Marty: Hey doc, you watch the Super Bowl?
Marty: Good game, better commercials. Hey, I ate some jalapeño popper dip last night that isn't sitting with me too well. My stomach is doing somersaults. What should I do?
Doc: Please stop texting me.
OK, this conversation never happened. I don't even have a primary care physician right now, but a conference I recently attended held a session devoted to patient-provider texting that piqued my interest. Is this how patients really want to communicate? Is it HIPAA compliant? Do doctors want to give that kind of unfettered access?
I spoke with Natasha Burgert, M.D., a pediatrician in Kansas City, Mo., who regularly chats with patients via text (she was also profiled on this last October in the New York Times). With the growing need to continue some conversations with parents and teens outside of the office, Burgert started texting a handful of them last summer. Thus far, she thinks it's had a positive impact on the quality of care she provides.
"Patients are begging to be able to communicate in a way that's easy for them, and the health care system is not easy to navigate," she says. "They're seeking providers that are willing to communicate in ways that fit with their active lifestyles. It allows me, as a provider, to give better care to more patients in the same amount of time from 8 to 5."
Burgert dove in last year and asked a handful of patients and parents whether they'd be interested in talking over text. Those she targeted had some sort of specific health issues and a need for ongoing support. It "was not a situation where patients could just send me a random text," she says, but more about continuing a dialogue.
Nowadays, she's texting regularly with a small patient population, about 50, and only receives a few messages a day. The typical exchange is along the lines of: "Hey, Johnny woke up today with a 101 fever; do you think I need to bring him? Gimme a call," or, "Sam is looking great today, thanks for the help yesterday." Or with a teenager, it's something as simple as, "I'm having back pain, can you call me?"
So, it's very basic stuff, and not to the level of developing medical plans or exchanging personal medical information. Doing so would trigger stricter HIPAA protocols. But Burgert points out that several software companies have developed HIPAA-compliant patient-provider texting apps and networks to allow for more-detailed discussions. She is part of a small practice that can't afford the fees associated with such technology, and doesn't often see the need to exchange sensitive details over the phone.
For her patients, pretty much anything during her waking hours, from 6 a.m. to 10 p.m., is fair game. Thus far, parents and patients have understood that it is not to be abused, and she hasn't received any odd texts during odd hours.
"The patients who communicate with me in this way understand that this is a privilege, and they respect it fully because they don't want it taken away," Burgert says. "If there are patients that I suspect would abuse it, they don't have that privilege."
There's also the question of whether insurers are willing to underwrite the time and money spent texting patients. Burgert isn't compensated for her messaging, but she also doesn't make any money off phone consultations, and she much prefers a two-second text to a 10-minute phone call.
Lots of stuff has been written about this before, so I'm not breaking new ground here. In this piece, surgeon Andrew Brooks, M.D., takes a look at the issue of HIPAA-compliant texting. A study by PricewaterhouseCoopers last year found that 30 percent of Americans would use their cellphone to track personal health, and 27 percent said they would find texted medication reminders to be helpful. And here's more on the risks of patient-provider texting and some of the ways to remain compliant.
Burgert understands that texting isn't for every doctor. Some worry about giving up too much time to patients, and would prefer to have their work concerns disappear at 5 p.m. But she believes those doctors might fall behind.
"I don't think that this is for everyone, but I think that they're missing an opportunity to advance their practice into the new era if they don't," she says.
What has your hospital's experience been like with texting between patients and doctors? Share your thoughts in the comment section below.