Is Txting 4 U? Doctors let fingers to the talking
■ The growth of wireless communication, and a new generation of doctors who have grown up with the technology, have led to more physicians using text messaging as a primary source of communication.
By Pamela Lewis Dolan — Posted Feb. 4, 2008
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R U N2 TMing?
If not, you are probably having trouble deciphering the previous line, which in English means, "Are you into text messaging?"
Text messaging is something often identified with teenagers incessantly punching gibberish into their cell phones. But many doctors have found texting to be an EZ (easy) way to SIT (stay in touch) with family and friends throughout the day when they are too busy to call or send an e-mail. More than that, those doctors are using it as a way to communicate with colleagues on the fly, or to communicate with patients.
And as more medical students -- who are as familiar with texting as they are with using the telephone (assuming they haven't given up the old land-line phone already) -- enter the field, text messaging is expected to become increasingly common among doctors.
With the cell phone's popularity, text messaging services can provide a convenient way for you to remind patients of appointments or send them a birthday wish. Automated systems exist, so that you don't have to remember every patients' birthday -- you can impress them not only by your apparent memory but also by your tech savviness.
But some suggest that texting has its limits for doctors because of an acronym EVRY1 (everyone) is familiar with: HIPAA. While advocates of texting say it's more private than actually talking into a cell phone, others say the tool is best used to facilitate the quick scheduling of a meeting or phone call, rather than for detailed, substantive patient issues. A quick phone consult, for example, could be arranged as fast as you can type PCM (please call me) on your keypad and hit send.
Here are ways in which text messaging has made life easier for some doctors, as well as some of texting's limitations. If you are already texting, MHOTY (my hat's off to you); consider this reassurance that you are keeping up with the times. For the others, I HTH (hope this helps) educate you. And there's no need to offer TIA (thanks in advance) for the lesson.
Way of life
David Stewart, a fourth-year student at the University of Texas Medical School in Houston, said he likely would be texting no matter what profession he pursued, because it's something he's used to doing anyway. But especially for medicine, he said, incorporating texting into the workday makes perfect sense.
"At times you are so busy you don't have the time to make the call, wait for it to ring or wait for them to call back. It's easier to send a message, convey what you want and go from there," he said. "It's kind of just become a way of life."
Stewart said he has been texting for several years. And when he and his fellow students started their clerkships, their use of texting just carried over. But it's not just students, he said. It's also residents and attending physicians.
Stewart said the hospital has a paging system, but it requires doctors to page from a computer. So when they are busy visiting patients, it's more convenient to send a text message than make the trip to a computer terminal, wait for the page to be answered, then play phone tag.
At about 200 text messages sent per month, Stewart considers himself a "light texter" compared with his fellow students, many of whom send more than 700 text messages per month, he said. But he suspects that as future generations enter the medical field, even 700 texts per month may seem light. His brother, a high school senior, sends more than 1,000 text messages a month, he said.
Future generations, much like his own, "won't cut out texting in the working world," Stewart said. "They will integrate it into what ever they do. It's a huge way to communicate."
Mia Sanders, MD, an ob-gyn at the Harlem Hospital Center in New York City, started using text messaging a few years ago when she was working at a rural clinic in South Africa, where it was cheaper to send text messages than to make a phone call. When she and friends made dinner plans, for example, they would send text messages indicating the time and place to meet. Now she uses text messaging so that her office or nurses at the hospital can contact her anytime.
Although Dr. Sanders said she doesn't use text messaging to communicate directly with patients, she does use it to keep updated on patient conditions or circumstances. A recent example was when a patient who was going to have surgery decided to reschedule, and Dr. Sanders' office sent her a text with the message. She received the text while she was near the OR waiting for another surgery to begin.
Dr. Sanders said she thinks texting would sometimes be more HIPAA-compliant than the telephone because there are no worries about who can overhear something.
But doctors also need to be concerned with the possibility the message could end up in the wrong wireless inbox.
"Where you can overhear a [telephone] conversation, you can intercept an electronic conversation," said Lisa Sotto, a New York-based partner at the law firm of Hunton & Williams LLP. She also is vice chair of the Dept. of Homeland Security's Data Privacy and Integrity Advisory Committee, which advises the department's secretary and chief privacy officer on privacy, data integrity and data interoperability matters.
"You can see who's around you when you're talking. You have less ability to understand your environment when you are sending your message electronically," she said.
Because HIPAA rules apply to the security and privacy incorporated in a doctor's "workstation," and if a cell phone is being used for work purposes, that device becomes a workstation, therefore subject to HIPAA, Sotto said.
Many wireless devices can be password protected, but further encryption really would provide the best security, Sotto said.
Steven T. Liu, MD, an internist who is the former director of medical informatics for the Hospital Medicine Unit at Emory University, is founder of IngeniousMed, a practice management system that includes wireless communication features through which doctors can chat in real time through hand-held devices. IngeniousMed's systems do not work on a cell phone platform, but many of its clients use cell phone text messaging because of the convenience, Dr. Liu said.
But the convenience sometimes can get in the way of HIPAA compliance, Dr. Liu said.
"I would almost be willing to bet some physicians are using TM in either a knowingly or unknowingly nonsecure way. Either they don't ask or they don't want to know [if what they are doing is HIPAA compliant] ... because it is so convenient."
HIPAA concerns aside, sometimes the problems can be too complicated to discuss through text messaging, Stewart said.
"Text messaging is a good source of communication [for] like, 'meet me here' or 'this patient needs this,' but we need to discuss and collaborate so much, it would take too long to text message all that," he said. Stewart said he makes more phone calls than sends text messages.
Randy Rudderman, MD, a plastic surgeon in Alpharetta, Ga., said texting helps him make more time for patients, even though he uses it only to communicate with people outside his practice.
Because he doesn't have time to make and receive phone calls throughout the day, he uses text messaging instead. For example, Dr. Rudderman is working to open a second clinic location, and nearly all the decisions he makes with his building contractor are made via text messaging. Texting is also the primary source of communication between himself and the public relations representative who markets his practice, he said.
"Text messaging is the best way to let people know that you respect their time," he said. "It allows people on the other end to pick the time that's most efficient for them to respond to your needs and questions; that's the nuts and bolts of why it works."
Increasingly, companies are coming up with practice management and other programs that incorporate texting.
A year ago, when Brian Loftus, MD, a neurologist in solo practice in Bellaire, Texas, got a text message from his dentist reminding him of an appointment, he decided that his own practice could benefit from a similar system.
Dr. Loftus became one of the first medical practices to use Smile Reminder, a system that sends automated messages to patients, developed by a Lehi, Utah-based firm by the same name that initially marketed it only to dentists.
Dr. Loftus said the system, which sends three reminders -- seven days, three days and two hours before the appointment -- has helped significantly reduce no-shows. "If roughly two or three appointments a month are kept because of the system, I break even," Dr. Loftus said.
Smile Reminder sends messages to patients to remind them when it's time for a follow-up even if they haven't scheduled an appointment, he said. It also sends birthday greetings, to which Dr. Loftus's practice manager Blakely Long said she is in the process of adding a photo of the staff adorned in party hats in front of a birthday cake.
Health care technology giant McKesson also has developed automated systems that help with the clinical side of medicine, said spokeswoman Leslie White.
One system can be set up to send patients reminders, via e-mail or text message, when it's time to take their medications. On another, doctors can monitor hospitalized patients and receive alerts via text messaging, such as when their blood pressure drops. Physicians also can check patients' symptoms via a cell phone.
At least one pharmaceutical company also is taking advantage of the captive audience cell phones create. Merck has set up an alert system that reminds patients receiving Gardasil, which requires multiple injections, when it's time for their next shot.
"Been 2mos? Call ur doc if you haven't had ur 2nd appt for Gardasil" is one example of the messages sent to patients who opt to receive them.