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Study Finds Texts from Physicians Motivate Patient Compliance


A study published in the Journal of the American Heart Association indicates that patients who receive text messages from their physicians are more likely to exercise. Physicians believe phone messages feel more intimate than email communication.

Practice Management, Columns, Telemedicine

A study published in the Journal of the American Heart Association indicates that patients who receive text messages from their physicians are more likely to exercise.

And not just any patients. These are patients at risk for heart disease, and the targeted interventions led to “significant increases in physical activity levels.”

David Applegate, MD, chief of primary care transformation at OhioHealth, isn’t surprised by the study’s results. And while many believe that texting and email are much less intimate forms of interpersonal communication, Applegate says the nature of texting creates a more intimate relationship.

“Not everybody has access to your text or cell or whatever device you’re using,” Applegate says. “And I think that type of patient has a different relationship with their provider, with their physician, or nurse practitioner than the average person who doesn’t feel connected. So, now you actually have a relationship that’s not just a doctor-patient relationship in a chart somewhere.”

Convenience and Support

Applegate explains that when physicians text their patients, particularly those at risk for heart disease or perhaps another chronic illness, it sends a message that another individual is there to support you. Getting the reminders helps serve as motivation.

The communication may also feel “special” to these patients who feel they have direct access to their physician, or other healthcare professional.

“And if you’re like me, walking out of the doctor’s office you forget half of the information,” Applegate admits. “So getting reminders helps in message retention.”

It was that rationale that led OhioHealth to launch a pilot in November 2015 with four of its employed primary care practices that involved video visits and eVisits. The pilot is called Care Connect, and it runs through OhioHealth’s new EMR platform, Epic.

“We literally connect care to our patients, as well as all our different healthcare providers,” Applegate explains.

The pilot uses an application called My Chart, where physicians can connect with patients, thereby extending service convenience while improving the quality of care being delivered.

“Customer service was a key driver,” Applegate says. “We’re all monitoring and measuring to show better quality outcomes.”

Email on Steroids

Applegate says that the video component of My Chart is a lot like communicating via FaceTime or Skype, except that it’s secure and imbedded within the chart. Everything that can be done during a traditional office visit, other than touching the patient, can be accomplished.

But it’s the eVisit that Applegate believes has great capabilities.

“In a regular email, you may have a conversation that goes back and forth, and it could take all day,” Applegate says. “Both sides could get tired of this.”

What the eVisit email does is package all of the questions a patient might be asked appropriate to his or her condition and delivers that package to the physician for a response. Patients can also input text information, such as being prescribed medication by a different physician.

“There’s still room for further communication, but it’s tidied up so this conversation doesn’t go longer than a day or two.”

There is a $20 fee for the service, which is similar to what patients’ co-pays are when coming in for an office visit. But with the eVisit, the patient’s credit card is authorized but not charged unless the physician dispenses advice to the patient. The patient is also not charged if the doctor recommends they come in for an office visit.

Learning Process

Applegate says he and his colleagues are learning as they move through the pilot. For example, they had set a goal asking each physician to do 40 eVisits by February 2016, and in early January each physician had conducted about 25.

“I think some of them embrace it more than others,” he says. “Not everybody’s going to want to do it. And right now we’re limited to iPhones and Android phones. We need to be able to use webcam on a desktop.”

There are also privacy and security concerns. Applegate says it’s important to protect the doctor-patient relationship, especially where the video visits are concerned.

“The patient should be concerned with who else is in the room with the doctor,” he says. “When you’re in the exam rom, you don’t have to consider that.”

Those who have had successful eVisit sessions love the convenience.

“We did surveys and the patients love it,” Applegate says. “It was convenient, and it saved them time. I don’t think it will replace being touched by another human being in the care process, but it’s another tool.”

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