sift through your patient contact info carefully, sometimes cell phone numbers are in the "Work phone" field or the "Home phone" field.
- Use a carrier query service provided by your text message vendor to determine whether a given cell phone number is valid: this generally costs about one cent per number.
- Texts send over the SMTP protocol are considered emails and fall under CAN-SPAM laws, so be sure to use the text messaging protocol SMPP, instead.
- Kaiser legal counsel decided that unsolicited text messages are permissible on the same basis that telephone messages have been permissibl.e
- Ensure that the text messaging vendor does not include a marketing message at the end of the reminder (Kaiser's vendor did at first).
- If a patient opts in, it's okay to let them incur the costs of the texts, however, in an opt-out only reminder service the care provider needs to pick up the cost.

Manaloto and his team had only four months to put together the "innovation project." Manaloto quipped that it's easy to see how far behind the healthcare industry is on adopting technologies when a pilot using text messaging is labeled "innovation."