Text Messaging Benefits for Patient & Health Provider

Did Not Attends (DNA’s) Wasted or underutilised resources Patients don’t receive care that may improve quality of life May present later with worse problems requiring more resources than previously

Wasted or underutilised resources

Patients don’t receive care that may improve quality of life

May present later with worse problems requiring more resources than previously

Efficiency & cost More cell phones than people in NZ Text costs approx half a stamp or call to mobile Low human resource cost as many done at once

More cell phones than people in NZ

Text costs approx half a stamp or call to mobile

Low human resource cost as many done at once

Text messaging pilots Two District Health Boards – Counties Manukau & Bay of Plenty Goal was to reduce DNAs Analysis of DNA rates before & after texting Analysis included ethnicity in Counties Manukau

Two District Health Boards – Counties Manukau & Bay of Plenty

Goal was to reduce DNAs

Analysis of DNA rates before & after texting

Analysis included ethnicity in Counties Manukau

Counties Manukau DHB DNA rate constant at 12% for some time Research showed “forgot appointment” major reason given for DNA Time gap between other reminder methods – letters & phone calls – and appointment

DNA rate constant at 12% for some time

Research showed “forgot appointment” major reason given for DNA

Time gap between other reminder methods – letters & phone calls – and appointment

Counties Manukau DHB Two texts sent 1st text – day before Outbound Callers attempt contact 2nd text – as close as possible to appointment

Two texts sent

1st text – day before Outbound Callers attempt contact

2nd text – as close as possible to appointment

Counties Manukau DHB Extracts from Patient Management System uploaded to Dialhog website 1st text – goal to reduce need for reminder phone call & therefore reduce expenses 2nd text – different timings for morning & afternoon appointments to increase immediacy

Extracts from Patient Management System uploaded to Dialhog website

1st text – goal to reduce need for reminder phone call & therefore reduce expenses

2nd text – different timings for morning & afternoon appointments to increase immediacy

Counties Manukau DHB Text messages generally from family & friends so an opportunity & potential hazard Text should be personalised with information relevant to the particular patient Text replies routed as emails to relevant booking area for follow up Content easily changed e.g. H1N1

Text messages generally from family & friends so an opportunity & potential hazard

Text should be personalised with information relevant to the particular patient

Text replies routed as emails to relevant booking area for follow up

Content easily changed e.g. H1N1

Counties Manukau DHB Manukau SuperClinic rollout started March 07 and was completed mid June 07 DNA rate in initial area dropped from 13% to 11% (15% reduction) 40% of patient records had cellphone numbers recorded in any of three phone fields

Manukau SuperClinic rollout started March 07 and was completed mid June 07

DNA rate in initial area dropped from 13% to 11% (15% reduction)

40% of patient records had cellphone numbers recorded in any of three phone fields

Counties Manukau DHB Results

Counties Manukau DHB Analysis of Results 17% reduction in overall DNA rate all from 50% of patients who received texts Maori DNA rate reduction 10% above average Patient reminded by text 33% less likely to DNA 6500 patients attended who wouldn’t have

17% reduction in overall DNA rate all from 50% of patients who received texts

Maori DNA rate reduction 10% above average

Patient reminded by text 33% less likely to DNA

6500 patients attended who wouldn’t have

Bay of Plenty DHB Utilise most of the Counties Manukau DHB strategy Change to reflect difference in their Call Centre system 1 st text only to unconfirmed patients No significant changes to text content

Utilise most of the Counties Manukau DHB strategy

Change to reflect difference in their Call Centre system

1 st text only to unconfirmed patients

No significant changes to text content

Bay of Plenty DHB Pilot started in November 08 ran till end Mar 09 Clinics added during period, particularly March Successful results have meant subsequent expansion of program

Pilot started in November 08 ran till end Mar 09

Clinics added during period, particularly March

Successful results have meant subsequent expansion of program

Bay of Plenty DHB Only clinics in texting program at end Mar available to work with for analysis Two comparisons decided on Jan – Mar 08 compared with Jan – Mar 09 Mar 08 compared with Mar 09

Only clinics in texting program at end Mar available to work with for analysis

Two comparisons decided on

Jan – Mar 08 compared with Jan – Mar 09

Mar 08 compared with Mar 09

Bay of Plenty DHB Results Clinics using texts at Mar 09 Clinics NOT using texts at Mar 09 Jan 08 - Mar 08 11.19% 5.72% Jan 09 - Mar 09 9.57% 6.27% Change -14.48% + 9.62% Mar 08 12.03% 5.76% Mar 09 8.85% 6.47% Change -26.4% + 12.3%

Bay of Plenty DHB analysis of results 44% of patient records with cell phones. 38% received text Patient texted 38% to 69% less likely to DNA In Mar 09 there were 510 DNAs from 5764 appointments in texted clinics Would have been 693 DNAs based on Mar 08

44% of patient records with cell phones. 38% received text

Patient texted 38% to 69% less likely to DNA

In Mar 09 there were 510 DNAs from 5764 appointments in texted clinics

Would have been 693 DNAs based on Mar 08

Return on investment Appts texted clinics Mar 09 5254 DNA’s 510 Expected DNA’s (Mar 08%) 708 Extra attendees 198 Value @ $100 per appointment $20,000 Texting cost in March $1200 $1 spent on texting = $16 savings

Appts texted clinics Mar 09 5254

DNA’s 510

Expected DNA’s (Mar 08%) 708

Extra attendees 198

Value @ $100 per appointment $20,000

Texting cost in March $1200

$1 spent on texting = $16 savings

Patient Acceptance “Recently you recvd a txt reminder about appt at {LOCATION} Hospital. Plse text bk YES if you liked reminder txt, NO if you didn't. Any other comments. Thanx “ Texts sent Response rate Approve Disapprove Counties Manukau DHB 361 46% 99% 1% Bay of Plenty DHB 160 55% 99% 1%

Patient Acceptance BOP Comments “ Yes thanks” or “Yes thank you” (5 times) “ Yes it’s a great idea” (4 times) “ Yes it was good” (2 times) “ Yes! What a great service. The reminder text was much appreciated. Thank you!!” “ Yes very good. Makes life easy” “ Yes I thought it was very helpful we all lead busy lives and a little reminder never hurts” “ Yes excellent service thanks”

“ Yes thanks” or “Yes thank you” (5 times)

“ Yes it’s a great idea” (4 times)

“ Yes it was good” (2 times)

“ Yes! What a great service. The reminder text was much appreciated. Thank you!!”

“ Yes very good. Makes life easy”

“ Yes I thought it was very helpful we all lead busy lives and a little reminder never hurts”

“ Yes excellent service thanks”

Patient Acceptance Survey Analysis 50% response = high level of engagement Surveys confirm each other & very high level of patient acceptance Patients see texting as valuable self-management tool Patients see texting as the friendly personal face of the Health Provider

50% response = high level of engagement

Surveys confirm each other & very high level of patient acceptance

Patients see texting as valuable self-management tool

Patients see texting as the friendly personal face of the Health Provider

Information Security All communication & transmission encrypted using https All data stored in encrypted databases in physically highly secure premises Different views on text content, privacy requirements and retention periods

All communication & transmission encrypted using https

All data stored in encrypted databases in physically highly secure premises

Different views on text content, privacy requirements and retention periods

Different text content choices No names other identifiers or replies *SCREENING APPT REMINDER* - {Appt Date} @ {Appt Time} at {Location}. To change, ph 0800 000 000. PLEASE DO NOT REPLY TO THIS TXT. Names NHI Numbers & replies {Title} {LastName} {NHI-NO} reminding you of appt at {LOCATION} {APPT-TIME} {APPT-DAY} {APPT-DATE}. Plse reply or ph 222 1234 if you cannot attend

No names other identifiers or replies

*SCREENING APPT REMINDER* - {Appt Date} @ {Appt Time} at {Location}. To change, ph 0800 000 000. PLEASE DO NOT REPLY TO THIS TXT.

Names NHI Numbers & replies

{Title} {LastName} {NHI-NO} reminding you of appt at {LOCATION} {APPT-TIME} {APPT-DAY} {APPT-DATE}. Plse reply or ph 222 1234 if you cannot attend

Letter / text security comparison Letters & texts can go to a wrong or an old address Letters & texts can be read by others if left unattended Texts may be marginally more secure as they do not generally get delivered to a shared space

Letters & texts can go to a wrong or an old address

Letters & texts can be read by others if left unattended

Texts may be marginally more secure as they do not generally get delivered to a shared space

Scalability Some scalability issues with database searches encountered as service expanded at Counties Manukau User setting allows time period to be specified Other issues addressed by providing separate database and functional areas for some service areas

Some scalability issues with database searches encountered as service expanded at Counties Manukau

User setting allows time period to be specified

Other issues addressed by providing separate database and functional areas for some service areas

Current customers include Counties Manukau DHB Bay of Plenty DHB Southland DHB Capital & Coast DHB Waitemata DHB BreastScreen Auckland BreastScreen South BreastScreen Counties Manukau BreastScreen Waitemata/ Northland

Counties Manukau DHB

Bay of Plenty DHB

Southland DHB

Capital & Coast DHB

Waitemata DHB

BreastScreen Auckland

BreastScreen South

BreastScreen Counties Manukau

BreastScreen Waitemata/ Northland

Other health users Text reminders work as effectively for small as well as large providers Physiotherapists PHOs Addiction helpline

Text reminders work as effectively for small as well as large providers

Physiotherapists

PHOs

Addiction helpline