Ensuring Patient Compliance Using Text Messages and a PHR

One of the really interesting things that I’ve heard at the Mobile Health Expo has been the use of text messages to assist with patient compliance.

I think this is at least the third time at this conference that I’ve been hearing about the use of text messages in healthcare as a way to remind patients of their need to comply with the doctors instructions.

In one case, NoMoreClipboard is working with a hospital to use medical minutes (basically subsidizing their cell phone plan) for participants in a diabetes program. In this program, users would access the NoMoreClipboard PHR through their cell phone where they can update their blood glucose levels or other information as designed by their hospital.

This is pretty cool, but the interesting part is the way they’re using text messages together with the PHR. For example, if the patient doesn’t check in with their information, then a text message is sent reminding them to do so. Plus, once they enter in their information, they can get proactive messages about how they should deal with various blood sugar levels. For example, if their levels are low it might instruct them to eat or drink something to raise that level (although in a nice medically appropriate way).

I should have written down the exact numbers, but in the above case they found that they saved about $18,500 in treatment costs for a compliant patient vs. the non-compliant patient.

I of course had to ask if this could actually be a problem for the hospital. Sure, it improves healthcare, which is incredibly valuable. However, would this impact the revenue that a hospital was receiving previously to treat patients? Sure, it’s a bit ominous to think this way, but let’s be honest that the hospital revenue is an important factor.

Jeff Donnell from NoMoreClipboard brought up a good point that in many cases these patients were ones who had no health insurance and so the hospital was often not making money from treating these patients, but in fact was having to pay for these patients. So, being able to lower these costs is a huge benefit on top of the clinical benefits.

Of course, this is just one example of the usages of text messages in healthcare. I’m really finding it fascinating. Text messages seem to be one of the most innovative technology I’ve heard discussed and not all the various “Apps” that are out there. Yep, the simple text message is being used in all sorts of creative ways. Plus, text messages tied to a PHR or some other web source is really interesting as well.

Of course, I can’t help but imagine how text messages could be integrated into an EMR. Appointments is one obvious area. Patient compliance is another interesting one. What other areas of an EMR could benefit from the implementation of text messages?

One speaker said that on average text messages are read within 4 minutes. There has to be a way to leverage this attention in healthcare and EMR.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • I’m a fan of learning how to use the tools that patients already are most familiar with (comfortable with, dependent on, pick your favorite) to help them manage their health.

    I’m definitely not a fan of the term compliance. I don’t like it when it is applied to me, as in audits to determine my compliance with outside standards. I assume that many patients have the same instinctive negative reaction.

    Adherence is somewhat better. Rephrasing to talk about helping patients manage an issue or communicate about issues or solve problems or collaborate on health related decision making (my favorite) makes more sense to me.

  • HealthCentral, my employer, has developed a system called Mood 24/7 that allows users to text in their mood on a daily basis. Daily mood ratings can then be used to fill in the gaps between doctor visits, and allow both the user and the medical professional to vizualize the effects of treatment.



  • pheski,
    Some use compliance, some use adherence. I can see how doctors need be careful how they phrase it. I’m personally fine with either and I think they communicate the same message on a blog like this. Although, I still refer to EMR and EHR as the same thing too. People know what I’m talking about if I use either term.

    How patients feel about the words you say does affect compliance, so it is a tangential topic worth considering.

  • Chris,
    Is there any research done on the regular update of mood status? Seems like there’s a lot of potential unintended consequences and I’m not sure about the efficacy of having such data. Is it meant to help depressed patients? I guess I’m not getting how this data is beneficial to doctors and what studies show that it is.

  • >> in many cases these patients were ones who had no health insurance <<

    So, patients who don't or won't or can't pay for health insurance are assumed to be paying for a premium cell phone service? That might just be true!

    You just gotta love American values and priorities!

  • Seth,
    Pretty crazy huh? Actually, this is subsidized cell phone service, so that helps some. Although, I think it was a PwC study that I saw yesterday that said that those that aren’t insured or that are on Medicaid are some of the highest users of cell phones as compared with those with other types of insurance. I was pretty shocked by the stat too.

  • “study that I saw yesterday that said that those that aren’t insured or that are on Medicaid are some of the highest users of cell phones as compared with those with other types of insurance.”

    Of course… what else would they do with all their free time?

  • Chris,
    Pretty cool stuff. I love the idea of helping people that way. Seems like it could have the opposite effect of reminding people to smoke if they’re not careful. I wonder how they deal with that.

  • The comment above how people read texts in 4 minutes is consistent with what we’re hearing: doctors and care professionals use text from their smartphones as a priority communications vehicle. After physicians contacted us after we launched our consumer app at TigerText, we developed our business product TigerTextPRO. We’re finding that using TigerText that sets a predetermined lifespan for texts and tells mobile users if they have been received or not or read or not can not only reduce HIPAA compliance risk and lower costs but also improve patient safety.

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