Making texting HIPAA compliant for Health Professionals and Patients

In this day and age it seems like everyone has a smartphone. One of the most popular ways to use our smartphones is to text. According to a Gallup Survey, texting is the most popular way of communicating for Americans under the age of 50. With younger generations continuously using their smartphones for communication with friends and family members it’s a natural progression to begin using text to communicate with their healthcare providers.

Being able to text your local clinician/doctor for simple questions like clarification on prescriptions and dosages is a game changer. This gives you a medium you can consistently refer back to with clear written instructions, and you don’t need to worry about misplacing the prescription itself.  It also provides patients with a great opportunity to get clarification on other instructions and care plans the doctor may have shared during an office visit.  It often happens that you receive so much information in a visit to the doctor’s office that you forget to ask important questions, and OhMD gives patients a tool to get those lingering questions answered quickly and easily.

The logical concern with texting is security. With the new demand for the convenience of texting comes privacy and security concerns.

If you are already in contact with your healthcare provider and are using SMS texting, you are violating HIPAA.

When it comes to HIPAA compliance, texting using the default texting app is not an option. Even though major cellphone carriers offer encryption on data being sent through their servers, text messages remain on the device.

If your phone is lost or stolen your protected health information (PHI) could be compromised.

In addition to losing your phone anyone can access your messaging app if they have access to the contents of your phone. Even if you have a password on your phone, think about all the people you let use your phone to make calls or text themselves so they have your number.  All those people could easily access your messages with your healthcare provider.

OhMD not only offers a HIPAA certified texting platform, it’s also free.  As a patient you can download and use OhMD for free to communicate with all of your healthcare providers that have the app — your primary care physician, your dentist, your counselor or your home health aid.  For patients who are accustomed to having their health data in many different places, this is a welcomed change.

Although there are valid concerns regarding HIPAA compliance, texting applications like OhMD offer a secure solution for patients and their care providers to communicate quickly and easily.

OMG – texting with patients

OhMD and one of our physician users, Dr. Julio Bracero-Rodriguez, was recently featured in an article in athenainsight about texting with patients!

Check it out here: https://insight.athenahealth.com/omg-%E2%80%94-text-doctor

Co-founder, Ethan Bechtel’s, goal for OhMD Texting for Doctors

Founder and CEO of OhMD, Ethan Bechtel, wants to protect healthcare from HIPAA violations for free. In this day and age texting and other alternatives to phone calling are ideal for the average person in America. Many people outside of the healthcare field don’t know or understand that they cannot communicate with their doctors over SMS. With so many different communication applications coming out everyday, the average person doesn’t think much about texting their doctor. By using SMS to send protected health information is a violation of HIPAA. Ethan’s goal is to address this issue with OhMD.

What does OhMD allow me or my doctor to do?

With OhMD doctors and patients can communicate easily and efficiently without violating HIPAA.  By using OhMD patients can have direct access to their practice and health information if they need it. For example if I go to a new Ophthalmologist for a new pair of prescription glasses, my new doctor will not have my old prescription on file.  If I were using OhMD I could have easily requested my information and been able to give my new Ophthalmologist accurate information. If a similar exchange happened over SMS, it would be a HIPAA violation. Using SMS to send protected patient information (PHI) is a violation because it is not secure. With OhMD all your information is being sent of HIPAA certified channels as well as stored in your doctors EHR. With OhMD patients can access their information securely, and not have to worry about non-medical professionals accessing their information. 

It’s clear that there is a disconnect between patients and Doctors in terms of the proper channels to communicate outside of calling in. Bechtel has addressed this with OhMD and will change the way people communicate in healthcare.

 

Alternative Facts in Healthcare

With all this talk of “alternative facts”, we thought it might be fun to list the alternative facts we’ve heard around texting in healthcare.

3 Alternative Facts about Texting

Alternative Fact #1: “Texting is impersonal”

This statement came from a physician who didn’t believe patients wanted to be able to text with their doctors and practices. In fact, she was adamant that patients would hate it.

It’s easy to debunk this particular alternative fact. Who do we text most in our daily lives? Close family and friends usually. And those are the people that we share very personal relationships with. Furthermore, healthcare is a very personal topic. The topics you choose to discuss with your practice are often very sensitive and highly personal.

The good news is, we studied her patients after a 3 month pilot. 98% of them said they would rather be able to text with their practice than pick up the phone or use the patient portal. Why? They believed it was more personal than the other two options.

Alternative Fact #2: “Texting is the same as messaging in the patient portal”

We’ve heard this one a lot over the years. From doctors to CIOs to patients, this alternative fact is widely used.

The truth is, texting and patient portal messaging are vastly different. The best parallel to draw to illustrate this point is to compare portal messaging to email.

The personal conversation scenario

We have a choice whenever we want to communicate with someone: in-person conversation, phone call, email, text message, and maybe even Snapchat.

But what makes us choose one medium over another? It often depends on the topic and the person. Since healthcare is often very personal, let’s pretend I’m planning to communicate something personal to a friend that isn’t in close proximity.

Alternative Facts Friends Texting

Do I call her? Maybe if it’s really time sensitive. While this ends up being the case for me sometimes, it’s not typical that I need a personal question answered ASAP.

Do I Snapchat her? Only if it’s about something really fun…which healthcare rarely is.

Do I text her? I’m biased, but absolutely. It’s personal, short, and efficient.

Do I email her? Maybe if it’s a longer message and I don’t want to type it all out on my phone. But that rarely happens.

So if we’re making the logical comparison of portal to email, the same would apply. In a healthcare scenario, I may want to use the patient portal for a longer message, but I would absolutely use texting for most questions I have.

The point here is, the use cases for both texting with my practice and messaging on the portal might vary based on the complexity of the topic.

Alternative Fact #3: “Phone calls are easier than texting”

Many practices believe this alternative fact before they start texting with patients. In a typical physician practice, an incredible amount of time is wasted leaving voicemails and trying to chase patients down.

Not only that, but often times the office staff at a practice is trying to manage multiple calls at once. At the same time, they are trying to figure out who each patient is and how to answer their question real-time.

What makes texting efficient and easy is that it is asynchronous, meaning I don’t need the patient on their smartphone during the conversation and vice versa. The ability to send a message and receive a response 5, 10, or 20 minutes later means an increase in efficiency.

In conclusion

Texting is new in the healthcare space! We believe there’s so much room for improvement in healthcare communication. If you believe any of these alternative facts, you may want to take a second look. There’s a good chance texting can really improve care for your patients, and save time any money for physicians and their practices.

Patient Portal is Dead

In theory, the patient portal is a beautiful thing. A place I can go to get all of my health data and communicate with my doctor. Any bit of health information I could ever want is there, catalogued for me within a carefully crafted user experience that keeps me informed and healthy.

This great new portal has a mobile app for my iPhone so I always have the information I need in real-time. I can see my recent x-ray from when I broke my ankle, schedule an appointment to deal with this nagging cough, or renew my meds. If I want, I can even pay my bill, all from the same place.

And that’s how I imagine the original vision of the first group of engineers to take on this task . The physicians, administrators, and healthcare visionaries set out to build it and were determined to change the way patients interacted with their care. It was a vision centered on improving patient care and outcomes.

But that dream is dead.

The hard truth about patient portal usage

It’s been 20 or so years since the original pioneers of patient portals started designing out the first portal. Unfortunately, their dream is no more realized now than it was then. They introduced it to the world under the false assumption that patients wanted all these things wrapped up into a single platform.

Steve Jobs said:

“Customers don’t know what they want until we show them.”

I think that logic applies here. Portal adoption is abysmal. Unfortunately, patients just don’t use them.

If you’re thinking “I love my portal!”, I get it. There are some of you out there that really get a lot of value from it. I acknowledge that your kind do exist, but the numbers show that you’re in the minority.

It’s also important to note that there have been a few success stories:

The big success story is from Kaiser Permanente. By 2015, Kaiser Permanente had registered 70% of their 5.2 million patients on their patient portal. In 2015 alone, 23 million secure messages were sent. Impressive!

But here’s the thing: Kaiser isn’t just a large grouping of hospitals and practices. They are also the nation’s second largest insurer. The incentive for Kaiser to drive portal adoption for their roughly 10M members is HUGE. A massive health system like Kaiser benefits when patients are healthier and engaged in their care. Considering they generate $60B in operating revenue annually, you can imagine that if the portal drives down cost for them by even just a fraction of a percent, we’re still talking big bucks.

In contrast, the vast majority of hospitals and health systems today get very limited return on investment (ROI) from their clunky portals.

Where did the patient portal go wrong? Seemingly every step of the way.

All the features

I picture the original patient portal visionaries sitting around a table, slowly edging towards the front of their seats with each new suggestion for a feature that patients were going to LOVE. They list an array of valuable features that no patient would ever want to live without:

  • Prescription renewals
  • X-rays
  • Lab Results
  • Secure messaging with a doctor
  • Appointment scheduling
  • Bill pay
  • Patient education materials

A white board on the wall fills with design ideas until they come to an agreement. They are going to change healthcare.

Then they celebrate the future and the change that the portal would bring to healthcare. The team builds exactly what they set out to build, and it is ready for primetime.

Features

This is what almost every portal flier looks like. So many features, but I’m not quite clear on the value proposition.

Getting patients to use it

With all these features, they shouldn’t have an problem getting users. What patient doesn’t want all these great features?

As it turns out, getting patients to sign up has proven far more difficult than anticipated.

Why? Consumer technology (the apps we all use in our daily lives) typically solve a problem in a very simple way. When I need to get somewhere, I use Uber. If I’m hungry, I use Seamless. If I want to snap a beautiful picture of a sunrise over the mountains across a lake, I use Instagram.

Uber Value Proposition

Successful consumer apps have simple value propositions for users to understand quickly.

Each app solves a problem very well in addition to making it ridiculously simple. When you compare the value proposition in the Uber image above with the portal marketing flier, it’s easy to see the differences. One is complicated, and the other is simple.

Simplicity

The simplicity of successful consumer tech companies is often a major contributor to their success. Even Facebook recently pivoted from offering all functionality in a single social media platform to breaking out functionality into separate apps, like Facebook Messenger.

When asked why he made this change, Mark Zuckerberg replied, “We wanted to do this because we believe that this is a better experience. Messaging is becoming increasingly important. On mobile, each app can only focus on doing one thing well, we think.”

So if Zuck is right, and I have to believe he is because he has access to more data than God, patient portals got it all wrong with the bright orange “Full of Features” badge.

The evidence

A new study shows that “96% of patients report leaving their doctor’s office with limited knowledge of how to use the patient portal. Of the 40% of patients who said they had attempted to use the software in 2016, 83% said it was too complicated to use.”

That means only 7% of patients find it simple enough to use, and actually care to use it.

7%

As a point of reference, 7% of the American population also believes the moon landing was faked, if that helps give you some perspective.

While the efforts to get patients onto portals haven’t yielded good results, most hospitals and practices will actually stop at nothing to get you using their portal. A program called “Meaningful Use” requires them to meet certain regulations that increase their Medicare/Medicaid reimbursements.

Stop. at. nothing.

I witnessed one particular hospital assign a nurse to every patient as they left the exam room. The nurse sat down with the patient, registered him for the patient portal, showed him the all the features, and then had him send a “test” secure email message.

This approach meets the short term goal of getting those Meaningful Use dollars, but if we assume the study above applies, we can assume 93% of patients will never come back again.

This is clearly an instance of a round peg in a square hole.  We know we need to engage patients, and we refuse to believe that the portal can’t deliver.

Registration

Imagine downloading a new app to your smartphone and running into a registration process like this.

So now what?

We continue to learn from consumer technology, and more specifically, mobile apps.  Consumers download and use apps that are simple and do one thing incredibly well. If we’re expecting to really bring value to patients and engage them in their care, we first need to simplify every step of the process in addition to the product itself.

The same hospital CIOs and decision makers that implemented the portal are still pushing them to patients, but something else is going on. They are simultaneously rolling out simple, more focused solutions that overlap portal functionality. And it’s only a matter of time until these solutions demonstrate more value than the portal ever has. Why? Because patients use them.

Finally, digital health has reached a turning point. Health tech companies are focusing on different ways to capture the attention of patients in an effort to improve health and engagement.  Through the lens of consumer tech adoption we can innovate healthcare and find a way to deliver on patient engagement dream of the patient portal…may it rest in peace. Do not resuscitate.

Starbucks Medicine and the Patient Experience

There are some rituals we covet.  For many of us, our morning coffee is among them.  For most of us, our annual physical is not.

Apart from feeding our caffeine addiction, visiting a coffee shop is a pleasurable experience.  It provides us with time out from the busy day to take care of ourselves, without sacrificing convenience.  But, in a perfect world, isn’t this also how we should describe a well visit to the doctor?

There is reluctance in the world of healthcare to let consumers dictate how medical care is delivered; medicine is, in some ways, inherently paternalistic.  But the fact is that patients use consumer value metrics to make decisions about their healthcare.  Data shows that patient engagement is the key to building a strong foundation of preventative care, limiting expensive emergency room visits.

Dermatology practice consultant Amelia Coleman

Written by Amelia Coleman, Physician Practice Consultant

Healthcare legislation has begun to address this simple fact and seeks to put in place measures to improve the delivery of primary care and reduce the costly burden on our nation’s ERs.  However, as is the norm in healthcare, things take longer than it seems like they should.  The good news is that there are great examples of the success of concepts like “Meaningful Use” and “Patient Engagement” in other industries. In this way, the world of healthcare has a lot to learn from the coffee shop.

No coffee shop has been more successful at building customer loyalty than Starbucks. The average Starbucks customer visits the store 6 times per month, while an astounding 20% of customers exceed 15 visits per month.  What Starbucks has managed to do is to create an experience that feels special, yet is efficient and scalable, and this is precisely what healthcare needs to do.

So what can doctors learn from baristas?  On a very basic level, doctors need to think more like businessmen and -women.  While the intrinsic motivation to stay healthy is powerful, choices about our health are often weighed against cost and convenience in the real world.  Just like any business, healthcare providers need a well-conceived value proposition.  Separate, but related, doctors need a lesson in how to effectively use technology to engage customers.

Starbucks has been met with tremendous success in their attempt to engage customers using technology.  The Starbucks mobile app has over 19 million users and it is used in 21% of Starbucks transactions totaling billions of dollars in sales to date.  The app tracks a customer’s loyalty and rewards them for their purchases, while also reducing friction at the POS.  In a recent report Sheryl Kingstone described how “transforming the point of sale into a point of engagement” creates a “broader, dynamic interaction” with the customer.”

The primary tool for consumer engagement in most medical practices is the patient portal.  Patient portals provide a direct link to a patient’s electronic health record and allow doctors and patients to share health information on a secure platform.  But the fact is that portal adoption has been slow, particularly as it relates to patient messaging.  So why do patient portals fail at the dynamic interaction Kingstone describes?

The fact of the matter is that electronic health records are designed for clinical efficiency, not user experience.  We, as consumers, have high expectations for technology, and any small barrier to use can dissuade even the most tech savvy consumer.  Businesses that are successful in engaging customers through technology, like Starbucks, meet consumers where we are: mostly on our phones.  While many patient portal companies offer mobile applications, the interface is unfamiliar and inelegant.

The technologies that have a meaningful impact on healthcare will end up being the those that view patient engagement through a consumer adoption lens.  And the ability to effectively use technology will increasingly be an important component of how doctors, hospitals, and health systems make money, acquire new patients, and reduce costs — both to their organization and the industry as a whole.

So what is your practice doing to drive patient engagement and patient satisfaction?  After all, Starbucks didn’t become a $100 billion dollar company without appealing to more than just our caffeine addiction.