Technology Moves Texting to Center Stage of Healthcare

Altura FQHC is among those providers where tech means abandoned phone calls are dropping.

Lengthy telephone hold times have frustrated patients long before the COVID-19 pandemic. New technology lets providers move those patients into texting sessions before patients simply hang up their phones.

The technology works with Cisco and GoToConnect office phone systems in two ways. First, it can prompt on-hold callers to opt to continue the call via texting instead; second, it can sense when callers have abandoned calls, and send them texts inviting them to get answers via text instead of a return call.

Arnie Reynoso, chief information officer, Altura Centers for Health. Photo courtesy of Altura Centers for Health.

One provider that has found the technology to be beneficial to its patient experience is Altura Centers for Health, a federally qualified health center (FQHC) serving populations in California's Central Valley.

"As a nonprofit FQHC, finding the appropriate staff or staffing levels is kind of hard, because we have a very fixed budget," says Arnie Reynoso, chief information officer of Altura. "As our patient population increased, we saw an increase in actual abandonment rates."

Altura was already using technology from WELL Health to send texts to patients, and then integrated the technology with its phone systems. Within 90 days, its call abandonment rate dropped from 20% to 15%, a drop of nearly 1,000 abandoned calls per month, Reynoso says.

"For our patient demographics, they're usually [working] eight to five, or sometimes two jobs," Reynoso says. "So being on hold is quite precious time."

Patients benefit from being able to move to asynchronous texting communication that allows them to periodically check back and keep a conversation going with their providers, Reynoso says.

Initial use during the pandemic proved the value of the technology to Altura.

"During COVID, we were short-staffed, yet we were still able to handle the volume we typically handle," Reynoso says.

A typical engagement begins while the patient is on hold. The provider's phone system prompts the patient to press the star key on the phone, which triggers a pre-recorded response that the provider will follow up with the patient via text message.

The system is also able to detect if the patient response is coming from a landline, in which case it will check available records and attempt to locate a mobile number for the patient, then text to that mobile number.

If staff cannot locate a mobile number, they follow up with an actual return phone call to the patient, Reynoso says. "It hasn't been a huge issue," he says.

When surveyed, between 90% and 95% of Altura patients say they appreciate the ability to reach their providers via text, Reynoso says.

Front office and call center staff, who are typically the personnel who patients are initially contacting, approve of the shift to texting. Such staff "would love for everyone to utilize the texting feature," Reynoso says. "It's less burdensome, and it allows them to handle multiple patients almost simultaneously, in a sense."

The increased usage of texting has another benefit to Altura's patient engagement goals: it increases usage of the FQHC's patient portal.

Once enough patients were connected to Altura's texts via mobile messaging apps, Altura was able to massively send text messages and reminders to patients, including prompts to utilize the patient portal, or select URLs to initiate medical record requests, Reynoso says. Texting "eliminates the need to actually make a phone call and talk to someone," he adds.

In the last six months, Altura has seen an increase in call volume, and also a slight increase in patients opting to continue calls via text messaging, Reynoso says.

Once patients are aware they are connected to Altura via messaging apps, often these patients "don't even initiate a call anymore," Reynoso says. "They just text us to request an appointment or a medical record. It's pushed them in that direction."

In the future, Altura plans to expand the capabilities of its texting interface, so that, for instance, patients could self-schedule appointments. The technology is capable of doing this, but "we need to iron out the details," Reynoso says. Similar issues, as well as security considerations, are behind not yet permitting prescription refills via texting, he adds.

WELL Health's technology also integrates deeply with multiple vendors' EHR technology, says founder and CEO Guillaume de Zwirek. It also brings in ADT data and interfaces with scheduling, referrals, and orders interfaces, he adds.

All told, the technology is already deployable to 30 million patients nationwide, and is in use by Houston Methodist, Cedars Sinai, and MemorialCare Health System, among others, de Zwirek says.

All this is possible without requiring patients to download another app, and this is by design, de Zwirek says.

"Apps are important for high-utilizers" with chronic conditions, he says. "For the 90% of people who visit the health system three times a year, you need to reach them where they are," which is texting, and maybe only move some of them to apps if they acquire chronic conditions, he adds.