Text messaging and healthcare

As healthcare tries to become more interconnected, there is a gap between what is “allowable” in a HIPAA-conscious medical environment, and how we communicate with each other socially in other domains of our lives. Mobile notifications of things like critical lab values or imaging reports have not been very useful, and often add to the burden rather than helping it.

IMG_6011The experience noted in a MedCity News article, “A digital health dilemma: how healthcare ruins text messaging” is a good case in point. When an alert of a critical issue is sent out to a physician via text messaging, it can’t contain Protected Health Information (PHI) because standard text messaging (SMS messaging) is not HIPAA compliant. Therefore, the text message requires the recipient to log in somewhere to see the actual information. This can be via a portal, or via a secure phone interface with the need for access codes to be entered through a robotic system that eventually gives the result. Notwithstanding the time burden of this, the values are without context. The hospital may be satisfied that their notification system “is working,” but the clinician then has to do something about it – look up the patient’s record somehow, see where the lab or x-ray value fits into the picture, find the contact information about the patient, and then call or somehow contact the patient with instructions. Not surprising that the result is screaming frustration!

What we need, then, is secure message delivery, into a mobile device (your smartphone), where the results are viewable directly in the message (not requiring to go somewhere else to log in), and the information is in its clinical context.

Enter the Flow Health provider app

Flow Health is a universal patient-centered platform that accumulates data from all sources – EHRs, payer data, lab data, patient-entered data both at home and at the point of care during check-in, and device data – and normalizes it in one place. In addition to the platform, there are a handful of apps that Flow Health has built to provide access to the universal data, and render it useful.

The Flow Health provider app is a mobile app that organizes clinical data like a social network, with a feed of posts about the patients that a given provider is following, and with the ability to look up any patient record that one has permission to access, and review their medical history.

Certain kinds of data feeds can be pushed into this platform. Notifications like Emergency Department or hospital admissions, discharges and transfers (ADT feeds) can be pushed into the platform, and will appear in a provider’s feed, with alerts for certain kinds of critical information. Lab results and imaging results can also be pushed onto the platform, so that the sending hospital gets a receipt notification of the message having been delivered and viewed (which they need for their documentation purposes), and the provider can see the information directly (no need to go somewhere else and log in, or go to a phone system with access codes to retrieve information), and in context (all the information about the patient is seen along with the new data).  If appropriate, a patient can be called directly from the smartphone app, or the patient can be messaged through the patient app if they are already on that system. In addition, given how the structure of these alerts are like social media posts, providers on the patient’s care team can comment on them, allowing collaboration between everyone taking care of the patient.  We have shown the important difference between “push” notifications (which physicians need) and “pull” queries (which is what many “interoperability” platforms are based upon).

What does it take to get started? For a provider, the app is free and available on Android and iOS. From the hospital side, it is as simple as providing the appropriate HL7 messages to Flow Health, and the routing to the right clinician is done on the Flow Health end. The system is free for the hospital to use too.

Why would a hospital want to do this, if they already believe they have an adequate solution? Look at the results: Any time a workflow (like pushing out messages to doctors) requires an interruption in order to go log in somewhere, the uptake rate plummets. Hospitals need a better solution in order to improve physician use and satisfaction, and in order to optimize patient care. Entrepreneurial start-ups like Flow Health can provide an improved interface that works seamlessly with hospital systems.

Comments (4)

Holden Anele

Feb 19, 2016 at 6:15 PM

This is awesome if it takes cognizance of the HIPAA regulations. Having a system that pushes these data right to the EMR of the hospital and from there both patients and clinicians will have access to them seems superior than an app installed on a smart phone. Note the current issues with smart phones being subject to various threats including loss of phone, phone hacking, etc. Epic currently implements a capability of both patients and clinicians accessing lab values and radiologic images. I doubt if Epic and other quality EMR users will like Flow Health in the presence of a more robust and highly protected MyChart. However, it’s something worth trying but the biggest issue is security, security, and security.


Robert Rowley

Feb 19, 2016 at 9:57 PM

The apps that Flow Health has built are meticulously designed around meeting and exceeding HIPAA compliance. Stay tuned for future posts addressing HIPAA in more detail. Secure “push” messaging is something that fits together with patient portals (such as MyChart), and addresses different workflow needs not met well met by EHRs and patient portals. Peer-to-peer instant messaging (without necessarily posting data to a patient’s record) using the Flow Health provider app is also popular, and has been used in some teaching and team-based settings within hospitals where EHR tools have been too cumbersome to utilize in the fast-paced settings of care.


Richard Adler

Feb 21, 2016 at 2:39 PM

Say back in 2009, I co-edited, with BJ Fogg, a book titled TEXTING 4 HEALTH – A SIMPLE, POWERFUL WAY TO IMPROVE LIVES. Even then, we were making the case for the value of SMS to prompt more healthy behaviors. I agree that security is a key obstacle, but we need to find ways to solve that problem.


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