Texting and patient-centered care

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Physicians know the power of in-person care. There is nothing like seeing a patient in person, not only to gauge outward physical markers of health but also when it comes to reading their body language, making eye contact and other non-verbal cues that allow doctors to form a bond with their patients. This early and consistent trust building can be crucial to a patient’s health outcomes.

But today’s patient isn’t just looking for a great health result, they also want a great experience. In one survey of health care consumers, 70% of respondents said convenience was either very or extremely important. This could be specific to geographical location or virtual options – 60% of patients chose telehealth because it was more convenient – as well as the availability of online scheduling, messaging and easy prescription refills.

In the past couple years, a new modality in the form of text-based offerings has come to the forefront of the patient-centric approach. As chatbots become more advanced, so too can their use-cases in health care. With the launch of ChatGPT specifically, many specialists in health care IT began to ideate on how text-based services and AI-led chatbots could be integrated into the everyday patient experience.

When done right, text-based modalities save physicians time and money while prioritizing convenience for the consumer and providing support even during off hours. Patients love that they can get in touch with their physician anytime, no matter where they are in the world. It’s accessible and flexible. Text modalities also have the benefit of being discreet. It’s much easier to text your doctor while at work or sitting on a train than to call them and discuss a health concern aloud. This discretion further increases the odds a patient will reach out in the first place.

To properly implement a text-based health modality, physicians must first conduct a comprehensive initial assessment to determine a patient’s suitability to participate in a text-based program and receive medical advice via this modality. As with any intake screening, doctors must establish that a patient’s concerns, capabilities and state of health are appropriate for communication around their symptoms and treatment that isn’t always face to face.

Similarly, patients themselves must be properly informed about the purpose and limitations of text-based care. This starts with a transparent introduction that details how the system works, what it will be used for and what it won’t be used for. By creating boundaries around the work that text-based communications are best suited for, doctors can better manage expectations and assist the client with their goals. It’s also crucial that patients provide informed consent upfront to build trust.

As part of this introduction to text-based modalities, physicians will want to craft open-ended questions to better hear the patient’s concerns and work with them to define their ideal outcomes upfront. From there, doctors should have a system for timely, responsive communication. Again, setting this expectation ahead of time, such as promising to respond within 24- or 48- hours, will go a long way towards customer satisfaction.

It's not enough to get patients on board, though. Implementing a text-based health care modality requires an understanding of legal and ethical implications. To deliver patient-centered services safely in the digital realm, physicians and their IT providers must be certain the following safeguards are in place:

Data privacy and security: Confidentiality is paramount in any health setting. The following data protection practices are key to security in text-based care:

Encryption and Secure Storage: It’s crucial to ensure end-to-end encryption is implemented for all patient communication and that data is stored in compliant and secure databases. Encryption standards must be regularly updated to align with industry security best practices.

Access Control: Access to patient data must be limited only to authorized personnel. Role-based access control parameters and regular audits on access should be considered.

Data Minimization: Only essential patient data should be collected to minimize data risks. Similarly, all staff should be educated on the importance of minimizing the collection of any data that may not be necessary.

Compliance: Regulations for both health care and data privacy, such as HIPAA and GDPR, should be adhered to for any text-based health care. Providers using these modalities should be sure to stay up to date as regulations in these spaces continue to evolve. Frequent compliance audits can help identify any gaps or areas for improvement.

Training: Finally, it’s critical that all staff are well trained on data privacy and information security protocols. Fostering a culture of awareness and continuous education ensures patient privacy is always prioritized.

Informed consent: Not everyone will want to use text-based modalities and that’s okay. Allowing patients to opt-in is foundational to ethical implementation. Informed consent includes several requirements:

Clear Information and Communication: The services provided, risks, benefits and limitations should all be clearly outlined for patients within the informed consent form. Importantly, be sure to use plain language and avoid medical jargon to ensure patients can fully comprehend the information.

Consent Reiteration: Consent should be obtained at various stages, including before initiating communication via text, when treatment starts or before any information is gathered with other healthcare professionals.

Digital Consent Mechanism: Implement a secure digital platform for obtaining and storing electronic consent. Patients must have the ability to easily access and review their consent at any time.

Licensing and jurisdiction compliance: Complying with legal requirements protects physicians and their practice while aligning with professional standards. Regularly verify the licensing and credentials of all healthcare professionals involved in providing services through the digital platform. Check regularly to ensure all licenses are valid and up to date.

Text-based care modalities are a game changer in patient-centric care. By giving clients the freedom and flexibility to reach their care team in this way, physicians enhance their sense of empowerment. With this autonomy and control comes a greater likelihood that they will take charge of their health, potentially increasing preventative health practices and improving outcomes.

Written communication not only leaves a text-based record for physicians to look back on, providing an easy way to track progress and revisit recommendations and insights, but it also allows the patient space to self-reflect. Many people find it easier to articulate their thoughts and issues through written communication. Just the act of drafting the note can be therapeutic and empowering.

Text-based modalities can be especially effective for physicians looking to increase their impact on patient mental health. Amid today’s current mental health crisis, many have called for GPs of family medicine to take a more active role in this area, but physicians often feel uncomfortable treating more serious mental disorders. Rightfully so!

As a psychologist, I’ve seen first-hand how powerful text-based therapeutic discussions can be. Supported by research evidence, text-based therapy stands as a legitimate and effective means of delivering mental health services. As a former skeptic turned believer, I am continually humbled by the transformative power of text-based therapy. It has allowed me to connect with clients on a profound level, offering them not only the freedom from structure and time constraints but also a safe space to vent, share and explore their inner worlds.

Text-based health care, either for physical or mental health needs, will never replace traditional in-person therapy. However, it’s a powerful and effective method for delivering support in the modern age, improving access, convenience and outcomes for all patients – no matter their diverse background or needs.

Smriti Joshi is chief psychologist and a member of the board of directors for Wysa, an AI-guided mental health platform delivering clinically-validated care.