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#HealthXPh: Use of SMS between Health Care Providers and Patients

The Philippines is the Texting Capital of the WorldCheck out this infographic, which says that in 2009, Filipino subscribers sent an average of 600 text messages a month vs 420 for their US counterparts.


Imagine then the possibilities for mHealth. Previously, the mHealth Observatory defined mHealth –

mHealth, enabled by mobile phones and other wireless computing devices (mDevices), is the revolutionary adoption of new communication patterns in healthcare that is stimulating the introduction of Participatory Health.

On Saturday (18 January 10 am Manila time UTC+8), the third #HealthXPh tweet chat and Google Hangout on Air will discuss the use of text messages between healthcare providers and patients.

T1 As a healthcare provider, do you give your personal mobile number if a patient asks for it? Why or why not?

Dr. Remo Aguilar (@bonedoc) of #HealthXPh wrote about this very question in 2011 here. Has his answer changed since then? We will find out on Saturday. Dr. Zero Mella (@ZeroMD), a Filipino rural health physician from Olongapo City wrote about the dangers of mobile consulting in his setting. A internist from India asks on not giving his cellphone number, Do you think of me as a selfish and uncaring doc?

Dr. Dillaway, a family physician wrote Why I Give My Cellphone Number to My Patients in a 2009 issue of Family Practice Management. This post is a psychiatrist’s take on this question. More recently, Dr. Denitza Blagev asked Do You Share Direct Contact Information With Patients? on Perhaps it matters which patients should have their MD’s contact number as this article suggests GPs should provide personal out-of-hours numbers to dying patients as best practice, review suggests.

Peleg et al did a study Providing Cell Phone Numbers and Email Addresses to Patients: the Physician’s Perspective in which Israeli family physicians answered a questionnaire. Study results show that physicians preferred to provide their cellphone numbers than email addresses but preferred to answer their cellphones at predetermined hours during daytime.
T2 What information can be safely disclosed in a text message between healthcare provider and patient?

The flexibility of the HIPAA Security rule can lead to uncertainty as to how SMS policies for public health can be crafted as Karasz et al raise in an article published in the American Journal of Public Health. The Philippines does not have a regulation similar to the HIPAA in place. Nonetheless, this is a relevant question as confidential health information can be exchanged thru SMS. Already, Jon Jansen of Doc Halo (a company that specializes in secure texting and HIPAA compliant real-time messaging) is predicting that mHealth will drive physician demand for secure text messaging in 2014
T3 In what ways is SMS used in your setting for patient engagement?

Dr. Celito Tamban and I have tried using SMS to support lifestyle modification for patients with type 2 diabetes mellitus in an outpatient clinic of the Philippine General Hospital. This randomized controlled trial was recently published in the Journal of the ASEAN Federation of Endocrine Societies. The use of SMS improved adherence to diet and exercise with HbA1c values significantly lower at 3 and 6 months in the patients receiving SMS. SMS was sent three times a week: about diet on Mondays, exercise on Wednesdays and consequences of non-adherence to diabetes management on Fridays. SMS was one way only, from MD to patient. I wonder if HbA1cs can improved further if patients could reply via SMS if they had questions about the messages being sent.

I know that the buzz globally is about mobile apps. I have tried recommending apps for tracking calories and steps in my clinic, only to be frustrated because while all of my patients have phones, these were usually not smartphones and not all had internet access. As Dr. Travis Good is quoted in Are We Missing SMS as a Patient Engagement Opportunity?

This is engagement. It is not an app that they have to download. You’re reaching them with what they already have.

Nasrin Dayani enumerates some ways SMS can be used in Texting Can Promote Patient Engagement in Healthcaretexting smoking cessation messages, texting for medication adherence and clinic visit reminders. Currently, I serve as thesis adviser to Aldren Gonzales in his project iNanay (Nanay means mother in Filipino). iNanay is one of the winners in the Globe (a local telecommunications company) Catalyst initative.  iNanay is an SMS reminder system for pre- and postnatal care and immunization for pregnant women.

I look forward to chatting with you on Saturday! Just follow #HealthXPh on Twitter and check out the #HealthXPh Facebook page for the link to the Google Hangout on Air.

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