Reach: Text-Message Appointment Reminder System

Problem

reach exampleIn aggregate, community health centers account for the care of about 20 million people in the US. Over half of these patients represent racial or ethnic minorities and over a fifth (22%) prefer to speak Spanish rather than English.

Most CHC revenue comes from fee-for-service reimbursement paid by Medicaid (40%), private payers (7%), and Medicare (6%). This has led CHCs to pursue many of the strategies for maintaining solvency as other care centers across the US, including increasing patient visit volume and improving operational efficiency.

One problem all clinic sites face is the incidence of no-shows, patients for which an appointment is scheduled but that do not show up. It is estimated that no-shows account for 5-30% of appointments scheduled across the US and it is typically higher at CHCs. No-shows risk failing to deliver appropriate care to patients for whom they are scheduled in a timely or continuous manner, reduce access to scarce healthcare resources for those waiting for appointments, and represent up to 15% of lost revenue for the clinic.

Patients report that forgetting their appointment is the primary reason patients no-show. Reminder systems involving calls from site staff, automated phone calls, and text messages have been attempted to reduce no-show rates. Randomized trials have identified text message-based (SMS) reminders as an effective and inexpensive means to reduce no show rates at clinic sites generally. However, the large proportion of non-English speakers at CHCs creates an additional barrier to avoiding no-shows. Interpreters often need to be available to assist with communication.

Solution

Reach is a multi-lingual, workflow-sensitive appointment reminder system that uses text messages and language translation to ensure patients make it to their appointments. Though there are services available to allow providers to send text messages to patients, multilingual support is limited. Patients cannot respond to text messages when they do have questions. Moreover, patients sometimes change mobile numbers resulting in failed attempts to communicate with patients.
reach schematic

Reach seeks to address these issues through 3 main innovations. First, all Reach content is written in both English and Spanish with the capability to add other languages. All messages sent to each patient are customized to their preferred language. Second, through use of computer translation, patients are able to confirm or cancel their appointment or send short clarification questions back to administrative staff. This reduces the burden demanded of CHC interpreters. Finally, Reach implements a staged process for confirming appointments rather than a single attempt resulting in an improved appointment confirmation rate.

Since piloting at MGH’s Revere Health Center, the clinic stands to reduce its No-show rate by 20%. 95% of patients want to continue receiving text messages.

Challenges

  • Epic (Cadence) scheduling integration
  • Incorporating APIs for sending text messages and language translation
  • Working with a local design firm to implement user-centered design
  • Partnering with a community health center to implement the system in a functional clinic while protecting health information and patient trust

Honors

  • Winner of $20k from the Harvard Medical School Center for Primary Care Agents of Change Grant

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