Can You Use Text Messaging With Patients?

Can You Use Text Messaging With Patients?

Have you ever said…

“If only I had someone to ask!”

Each month, we discuss your questions about practice management, human resources issues, clinic management best practices, procedures, resources, practical privacy tips, and more in Practice Management Success membership.


In this Q&A, we’re talking about:

Can you use text messaging with patients?


Can you use text messaging with patients?

The short answer is, ‘Yes’.

The longer answer is ‘Yes, but . . .  make sure that you are really clear about why you want to use text messaging, carefully plan the implementation and monitor its use.’

What is the Purpose for Texting?

Clinics are feeling pressured to provide texting as a communication option to their patients.

It is important to be clear about why you want to use texting.

Texting from the Patient to the Clinic

What is the primary purpose for patients to text the clinic? It may be because they are in a remote community and texting is the only way to keep in touch with their healthcare provider. You might choose to accept text messages for appointment requests or continuing care and treatment.

Texting is generally not a secure communication method. It is difficult to confirm the identity of both the sender and receiver which can result in both communication and medical error.



It is difficult to communicate clearly using text short form and emoji!


What Are the Risks?

As the custodian, you need to weigh the risks of using texting vs not using texting. For example, if your work includes assisting people who are in crisis or are otherwise at risk, you may decide that the risk to the patient who has access to their healthcare provider using unsecured text messaging is less of a risk than the patient who experiences a critical incident and does not have other access to their healthcare provider.

You must decide what are the acceptable risks and appropriate use of text messaging.

I find that creating scenarios is a good way to do help you set up your boundaries. In what situations is using text messaging OK? In what scenarios is it not appropriate to use text messaging? Are there alternative technologies that can better, and more securely, meet these needs?

Record your reasons about what you will – and what you won’t – accept in your text messaging solution as part of your project documentation and implementation training.

text messaging risks

Workflow When You Receive Text Messages from the Patient

Consider how you will document the communication from your patient into the patient’s health record.

  • Is the device to receive the text message registered with the clinic?
  • Who will receive the text message from the patient?
  • How will you transpose that meaningful communication with the patient to the patients’ health record?

Be guided by the discussions in your team and with your patients to develop your policies and risk mitigation plans.


Texting From the Clinic to the Patient

Is your goal of a text solution to automate a workflow like routine appointment reminders? Or, perhaps, some episodic messaging like offering follow up appointments to discuss test results?


Remember that the custodian (physician, pharmacist, dentist, dental hygienist, chiropractor, and more) assumes the risk of using unsecure technology. You can’t transfer the risk to the patient. However, you can mitigate the risk of error and unauthorized use of the health information by creating rules for use and ensuring that the patient understands:

  • how the technology is used,
  • your offer to use the technology in your healthcare practice,
  • the risks to the patient’s privacy and security of their personal information,
  • the patients’ role to prevent misuse of their personal health information, and
  • an agreement to follow the rules about the technology solution.

If you are a member of Practice Management Success, click here to access the sample authorization agreement.

Mitigation strategies

Alternate Technology Solutions

There are some third party vendors that can help you with routine text messaging with your patients. Wherever possible, use two factor authentication. For example, you might have a system where the patient must enter a PIN number before they can read the entire message from the clinic.

There are trusted technology solutions that you can use for text messaging. Many EMR providers now allow the clinic to text message your patients right from the EMR or patients can access the EMR using a patient portal. This is, by far, the most efficient workflow. It is usually the most secure technology and integrates the communication into the patients’ health record without copying and pasting, uploading, or re-typing into the patient record.

Microquest’s Healthquest EMR, for example, offers integrated appointment reminders via email, text, or voice messaging. Clinics can also allow patients to book their own appointments online with an online calendar integrated to the clinic’s Healthquest EMR.

Alternate third party texting solutions from trusted vendors that we have interviewed on our podcast, Practice Management Nuggets for Your Healthcare Practice, include Bleen and ezReferral.

Bleen is a third party patient appointment management application that allows patients to register with your clinic to receive appointment reminders by text message or phone call. The system also provides a self-help solution to patients to schedule their own appointment with their healthcare providers.

Clients with Bleen have seen dramatic changes in their patient management resources – reducing 40% to 60% of phone calls and 75% of no shows.

Click here to listen to the Practice Management Nuggets interview with Chris Narine and Robert Cove of Bleen.

ezReferral provides a third party referral management application that improves communication  between the patient and the referring and consulting providers. The system saves an average of 60 minutes of staff time for each referral and improves the patients’ access to health care in a timely, efficient manner. It also includes a built-in secure fax solution.

This solution is ideal for healthcare practices with referrals within the medical community and even better when you are working with multidisciplinary referral teams. ezReferral works well for both paper based and electronic medical record based practices.

Click here to listen to the Practice Management Nuggets interview with Dr. Denis Vincent of ezReferral.

Privacy Impact Assessment

Before you implement a text solution to your practice you need to update your privacy impact assessment (PIA) or prepare a new, project based PIA. This doesn’t have to be a big undertaking but it is really important that you take the time to design and document your application and implementation.

Privacy Impact Assessment

If you need some help with your PIA, I encourage you to take a look at our on-line e-course, Protect Your Practice, Your Assets, and Your Patients with Privacy Impact Assessments.

Efficient work flow, clear procedures, and rules of use authorization with your patients improves the likelihood that text messages will be used the way that you intended. However, these practices does not make the technology breach-proof. Carefully consider the merits of text messaging and how you can mitigate the risks before implementing text messaging in your healthcare practice.

If you are a member of Practice Management Success, login and access the webinar replay, and the patient authorization form template.


When we know better, we can do better…

Jean L. Eaton is constructively obsessive about privacy, confidentiality, and security expecially when it comes to the handling of personal health information. If you would like to discuss how I can help your practice, just send me an email. I am here to help you.

Jean L. Eaton
Your Practical Privacy Coach

When Clients Ask for Their Records – Release of Information Tips

When Clients Ask for Their Records – Release of Information Tips

When Clients Ask for Their Records – Release of Information Tips

I recently had the pleasure of being a guest on Kayla Das’ The Designer Practice Podcast, where we talked about an important topic for therapists and coaches: managing the release of information when it comes to record disclosure requests.

During the podcast, we covered a range of topics that are essential for therapists and coaches to understand. Here is a summary.

Listen to the full podcast “Episode 5: When Your Client Asks for a Copy of Their Therapy Record with Jean Eaton” for more insights and details.

Client’s Rights and Therapist’s Obligation

Individuals have the right to privacy and can choose what information they share and with whom they share it. As a therapist or business owner, it is your obligation to keep the information that patients or clients share with you confidential and secure.

Case Note Retention Practices

Therapists have an obligation to keep patient information confidential and secure, and to maintain records for the required retention period. The retention period varies depending on the province and discipline, but it is generally 10 years (plus the age of majority. It’s important to ensure that you keep control of the patient information for the entire retention period whether it’s on paper, electronic, or in the cloud.

Reasons Why a Client Might Request a Copy of Their Therapy Record

It is important to inform clients about the purpose of collecting their identifying information, as well as encouraging them to regularly review their records for accuracy.  The client has the right to access a copy of their own information. Trust is a key factor in building a positive therapist-patient relationship, and open communication about record-keeping practices can help establish that trust.

Conversation with Client About Release of Information

At the time that you collect information from the client is the ideal time to discuss with the individual about what information is being collected and how it will be used. This is also an opportunity to discuss how the information may be shared in the future.

Best Practices for Third-Party Disclosure Requests with Client’s Expressed Consent

To ensure patients’ information is not disclosed without their consent, it’s important to have a conversation with them about what information is being collected and how it will be used. If a patient expressly states how they want their information shared (or not shared), you must record their wishes in their file and follow those instructions.

Privacy Legislation

All businesses must comply with privacy legislation. Therapists and life coaches in Canada will likely follow PIPA or PIPEDA legislation. Regulated health professionals (like registered nurses, physicians, pharmacists, chiropractors, and other custodians) working in private practice in Alberta are guided by the Health Information Act.

Best Practices for Third-Party Disclosure Requests Without Client’s Expressed Consent

Before disclosing any information without a client’s expressed consent, one should first determine if there is an immediate safety concern. If there is no immediate danger, it is essential to have the right paperwork in place, and appropriate legal authorization should be obtained before releasing any information without the client’s consent.

How to Manage a Conversation with a Third-Party Before Client Consent is Obtained

When managing a conversation with a third party before obtaining client consent, it is important to have a prepared script to respond to the request. The person making the request should know their legal authority and provide the request accordingly.

Considerations When Using Online Communication to Connect with Client

The use of technology in healthcare requires a proper risk assessment and due diligence to ensure that patient information is secure. Healthcare providers cannot transfer all the risks to the patient and need to take responsibility for the technology they use.

See the Practice Management Success Tip, “Can You Use Text Messaging With Patients?” for more help.

Release of Information Checklist

Businesses must document their policies and procedures for handling requests for information, and to be transparent with clients about the process.

Use the Practice Management Success Tip, ‘Release of Information Checklist’ as a resource for managing and responding to access and disclosure requests.

This checklist will help you release patient records while keeping the privacy, confidentiality, and security of patient information top of mind!

release of information checklist cover image