Patient-initiated collaborative texting [PODCAST]

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“Nearly three-quarters of consumers say they prefer texting with a business if an actual human is the returning texts — no bots need reply.

But the rise of artificial intelligence has led to further advances in smart texting, including the ability to answer simple questions — such as “when is my next appointment?” — without human intervention. Texts regarding certain actions like prescription refills or payment questions can be automatically routed to the correct department for follow-up.

Because of privacy concerns, texting in a medical setting must occur on a HIPAA-compliant platform, but solutions exist today where secure text communications flow to the patient record and enable video calls and the ability for patients to pay their bills by text.”

Keith Dressler is a health care executive.

He shares his story and discusses his KevinMD article, “3 reasons practices should implement patient-initiated collaborative texting.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show we have Keith Dressler. He is a health care executive. We’re going to talk about his KevinMD article, “3 reasons practices should implement patient-initiated collaborative texting.” Keith, welcome to the show.

Keith Dressler: Thank you. Thank you for having me, Kevin. I come from a multigenerational physician family. My dad’s a retired OB/GYN who pioneered laparoscopy throughout the Southeast. He owned a hospital, so literally I’ve just grown up within the health care world. I was sort of the outcast orthodontist. I am an orthodontist in my day job, so to speak, but serial entrepreneurship is really my love. For whatever reason, my brain is that of a Lean Six Sigma, process type of thinking guy who wants things as simple and easy as possible and efficient for both patients and the staff and practitioners. I’m a serial entrepreneur. This is what I do. When I see a need, I try to solve it.

I am not a technology-for-technology’s-sake person, meaning we have to bring real value, real-world improvements, for me to look to get in and to either invent or evolve a technology to help the health care world. And I felt communication is really where it needed to be at this stage in time in the country.

Kevin Pho: Yeah. So I talk to a lot of health care professionals who want to go into entrepreneurship. Now, as a successful entrepreneur yourself, with, of course, a health care background, what would you say is your number one tip for those clinicians who want to pursue entrepreneurship?

Keith Dressler: Well, I would say you’ve got to have persistence. Especially if you’re an out-of-the-box thinker like I am, you’re going to have a lot of naysayers. And I think when you’re dealing in the health care world, you have to understand that the sales cycle is going to be much, much slower than in any other industry. We have a lot of legacy thinking. We have a lot of cautious people. Before they really do things, they have to think through it. And of course, you have this huge resistance to change. So I think patience and persistence would be the two biggest things that I would give the audience, for people wanting to be entrepreneurs.

Kevin Pho: All right. So let’s jump right into your KevinMD article. It’s titled “3 reasons practices should implement patient-initiated collaborative texting.” Now, for those of you who get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Keith Dressler: The biggest reason I decided to write it is that patient engagement has been a topic in all of health care for a long time, and actually improving the patient experience, and so forth and so on. I think the problem that we have is that communication changed in 2007, when texting became the dominant form of communication versus voice, yet practices still require patients to voice call. In my mind, that’s like, when telephones came in and you had a teletype, never moving to the telephone and just still using the teletype.

So I think we have to understand that you’ve got to look outside the practitioner side of things. Patient engagement was about how I could improve the office’s engagement with the patient, not considering how I could improve the patient’s ability to communicate with the practice, or the health care facility, or whatnot. So there’s a huge gap. To me, patient engagement is all of it. That’s why I say it’s not just doctor-initiated things, that I, the practitioner, can communicate better with the patient. It’s allowing the patient to communicate better with you, which means modernizing your communication, meeting patients where they live, and allowing them to choose which form of communication they want with your practice.

That’s why I’ve named it patient-initiated collaborative communications, because when you can convert a voice call to a text message coming in, then what has occurred is the phone stops ringing. You are going to get a 70 percent decrease in phone calls, and so that means only 30 percent are going to call you. And guess what? You’ve got plenty of time in your day to pick that up and talk, whether it’s your receptionist or whomever. They’re not being sent to voicemail. They’re not having to leave a message. The efficiency of what goes on is phenomenal.

In the article, I share with you the Rhinogram practices across the country who have implemented patient-initiated communications: SMS, MMS, no downloading of an app, no logging into a portal, making it as simple and easy as it is. Rhinogram basically gives the practice a HIPAA-compliant textable number that matches their voice number. So with the number that patients already have in their phone and are voice calling with, it’s very easy to convert them to texting by saying, “Hey, do you realize you can text me now?” Now, when they begin texting in, the practice can handle six to 10 different patient communications in the same amount of time it takes to speak on the phone to one patient.

Now let’s imagine this. Of the benign things coming in that could be understood through our natural language translations, AI, ML, and for those in the audience who may not know those acronyms, that’s artificial intelligence and machine learning, those questions can be answered automatically, with nobody touching them. So imagine somebody calling in and saying, “Hey, do you take this insurance?” And your person who’s answering the phone says, “Yes, we take that insurance,” and so forth. But that type of question can be answered through a text automatically, with nobody having to touch it. “What are the directions to this location?” Again, these types of benign things can now be handled, where it’s going to then give back time to everyone.

And I would also share with you that those practices that have initiated this idea of patient-initiated communications are also able to decrease the number of people needed in their organization, and most have decreased 30 percent or greater. So in today’s world, with employee shortages and doctor burnout and employee burnout happening, this allows organizations to just simply do this one thing, and now they’re more efficient than they were when they were more fully staffed. With a 30 percent decrease in staff, they actually still get one to two hours of time back a day, which then gives practices the opportunity to get back to my dad’s day, which is getting to know the patient, getting to spend lots more time with the patient, and doing what they really got into medicine to do, and that’s care for the patient in all kinds of ways.

I also think about virtual care. OK, now I want the audience to divide that in their mind into two areas of care. Most practices are going to view virtual care, that word, from a clinical standpoint. That’s a video visit of some sort. That’s remote patient monitoring of some sort. They call that virtual care, with the word virtual meaning the patient’s at home or not in the office. OK, I want you to understand there can be, and is, plenty of virtual administrative care. Administrative is all the things that you can think of, from inbound forms to “What’s your insurance?” You could take a quick selfie of the front and back of an insurance card and send it in. You operate very much like how you operate in your everyday lives with your friends and family, where the patient can simply do things with your practice that they do with their friends and family.

Things like a prescription refill, for example. Our natural language translation would understand this patient has texted in a prescription refill, and it routes that automatically to a refill team, who gets a notification: “Oh, I have something to do.” And that refill team begins to do whatever it is. My vision for the future would be, yeah, it gets routed there, they check it, and the patient gets a text back that says, “Hey, we have got your prescription. It’s going to be delivered to your home in two hours.” For those patients who are homebound, cannot drive, and rely on their family to pick up the prescriptions for them, this would be a huge, huge convenience for everyone involved. And that’s a lot of people that you don’t even think about. But this is how I see it going.

The reason we use the word collaborative in this is the beautiful part of everything: You have real-time team awareness of everything that’s going on. So for example, in my practice, when patients really get into this patient-initiated communication, in December, without prompting, I’m getting the front and back of an insurance card texted in to my practice saying, “Hey, I want you to update my insurance.” But then it’s also asking, “Hey, can I get an account balance?” And within that same text, it’s saying, “I need to change my appointment from this week to this week.” OK, so that’s three things.

Well, the beautiful part of our system is it allows us to bring in three teams, three different teams, three different individuals. It can be docs; it could be anybody. But we would bring in the insurance team, we would bring in the appointment team, and we would bring in the financial team, and all three of them in real time are communicating back to the patient. They’re basically saying, “Hey, thank you, we’ve updated your insurance.” That’s the insurance team communicating. The financial team would say, “Hey, attached is an invoice. We have text to pay, if you’d like to pay your balance. You can go ahead and do it.” And then the appointment team may say, “Hey, we have the same day and time next week or the following week. Would that be OK with you?” They say yes, and you’ve handled all three, just like that. And all three teams are aware of that conversation at the same time.

And likewise when it’s clinical things. So let’s say somebody has just had a wound, or they’ve had surgery, and they think the wound’s not healing right. They snap a picture of it and send it in. Then the doc who did the surgery, or a care team, it doesn’t even have to be the doc, gets pulled into the conversation to look at that picture and tell the patient whether that’s something they need to come in and be seen about or whether it’s healing just fine. Those are the types of efficiencies that are built into this whole thing, and the whole idea about patient-initiated communications, which, in my opinion, is the biggest thing that will cause a practice to run so much more efficiently and smoothly with fewer people, and, I would consider, give patients what I call communication equity, where it’s not just on the doctor sending to the patient. That’s not communication equity in my mind. It’s the patient being able to communicate with you the way they want to, when they want to, and from how they want to.

Kevin Pho: So one of the barriers that I often hear that prevents more patients from texting, of course, are the privacy barriers, the HIPAA compliance barrier. So tell us how your solution gets around that.

Keith Dressler: Well, if you’re aware, and again, the listener is aware, we have two compliance things. One is with patients, and then one is doctor to doctor, if you’re in referral. OK, when it’s doctor to patient, patients rule the day. They tell you, the doc, how they want to be communicated with. So it’s consent; it’s all around consent. In our platform, we have consent management, where we share with them that we protect their stuff on our end, and it’s up to them to protect their stuff on their end.

And then when you look at it, most people are hung up because when texting was first described, it was described really doctor to doctor, or referring doctor to doctor, and basically that law states that you must be encrypted end to end if you’re going to talk doctor to doctor. That is how you have to talk. And we do have end-to-end encryption for that form of communication between doctors within our platform. But when we’re talking to patients, we have consent management built in for all the various things, because it’s not just HIPAA and privacy that you’re dealing with. You’re dealing with TCPA, which is the Telephone Consumer Protection Act, which basically says you’re not allowed to text anybody without their consent about anything other than an appointment reminder. You can do that without their consent. But if you’re going to text them their bill, then you have to get a bill consent, meaning, “Can I send you this?” And if you’re going to use marketing materials to market, then you have to get that.

The reason that law is in place is there are still plenty of people who pay per text, and no business, whether you’re health care or otherwise, is allowed to run up a patient’s bill without their consent. So when you text them and they’re paying individually, they’re not on an unlimited plan, and you’re soliciting them about something, that’s really against the law. So we have consent management built into our whole system. It’ll protect the practice and protect the doc, and it really won’t allow certain things to happen without their consent.

Kevin Pho: We’re talking to Keith Dressler. He’s a health care executive, and his latest KevinMD article is titled “3 reasons practices should implement patient-initiated collaborative texting.” Keith, what are some of the take-home messages that you want to leave with the KevinMD audience?

Keith Dressler: I would say that for all of you who feel overwhelmed day in and day out, we’re here for you, because we want to give you your life back. We want to have you going in and having a really pleasant, happy day, and let you focus on what you got into medicine to do, or dentistry to do, and that’s to treat patients. You’re not there to run on this mouse wheel that you’re on and be frustrated every day and get burned out very easily. I can share with you that the doctors that use our program have much, much happier lives. They have much, much happier days at the office, and so do their staff. So to me, that would be the number one takeaway.

Kevin Pho: Keith, thank you so much for sharing your time and insight. Thanks again for being on the show.

Keith Dressler: Yeah, thank you. Thank you, Kevin, for having me. More than happy to come back anytime.

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