I sat down with Dr. Kahn and Kathleen this morning to discuss the application of SMS text messaging for HIV impacted patients. Dr. Kahn conducts research on patients at the Positive Health Program at San Francisco General Hospital (SFGH). Ward 86 is a primary care clinic for patients infected with AIDS/HIV and is one of the oldest in the country. The internationally recognized clinic is the result of a collaborative effort between San Francisco Department of Health and the University of California San Francisco’s Medicine Medical Service.
Ward 86 has a comprehensive care model that includes the following services:
- Outpatient primary, specialty HIV Care, integration of patient care and clinical research, and education for patients, providers and local community
- Access to specialty clinics such as urgent care, sickle cell, diet and nutrition an oncology…
- Crisis and intervention management, social work services, and referral services
We discussed Dr. Kahn’s SMS texting program for his clinical patients at Ward 86. The population served is 90% male. 44 years old is the median patient age. Dr. Kahn is studying the efficacy of SMS messaging for disease management. His communication strategy sends text messages to patients that manage the following diseases/health conditions: HIV, Drug Use, Diabetes, High Cholesterol, Hypertension, Depression.
Dr. Kahn spoke about engaging his patients in receiving SMS text messages to manage their diseases. The main barriers patients face in retrieving their electronic patient health information is access to the Internet, literacy and computer competency. Dr. Kahn provided great insight on how important electronic health records are to delivering SMS messages to patients. His database maps ICD 9 codes to patient messaging. Patients receive messaging based upon the diagnosis that’s queried from their database.
Each disease has a ten messages that have been created for patients to receive. The SMS messaging service is automated. Text messages are set up on timed intervals. Patients that take ART’s at 8am receive a message reminder at the time. Patients also receive notification of new information that’s been added to their electronic health record.
Dr. Kahn has found a mixed level of literacy skills in the population that he studies at Ward 86. Many of his patients have limited or no access to the Internet at home. His patients typically access the Internet at the public library, hospital library or community based organizations. His study connects patients to their electronic health record. The EHR is a free and secure web-based product that he’s developed for his research called HERO.
Although his patients have limited access to the Internet when surveyed. He found that they all had cellular phones. The mobile phone providers varied among the population. He found that the majority used Metro PCS a pay as you go service and less than 50% had a smartphone. All of his study participants can receive basic text message services.
The connection between cellular phone and the Internet based electronic health record is quite intriguing. Dr. Kahn has collaborated with SFPL’s Project Read to increase literacy and computer competency skills among his patients. Many of his patients have set up an email account for the first time. They are teaching these patients basic skills on how to use the computer and browse webpages for information . Each participant must learn how to find the cursor, cut and paste, scroll down a page, and find a URL. These are pretty basic skills that most of us take for granted.
Dr. Kahn opens up the discussion on how basic skills need to be taught in order interact with electronic information. Message notifications trigger patients to retrieve new information from the their health record.
Barriers to accessing patient information include:
Language: All messages are currently in English. Translating them into Spanish and Chinese would be enhance the services to bilingual patients.
Mobile phones: Shared tool. They get lost. Lose connection.
Messages sent to patients are for reminders, notifications, and supportive services. Patients can also query the database for information on their lab results from their phone. This information now becomes accessible without having using the Internet. I found that to be ingenious. It helps the patient take ownership and manage their disease directly from their phone. Supportive or lifestyle messaging seems to have a positive effect. Additional areas of research might look at how GPS can deliver nutrition based messages to patient at the point of need. Point of need would track patients coordinates and send a message making on making a healthy choice for lunch. Ideally, all the McDonald’s and Burger King’s in a geographic area would mapped to help facilitate this messaging to patients.
mHealth has a broad application. It’s a low barrier entry tool that connects end users to information at any time. Mobile phones and SMS texting have a place in public health communication strategies.
Can this model be replicated for women that are infected with HIV? Onward to find out from the Women’s Clinic. The Women’s clinic provides primary care services to HIV/AIDS impacted women and youth. I am very interested to see if a similar service has been deployed to this population.
Questions to ask:
What about using Twitter to get health information to patients and clinicians? Do you clinicians tweet to each other? Do they tweet to their patients? Do they have time to tweet health information? SMS messages can be automated and sent out. Can you automate tweets?
SMS messaging and electronic heath records aren’t separate functions. Dr. Kahn demonstrated that it’s an integrated information flow. Key finding report that the database and CRM tool needs to work together. These functions are interdependent not independent systems.
HIPPA issues. Dr. Kahn’s patients consent or opt-in to his service. He brought up an excellent point that a text message is no less private then a fax or voice message that exchanges heath information between patient and provider. Learning more about the consent process and patient privacy issues should be investigated to gain more a greater understanding in this area.
Tammy A. Magid 