NHSmail promotes free SMS for reminders

1

Wow something useful

29 Oct 07 14:10

At last, something unexpectedly useful associated with NPfIT. How long do you think it will take before they break it?

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2

Excellent use of existing resources

glen.griffiths@interactivhealth.co.uk

30 Oct 07 13:10

The Ashford and St Peters Hospital Trust implementation appears an excellent example of grass roots innovation yielding benefits for patients whilst improving the efficiency of health services.

Win / Win I'd say!

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3

Consent

30 Oct 07 15:10

Has patient consent been sought before the Trusts bombard patients with text messages?

People can opt out of these types of texts from banks etc but once you use the NHS one seems to lose all their rights?

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4

Consent

30 Oct 07 16:10

How very typical of this forum that someone finds something negative to say about such a positive initiative! The system at Ashford and St Peters was given full approval by their Caldicott Guardian and the patients are sent a single reminder 3 days prior to their appointement - hardly being 'bombarded'! The feedback about the reminder service from patients at the Trust is 100% positive.

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5

NHS Mail

30 Oct 07 19:10

As an NHS Mail user (and a frequent user of the SMS service) I'd like to say that generally it does exactly what it says on the tin. The one problem I have with it is that you have to remember to remove the auto-signature which Outlook inserts (and which we at CFH are mandated to have) otherwise it becomes part of the SMS and turns a simple text message into one which is too long to be sent by the system - it can't split a message into multiple parts - or at least it couldn't last time I forgot to remove my signature. I'm not a fan of NHS Mail generally as I find it too slow and unresponsive compared to what we used to have - but the SMS part works fine.

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6

Re Consent

stressfreedave@hotmail.com

30 Oct 07 19:10

"How very typical of this forum that someone finds something negative to say about such a positive initiative!"

Here was me thinking consent was an important issue, guess it is not that important for some.

There is nothing wrong with asking if consent was asked for. Yes it is a good idea, in fact even I would say it is a great idea, but that does not mean patients should not be asked for consent to be sent the reminder when they book the appointment. The quest about patients being asked for consent does not seem to have been answered and the idea that the Calldicott Gaurdian aproving it making it good, is far from being a recomendation (Having had experience of these opeople, I know their standards vary from the low, to the none)

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7

Paralysis by security

30 Oct 07 22:10

I was pleased to find I had two such txt rmndrs the other week, and its an interesting anecdote, I was referred to a private run DTC for ... D .... and I had nice txts to me three days ahead, and the day before. Arriving at the private DTC the posh decor was in place, but their PAS had no record of my appointment, a slightly confused receptionist was surprised to see the txt on my mobile screen, location, timeslot, procedure, which their EPR was not finding ... so one up for the NHS I say.

If we allow security anziety to dominate rather than inform each decision point, we would still have wax sealed papers delivered by errand boys. So an opt-out could make sense in a few circumstances, but not many. I do not grant assumed consent for the zealous governace lobby to inhibit even this minor progress, and by the way, the man with the red flag walking in front of the locomotives on the early railways was redeployed quite fast once reality took hold.

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8

Positive news

philip.wilford@rsh.nhs.uk

31 Oct 07 03:10

The Shrewsbury and Telford Hospital have been using the free SMS service for quite a while now. They have an automated application which runs once a day and sends out OP appointment reminders to "patients' that said they would like an SMS reminder". We simply ask the patient when they make the appointment and mark our PMI record with a T before the mobile number so we know they have consented. Its only a small VB application, but it works great (Copy of code freely available). Whether it actually reduces the DNA rate is up for debate, but anything that reminds a patient they have an appointment has got to be good. We also worked with the PCT and got them using it so they could automate the SMSing of patients who where on the H2Q smoking programme. It gives them daily support and a way of regularly reminding them how they are getting on.

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9

Breach of Confidence

31 Oct 07 08:10

What about the patient who has not told their family they are attending a hospital appointment for example, a case of suspected cancer and the patient does not want to worry his/her family? Or indeed any other condition the patient does not wish his/her family to know about.

If you send a text without patient consent and the mobile is on the coffee table that is breach of confidence. The Consultant is then faced with a possible professional compliant to the GMC for breach of confidence and the Trust and Consultant may also face legal action. This may have also done untold damage to that family at a time that individual was undergoing great stress about a possible cancer diagnosis.

What is so wrong with seeking patient consent to contact them in this manner and so avoiding these possible dreadful consequences?

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10

Consent

31 Oct 07 13:10

Do you we have to ask patients for their consent to have a letter sent to them?

Text Messages work in a similar way as a letter. I have an alert flag up on my phone that says an SMS has been received but NOT the actual content. I then have to open the message to read it.

It takes a positive action by a person to illicitly read an SMS and one that will inform the intended recipient that the message has already been read. A bit like seeing that the envelope to a letter has been pre-opened.

Getting the right consent for various components of how patients health records are accessed IS important. But not ever "e-action" requires it.

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11

Disgaree

31 Oct 07 14:10

Text are very different from letters. A letter is addressed to your home. One leaves there mobiles next to them at friends and family and in ones own home ( I never seem to be in the same room as my mobile) and so they are very easy to read if one accidentally leaves mobile unattended. This is especially if a Trust has failed to warn a patient they may receive a text message and given them the opportunity to opt out.

By contrast a letter can easily be hidden away after it arrives. There is a big difference here.

Patient consent is needed here to avoid possible consequences of GMC and legal action. These are avenues I would take if Hospital Trust did this to me without my consent.

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12

Doesn't hurt to ask..

glen.griffiths@interactivhealth.co.uk

31 Oct 07 14:10

In terms of consent - I think it makes practical sense to affirm that patients are happy to receive a reminder via text each time an appointment is made as in practice I'm sure we're all aware how regularly an individuals mobile phone number can change / be passed on to family members etc., particularly relevant where individuals change jobs and have hd use of a company phone.

My assumption - and the reason that I believe the initiatives listed here are so positive - is that this would indeed be the case and not that a mobile number was used just because it was on file - as an anecdote my wife still receives calls for me from time to time event though I changed numbers over 5 years ago and passed on my phone. My address hasn't changed in that time.

Fundamentally this is a service to patients that has a knock on benefit in efficiency due to the possible reduction in DNAs. It also feels 'professional', modern and appropriate when implemented this way.

The ideal situation as I see it, is that when appointments are arranged with a patient either via Choose & Book or directly with a secretary from the hospital or other provider - A confirmation by the patient of the agreement to be contacted / reminded via SMS and the correct number to be used for that instance of care should be mandatory. I would imagine that 95% of people wouldn't have a problem with that although a reasonable percentage might say they don't need a reminder which is of course perfectly acceptable.

Definitely opt-in rather than opt-out as far as I am concerned.

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13

Consent

31 Oct 07 14:10

Just a thought - in order for the Trust to text you a reminder they will need your mobile phone number, surely you will want to know why they want your number before you give it to them ? And wouldn't the request make it occur to you that they may use the number to contact you and give you the opportunity to withdraw consent at that point (by not allowing them to record the number).

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14

Once Again

31 Oct 07 17:10

Phone calls are dealt with under strict controls by the NHS. Messages are not generally left on answerphones for patients and generally NHS staff double check by date of birth etc they are speaking to the correct person. If its not the correct person they do not disclose where the telephone calls is from.

I know I have trained staff in both Trusts and Primary Care in the correct way to make calls to patients.

Text messages get around all these controls and you have absolutely no guarantee whatsoever that the text has been picked up the patient.

Tonight is a classic example my teenage Nephew has no credit so he has taken one of mobiles with him to a party as he needs picking up later. I am myself have 2 mobiles so still have my Blackberry. Hence if I was getting a text from a gynae clinic my Nephew would get it, he has had my phone from 4pm! He will be watching out for texts from me nagging him to come home as its getting late!

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15

still no answere?

stressfreedave@hotmail.com

31 Oct 07 18:10

When you give your number it is so that they can contact you at short notice if they sudedenkly need to cancel your appointment, it does not mean you are consenting to them texting you data that is classed as 'sensitive' under the terms of the DPA.

How many people give their bank a mobile number? Does that mean you are 'consenting' to the bank sending you text messages?

Like I said before, this sounds like a good idea, but there are patients that may not want this ever, while some might not want it for some things but will allow it for others. It is about chiove and it is about asking when it is very easy to do so. It takes no time to ask them. I point out, again, that the question about consent has not been answered.

Just to make things a bit more controversial, try reading the article http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/27/nphones127.xml which is about monitoring text messages. This is an opt-in thing, but there is a difference between the patient allowing the phone company know they have booked dinner and the phone company knowing their medical info. Should they at least not be asked? should those oppposed to asking patient consent for anything be allowed to do what they want?

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16

Countess of Chester NHS Trust seeks Consent

mark.a.jones@coch.nhs.uk

01 Nov 07 12:11

We have been live since July 2007 with our Countess 'RemindMe' appointment reminder system and have sent over 7000 messages to patients.

We ask on patient attendance, for permission to contact them electronically and for their mobile number as we feel it is important to record the permission in our MEDITECH patient administration system, as any other text service in the private sector requires an opt-in.

We created a .NET C# application that has a scheduled run every morning and ‘Remind Me’ automatically sends messages to patients: 2 weeks, 1 week and 1 day before a patient’s appointment. The application interrogates the appointments file from MEDITECH to determine who has consent and automatically sends the text messages through NHS mail without the need for any manual intervention at any point.

Since July we have noticed a 13% decrease from our average new DNA rates, and an 8% decrease for follow-ups.

We are also just about to launch an email reminder service through Countess ‘RemindMe’ with full patient opt-in

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17

measurable benefits and service to patients..

glen.griffiths@interactivhealth.co.uk

01 Nov 07 12:11

..is a win / win

This discussion has rightly raised comments and concerns and the response from Mark at Chester puts this into context. Whilst it is essential that ALL communications conform to acceptable standards - asking a patient if they would like to receive a reminder and checking that the phone number on file is the correct one to be used is part of the conformance process and demonstrates a service approach which has resulted in the case of Chester of significant resource improvement. It may well be that most hospitals have this in place now? but if not even a 10% improvement in DNA rates across the UK would yield huge savings.

As I haven't received a reminder myself, I can only imagine that just the bare details around confirmation / cancellation of the appointment that was due were included in the message (with a telephone number to change arrangements) and not personal details around a particular procedure etc., whilst I am very conscious of the issues surrounding privacy, where privacy might be an issue for an individual patient they could simply say that they did not want to receive a text reminder - it should be as simple as that.

In no case in my view should an individual be routinely contacted on an arbritary mobile number held in a database and this appears to have been confirmed by the contributions from Chester and Shrewsbury & Telford and I assume this applies to Ashford & St Peters as well.

A small but significant step that could find itself universally employed in Primary Care as well.

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18

mistakes do happen

02 Nov 07 09:11

I have received a text reminder addressed to a named person for an OP appointment. It was sent to a wrong number. What checks are in place to ensure typed in details on a system are correct? When I contacted the hospital they were unable to help as it was against confidentiality rules - so I guess I will just keep receiving this person's messages.

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19

Short term again missed opportunity

02 Nov 07 09:11

It is a fact that texting works in reducing DNA's . Beware of the short term gain a "free text messages" with the missed opportunity to have effective information regarding attendance and it's knock on effects to 18 weeks and PbR. The system does not allow delivery reports to be assembled so relevant staff know who has received a text and who needs an alternative form of contact. This is very basic text meassging, there are better and more advanced sytems available that do cost money. Short term gain offerring free texts will be wiped out with the missed opportunity to use text messaging to best effect within your environment. Good to see it's finally getting some attention, reduces DNA rates by 20%.

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20

We're all doomed!!!

02 Nov 07 09:11

OH MY WORD!!

It seems to be that if someone comes up with something positive, the doom-meisters are ready to pour cold water on it.

Okay - let's look at this logically. When my Trust asks for a mobile number it asks the patient if it may send it text message reminder. If the patient says 'no' then their mobile number is recorded as +447 if they say yes then it's recorded as 07 (The script will only match number beginning with 07). Therefore, patient consent is assured and recorded.

The issue of the mobile being on the coffee table. As the patient has given consent for the Trust to send txt messages then they should bear responsibility for the security of their mobile and their messages. In much the same way as for letters. Personally, I don't open letters addressed to my partner (unless she asks me to) and she doesn't open mine. Likewise I don't read her texts without her consent (actually, to intercept someone's mail - which is effectively what this is - without their consent an offence (Telecommunications Act I believe - shoot me if I'm wrong). Therefore, if I was expecting test results from Oncology to confirm/deny whether I had cancer, and I hadn't told her, I would simply not ask her to open my mail. The same applies to texts.

It should also be remembered that this text is a 'reminder'. Therefore we would not be sending a text that stated "Dear Mrs Bloggs, this is to remind you of your appointment with the GUM clinic to have a check up on your galloping syphillis on 15:30 02nd November 2007" - I think it would be "This is a reminder of your out-patient appointment on 1530 on 02-11-07". Oh and as for hiding a letter, christmas is coming and kids (of all ages) will be searching high and low for what Santa might bring, work that one out. - and how can you hide a text message? - try deleting it, it's only a reminder! Of course, if you lend your mobile out knowing that you might get a text from a hospital, who's fault is that?

I am a Data Protection consultant and think that we all have a responsibility to be pragmatic while remaining compliant with the Data Protection Act 1998. i.e. Let's apply some common sense here. And this responsibility works both ways, patients also have responsibility for their own security. Hells teeth, we aren't a nanny state are we?)

Finally, Caldicott Guardians, I take exception to the statement "I know their standards vary from the low, to the none". Caldicott Guardians have an increasing workload in terms of information governance (not to mention their 'day job' workload) and every Caldicott I've worked with has been nothing short of totally professional and acknowledge their lack of specialist knowledge and lack of resources (time) to get their teeth into the real issues.

This is why they need the support of adequately trained and qualified people to act as advisors and to deal with the simple day to day issues. My Caldicott Guardian allows me to work with a fair degree of autonomy and update them on a regular basis and escalate issues that I feel are appropriate (not to mention that he can see me at any time or look at my records management to update himself on any ongoing issue).

And so endeth the further ramblings of a lunatic.

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21

Risk Balance

02 Nov 07 15:11

Information security is all about risk balance - it's the basis for all HMG IA policy.

The business benefits have to be weighed up againsts the risks (to confidentiality in this case).

The business benefits are clear - the service has better availability to the customer because they are less likely to miss appointments and wait (even) longer for a new appontment. The NHS cost savings are also significant especially with respect to the negligible cost of the service.

The risk to confidentiality is very limited. More importantly though, the risk is no worse than for 'normal' forms of communication such as letters and fixed telephones and may in fact be better. Fixed telephones are no safer from eavesdropping than mobiles (CESG National policy). A mobile subscriber has better control over who has access to this medium: it's portable so users can prevent others answering it; it can have a PIN number that will resist casual attacks; if its compromised (stolen) it can be disabled. Finally mobile phones are usually (but loosely) associated with an individual, postal addresses and fixed phones are associated with locations. Surely best efforts should be made to communicate with individauls not buildings? - On the subject of consent - surely the patient's act of providing a moble phone number in the first place is adequate implicit consent to use it for communications to that individual. Do you request consent to send someone a letter? Safeguards/policy should be in place, of course, to limit the sensitivity of the information sent.

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22

Sensible approach

06 Nov 07 10:11

Consent surely is not a issue here - you have given your mobile number - therefore it is not unreasonable for the Trust to use it - whether that be for SMS or calling you. If you don't want the Trust to use your mobile number, then don't give it.

It would be more of an issue if more sensitive information was being text out - i.e. "your test result is..."

More of an issue will be a process for ensuring that these mobile numbers are accurate & up to date.

Reducing "did not attends" is in everyones interest, not only do they cost the NHS money - they also mean patients are waiting longer to access a service than perhaps they need to.

The NHS has to move forward and use "new" technology, like every other business does. if it benefits both the patient & the service, then thats give it a go.