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Getting the Message

July 20, 2010
by Kate Huvane Gamble
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Pioneering organizations are using tools like text messaging to enable patients to take better control of their health


As text messaging becomes more established in everyday routines by millions of users, healthcare organizations are embracing the technology as a powerful tool to allow patients to better manage their health. Two health provider networks, Kaiser Permanente and Riverside Health System, have launched successful pilots and plan to build on those initiatives.

In the midst of all the discussion surrounding healthcare reform, one topic that continues to surface is the rising cost of care for chronic conditions such as diabetes and heart disease. According to a report published by the Falls Church, Va.-based research firm CSC, spending for chronic disease management accounts for three quarters of the more than $2 trillion spent annually on healthcare in the U.S. And the problem looks to only worsen, as recent data show that 44 percent of Americans had at least one chronic condition in 2005.

With healthcare reform, we're going to be taking a closer look at keeping people out of hospitals and doctor's offices, and being more in control of their health.-Fran Turisco

The solution, many healthcare organizations are realizing, is to increase the role patients play in the care process. “This is going to be a huge priority going forward. Patients have to start taking their care into their own hands,” says Fran Turisco, principal researcher in CSC's Waltham, Mass.-based Emerging Practices division. “With healthcare reform, we're going to be taking a closer look at keeping people out of hospitals and doctor's offices, and being more in control of their health.”

Fran Turisco


And technology can potentially play a significant role in this new paradigm, both in supporting care-related tasks, and in allowing providers to monitor and communicate with patients without requiring face-to-face or telephone interaction, according to the CSC report, “Next Generation Patient Self-Care: The Role of Technology.” The most promising technology venue for self-management applications and services, it states, is the mobile phone-a technology that is already part of everyday life for most patients.

Some organizations have already begun using technology to send automated reminders and care recommendations to patients, which can both empower patients to better manage their health, and strengthen the relationship between patients and their providers.


One of those organizations is Kaiser Permanente, the massive Oakland, Calif.-based network that includes the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and their subsidiaries, and the Permanente Medical Groups. In 2009, as part of an ongoing commitment to engage patients in their own care, Kaiser launched a pilot in which appointment reminders were sent to a group of patients via short message service (SMS) text messaging. The project has been well received, and is being expanded in the northern California region, according to Phil Fasano, senior vice president and CIO. Patients can elect to get text reminders, if that is the most convenient mode of communication for them, or they can choose to receive notifications via phone calls or postcards. “It's all based on their preference and what's easiest for them,” Fasano says.

Phil Fasano

Attention to patients' preferences is critical, according to a report published by the Rockville, Md.-based Agency for Healthcare Research and Quality. It found that patients are less likely to use technology that does not fit seamlessly into their normal daily routines.

John Stanley

On the other hand, tools that already play a key role in patients' everyday lives tend to have higher success rates. According to Fasano, about 3 million of Kaiser's members regularly use the company's patient portal,, to check lab results, send e-mails to physicians, and schedule visits. “We have a very successful Web presence,” says Fasano. “It's an intricate part of our system. It helps patients manage their health, and it's been very positively received.”

The organization plans to employ text messaging for more functions, such as notifying patients of lab results and providing information on maintaining a healthy lifestyle. It shouldn't be difficult, says Fasano, since all of Kaiser's systems, including the electronic medical record from Verona, Wis.-based Epic Systems, are tied to the organization's health information system, KP HealthConnect.

For Kaiser, an implementation that is relatively simple from an IT standpoint and can lead to improved outcomes is a no-brainer. “It's our belief that text messaging can be highly effective in helping support chronic care management of patients, so this was a natural step for us,” Fasano says. “We're a preventive care organization at our core, and we have systems that support those activities across our organization today.”

Fasano believes text messaging is the next channel that health systems need to exploit. “It creates a virtual environment that makes care more convenient, and can lead to better outcomes,” he says. He adds that as more organizations take steps to improve chronic care, the entire nation will benefit in ways that are obvious, like improved health and decreased cost of healthcare, and some that are not so obvious, like making care convenient and more satisfying for consumers.