Automated Texts From Your EMR — More Contact, Less Work, Fewer Readmissions

CORRelations staff regularly visits with leaders at efficient practices to learn about the innovations, modifications, or upgrades that have made big differences.

This week, CORRelations spoke with Eric Bressman MD, MSHP, of the University of Pennsylvania. While normally this part of CORRelations focuses on innovations in private practices, Dr. Bressman's research focuses on how best to integrate technology into good, efficient care. One of his papers — about how an automated texting program decreased readmissions after hospital discharges — was featured in our Need to Know section because it was so successful.

Even though many orthopaedic surgeons increasingly care for patients at ambulatory surgery centers (ASCs), hospital admissions are a part of many practices, and many practices communicate with patients after home discharge from ASCs just as they do after hospital discharge.

CORRelations: How — or how much — might automated texting programs after hospital (or, perhaps ASC) discharge improve care and, importantly, practice efficiency?

Dr. Eric Bressman: It’s all about opening lines of communication, so if patients need something after discharge, they feel empowered to let us know. This enables the practice to intervene earlier and more often. Automation allows us to significantly scale up touchpoints with the patient and only requires human involvement once a need has been identified. Text messaging is simple, widely used, and, importantly, asynchronous. By contrast, traditional call-based programs are time-intensive. They have lower response rates, and, even when they are answered, often are low-yield.

CORRelations: What first steps do you recommend for a practice interested in integrating automated texting into their electronic medical records and patient-care flows after outpatient surgery and/or hospital discharge?

Dr. Bressman: You hit the nail on the head with your question. Integration with the EMR and into staff workflows both are essential. On the informatics side, not every messaging platform will easily integrate with every EMR. It may require a separate user interface and involve staff toggling back and forth to manage the program. The success of our program has relied heavily on its relatively seamless integration into staff workflows, and being able to receive notifications within the EMR where they are already spending their time has been a big part of that. The second piece of advice is to involve these frontline staff in the development of the program from the beginning and to be open to making changes in response to their feedback. Their insights are essential.

CORRelations: Innovations like these always have pitfalls. What should practices watch out for, and how can they avoid problems when adding on systems like these?

Dr. Bressman: A common concern when increasing access through these types of connected care approaches is that it will promote overutilization. That hasn’t been our experience. Still, there do need to be safeguards on staff time, and the quantity and quality of work being generated by a program like this should be monitored. In addition, patients now have a multitude of ways to reach their providers — telephone, patient portals, and text-message programs like these — and those professionals may receive messages from a number of sources these days (the discharging hospital, the ambulatory practice, and the pharmacy, among many others). This can become overwhelming. Practices need to be mindful of this landscape and provide patients with clear guidance on modes of outreach and working with other parties where possible to provide patients with the most seamless experience.

[Editor's Note: Dr. Bressman made the point of saying that he does not endorse any programs and does not speak on behalf of the text-messaging product that he mentions here. With a little searching, we found a variety of commercially available alternatives that seem to offer the same basic service, and, not surprisingly, some EMR systems have developed their own in partnership with other tech communication companies. The right choice will depend on each practice's needs, resources, and EMR system, but the general approach here — using automated text messaging to reach patients — seems very promising, as noted in our recent Need to Know post on a study evaluating it.]

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