The Role of Text Messaging: To Text or Not to Text?

The Role of Text Messaging: To Text or Not to Text?
As patients take more control of their healthcare, providers can lose out if they don’t meet modern-day expectations by providing conveniences like text messaging. This isn’t just a youth movement, either. Currently, 20% of boomers, 44% of Gen Xers, and 42% of Millennials are likely to switch practices unless they can get clear, concise, convenient communication from their providers, according to a Solutionreach survey released last month.
There is evidence that texting is more than mere convenience. Patients who receive text message reminders are more likely to show up for appointments and take medications as directed. One study found text messages are likely to improve patient care in the treatment of HIV and tuberculosis.
The legal and regulatory terrain is shifting a little with regard to text messages in healthcare settings. The FCC amended the Telephone Consumer Protection Act in 2015 to allow healthcare providers to send automated texts to wireless numbers for appointment and exam confirmations and reminders, hospital pre-registration instructions, and pre-operative instructions, and post-discharge follow-up.
Texting patient information is still a thorny area. A 2016 report from Skycure found that more than 60% of physicians transfer patient information via text message, but if these physicians use their phones’ native text messaging apps to communicate, the messages probably reside on servers that are not privacy protected.
According to Joint Commission policy, physicians can text orders, as long as they do so in accordance with applicable standards of practice, laws, regulations, policies, and procedures. Text-messaging platforms must include the following features to be considered secure:

  • A secure sign-on process
  • Encrypted messaging
  • Delivery and read receipts
  • A date and time stamp
  • Customized message retention time frames
  • A list of individuals authorized to receive and record orders

According to the HIPAA Privacy Rule, physicians and patients can exchange unsecured email and text messages as long as patients are aware of and accept any potential privacy and security risks. Physicians can ask patients to sign paperwork acknowledging the physician may contact them via unsecured email or text messages. They can ask for patients’ consent over the phone or via a secure message through a portal. Electronic signatures are sufficient, as long as they meet federal and state law.
Proprietary HIPAA-compliant messaging apps are emerging that allow physicians to securely exchange information about a patient with other physicians.
Beyond privacy concerns, there’s the issue of immediacy. Texting creates an expectation of instantaneous response, which can be difficult for practitioners to maintain. Some medical offices inform patients that the practice will respond to texts within 48 hours and advise patients to dial 911 for emergencies. These strategies can also apply to response standards (and expectations) for provider texts to patients.
The bottom line? Texting has a place in a medical practice, as long as patients and providers alike understand its capabilities and set realistic expectations.

  1. Utah Business, June 20, 2017, “Study: Patients Leaving Practices Due to Dissatisfaction, Lack of Convenience,” press release
  2. Specialty Pharmacy Times, July 11, 2017, “Text Messages Improve Patient Care in Treatment of HIV, Tuberculosis,” by Lauren Santye,
  3. MedCity News, March 10, 2016, “Can a messaging service for patient communication with front office staff eliminate time suck?,” by Stephanie Baum,
  4. Becker’s Hospital Review, July 18, 2017, “Do cellphones in the OR jeopardize patient safety? 5 thoughts,” by Mackenzie Bean,
  5. Modern Medicine, July 10, 2017, “Think carefully before engaging patients via text,” by Lisa A. Eramo,
  6. Physician Practice blog post, September 8, 2016, “Rules of the Road for Texting Patient Information,” by Kelli Fleming
  7. Medical News Today, July 3, 2017, “Mobile technology: A blessing or a curse for doctors?” by Laurie Budgar,


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