The Role of Text-Based Modalities in the Future of Healthcare

Way before the days of the 911 call system and the huge network of doctor’s offices that exist today, transportation made it nearly impossible for patients to visit the doctor. Instead, family doctors made house calls with specialty doctors’ bags and vehicles just for that purpose. As transportation became more readily available, specialists more common and healthcare evolved, the convenience, comfort and privacy of the house call all but disappeared.

In contrast, today’s healthcare consumers are used to paying a premium for short appointments and feeling like they’re being pushed through the system as quickly as possible. Many blame this on the corporatization of care which forces providers to skimp on time spent with patients and places extra emphasis on filling out electronic medical records while battling with insurers. Being unable to provide high-quality care has been described as a “moral injury” providers experience and could be the driving force behind more and more health care workers leaving or considering leaving the industry.

While there is no substitute for in-person care, the freedom and empowerment associated with the house call need not die with modern, corporate healthcare. By embracing new technologies, specifically text-based modalities, providers in a variety of specialties can offer an improved patient experience from start to finish, achieving more positive outcomes and even increasing revenue.

General Care

Text-based modalities can vastly transform one of the biggest bottlenecks of healthcare, the front desk. Research shows that, despite the adoption of software designed to streamline the patient experience, the biggest pain points for patients remain difficulty seeing a doctor (78%), followed by finding an appointment (49%) and the scheduling process itself (40%). Meanwhile, providers are struggling with staffing shortages impacting their ability to provide top-tier service while working with insurance companies.

The introduction of an AI-led chatbot and/or human text-based communications allows staff to quickly and conveniently schedule patients and get them in to see a doctor sooner, without needing to drastically increase human resources. Patients agree; 76% of patients would like to schedule appointments online or via mobile device and 56% want more digital options than are currently provided.

Text-based communications for general practitioners can go beyond the front office. Physicians can use this technology to quickly check in on patients, ease prescription management and refills, and provide follow up care. Just a few texts can increase the doctor’s perceived accessibility, making them feel more in control and empowered. While it can’t replace face-to-face care, it can improve the patient experience around visits.

Mental Health Care

Use of text to deliver therapeutic care is hardly a new idea. It can be traced all the way back to the father of psychoanalysis himself, Sigmund Freud, who corresponded with and treated his patients through letters. Just as these exchanges offered a structured way to share insights, interpretations and guidance, modern-day text-based therapy allows patients to express themselves, articulate their thoughts clearly and experience growth outside of therapy sessions.

In the still-stigmatized mental health space, written communications are more inconspicuous, providing a safe space for patients. They’re also a reflective medium. Writing itself can be therapeutic and the text-based work provides a record of conversations.

Hospital Care

In addition to scheduling support including appointment reminders and follow up check-ins, there’s new research that shows the positive impact of text-based care in post-surgical settings, especially in orthopedic hospitals. Successful trials and clinical studies demonstrate the clinical effectiveness of an AI-led text services to reduce symptoms of depression and anxiety, as well as reduction in pain interference for orthopedic patients. Hospitals around the country, including The Living Well Center of Washington University in St. Louis, Hospital for Special Surgery (HSS) main campus in NYC, and The University of California, San Francisco, Department of Orthopedic Surgery are adopting this new modality to offer patients mental health relief at one-tenth of the price of an in-person session.

Correct Implementation

Whether in a general practice, a mental health setting or a hospital, text-based modalities can improve the patient experience if implemented thoughtfully and ethically. While it’s not an absolute requirement for a physician to see a patient in person before offering advice through online text-based modalities, there are essential best practices to ensure safe and effective care:

Initial Assessment and Informed Consent:

a) Thorough Initial Assessment: Conduct a comprehensive initial assessment through text-based communication to understand the patient’s medical history, symptoms, and concerns. Gather sufficient information to make informed decisions.

b) Clear Informed Consent: Obtain informed consent from the patient, clearly explaining the limitations and capabilities of text-based communication. Ensure they understand the nature of the services being provided and any potential risks or benefits.

Establish a Professional Relationship:

a) Building Rapport: Focus on building a strong therapeutic relationship with the patient through clear, empathetic, and professional communication. Engage actively and attentively to understand their needs and concerns.

b) Effective Communication: Use language that is easy to understand and appropriate for the patient. Clarify medical jargon and provide explanations as needed to ensure patient comprehension.

Documentation and Record-keeping:

a) Detailed Documentation: Maintain thorough and accurate records of all communications, diagnoses, treatments, and medications prescribed. This ensures a clear history of interactions and supports continuity of care.

b) Adherence to Legal and Ethical Standards: Comply with all legal and ethical guidelines regarding patient record-keeping and confidentiality, just as in traditional healthcare settings.

Patient Evaluation and Follow-up:

a) Regular Check-ins: Conduct periodic check-ins to assess the patient’s progress, response to treatment, and any changes in symptoms. Adjust the treatment plan as needed based on this assessment.

b) Referral to In-person Care: If necessary, recommend and facilitate an in-person visit for a more comprehensive evaluation, especially if the patient’s condition warrants physical examination or diagnostic tests.

Collaboration and Consultation:

a) Inter-professional Collaboration: Collaborate with other healthcare professionals when needed, especially in complex cases or when additional expertise is required.

b) Peer Consultation: Encourage peer consultation and case discussions to ensure a high standard of care and to learn from collective experiences.

Continuous Education and Training:

a) Professional Development: Stay up to date with the latest advancements, guidelines, and research related to telemedicine and mental health to continually enhance your knowledge and skills.

b) Training on Telemedicine Platforms: Ensure proficiency in using the telemedicine platform to provide a seamless and efficient patient experience.

Emergency Response and Crisis Management:

a) Clear Crisis Protocols: Establish clear procedures for handling emergencies and crisis situations, including guidelines for appropriate referrals and accessing emergency services.

b) Educating Patients on Emergency Response: Educate patients on how to seek immediate help in case of emergencies or when facing severe physical or mental health crises. Establish clear safety plans and crisis escalation pathways.

At a time when 83% of patients agree that accessing healthcare is the same or worse than it was in the past, text-based modalities could be part of the secret sauce for improving satisfaction with the system, providers and outcomes if correctly implemented.