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Text messaging: The next frontier for post-operative care?

August 19, 2019

Text messaging: The next frontier for post-operative care?


Three years ago Goshen (Ind.) Health, which operates a 123-bed hospital, began looking at secure text messaging as a way to improve clinician communication—and now, it’s taken on a patient-centered twist.

In 2016, Dr. David Koronkiewicz, then Goshen Health’s medical director of quality, was given a task: look into text messaging for clinicians and staff. The hospital soon selected a service and implemented it systemwide for clinicians, nurse case managers and nursing supervisors. But Koronkiewicz realized the product could prove useful for checking in with patients, too.

“I started using secure messaging with my patients, even before I brought it up to my partners” at Goshen Orthopedics & Sports Medicine, the hospital-employed orthopedic group at Goshen Health where Koronkiewicz practices as an orthopedic surgeon, he said.

Koronkiewicz began experimenting with enrolling his patients and their caregivers into an app—Backline, a secure messaging app from software provider DrFirst—on the day of surgery. Through the app, Koronkiewicz could chat with patients via direct messages, similar to texting.

During the patient’s procedure, Koronkiewicz would use the app to keep the patient’s caregiver updated on when the surgery would be over. Then, in the days following, Koronkiewicz would message the patient directly to check in on their recovery. Patients are alerted of a physician’s Backline message through a text message, which directs them to a secure chat webpage—and for 72 hours after Koronkiewicz sends a message on the app, patients are able to respond with their questions or concerns.

It was a hit. “I’ve had patients text us that say, ‘I need new pain medicine,’ or ‘I’m nauseated,’ or ‘Can I (take) a shower?’ ” Koronkiewicz noted as examples.

So last year, Koronkiewicz proposed implementing physician-patient messaging throughout Goshen Orthopedics & Sports Medicine. His colleagues, understandably, had some concerns—including a worry that patients would reach out to them with “every little single question,” Koronkiewicz said.

But they agreed, and in January, Koronkiewicz conducted a monthlong pilot study of 38 patients for a deeper look at this type of messaging. Seventy-eight percent of the patients said the ability to message their physician improved the overall care process, while 83% said it helped to make them feel at ease, according to Koronkiewicz’s findings. Ninety percent said they would recommend the practice to others.

And over-communication wasn’t a problem, Koronkiewicz said. Only two patients enrolled in the pilot study messaged their physician four or more times, and there was only one case where a physician expressed frustration about a patient texting multiple times in the middle of the night.

Dr. S. Luke Webster, a consultant with Maestro Strategies who has experience implementing secure messaging systems for providers and patients, said it’s important to address providers’ concerns about added workload at the outset.

Careful integration of such a system should include having other clinical staff, such as nurses and physician assistants, triage messages and answer questions that don’t require physician input.

Dr. Lew Schon, who joined the Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore as director of orthopedic innovation this spring, said he has used direct messaging to check in on patients after surgery for the past five or six years, though on a less formal level. “It wasn’t something that the hospital had adopted, but it was something that I was doing,” he said.

Schon uses WhatsApp to set up group messages with some patients and members of the care team, and is considering working with Zimmer Biomet’s myMobility app, which includes a direct messaging capability. Schon doesn’t set up messaging for routine cases, but said he will sometimes offer the capability to patients with more complex needs or who are based out of state or internationally.

He agreed patients have not misused the capability in his experience, but stressed the importance of setting expectations, both in terms of timeliness—explaining that he won’t be able to respond to most messages immediately—and setting boundaries on what types of issues warrant a message.

The key for hospitals considering this type of program is starting slow, Schon added. “Implement it for certain patients, with certain diagnoses, with certain procedures and learn it—become more comfortable with it, test drive it, and figure out what’s best for your unique set of doctors and your hospital.”

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