It’s fascinating to think that 20 years ago on Dec. 3, 1992, Neil Papworth sent the first text message. The message was “Merry Christmas” and it’s not only timely given the holiday season but also in light of new expectations for communications between healthcare staff and patients. As soon as 2014, with the advent of Stage 2 Meaningful Use, eligible providers are expected to engage with no less than 5% of their patients via secure messaging.
The convenience of text messaging and other forms of asynchronous communication is that they allow recipients to receive messages and respond at their own convenience rather than in real time. Since not every exchange has to be an extensive conversation, the brevity of the message is also convenient for both sender and receiver. In clinics around the country, the traditional communication channel for patients has been through synchronous communication (i.e., the telephone). However, the response to the patient has often been asynchronous as the clinic recipient is not able to engage with the patient in real time. As we add in other forms for this exchange, such as secure messaging or even social media, we anticipate both apprehension and confusion in terms of the expectations for the synchronous response.
In our culture, you need look no further than the person in the car next to you on the highway. What you are likely to see is that person looking at his smartphone while driving his car. Besides being obviously unsafe, it also represents the urgency to send and respond to asynchronous forms of communication. Texting and driving has received so much publicity as a result of fatal crashes and horrific views from in-car cameras that recorded crashes where the driver survived.
What this represents for the clinic staff and patient is the need to set real and clearly expressed expectations regarding what synchronous and asynchronous communication will be in practice every day. As an example, secure messaging is a great way to open the door of communication to patients to sustain a dialogue in between clinic visits. However, this open door also represents a new set of assumptions that are quite different from that old-fashioned phone call to the receptionist.
The accessibility that these multiple forms of communication bring into to the clinic also lead to concern about the appropriateness of how and when to respond and perhaps even who should do so. There is an important dialogue that must take place among the clinic’s staff regarding real policies and procedures for handling these expectations to ensure that the clinic as a whole responds in a timely and accessible manner.
So as we move forward in the clinic with meaningful use in the EHR Incentive Programs and multiple modes of communication with patients, an important new conversation between all these stakeholders must occur within the culture of care. Everyone has experienced the bottleneck of the reception area where the phone is ringing off the hook and one person is doing her best to answer questions, take messages for colleagues, and direct calls all in real time with patients. The reality is that even with that sustained real-time diligence at the reception area of the clinic, many of the responses made to each patient are far from real time.
As patients and providers are encouraged to interact much more frequently and in more ways than during clinic appointments in order to produce greater health outcomes, the robustness of this aforementioned dialogue needs to include concrete strategies for managing both synchronous and asynchronous communication. The standards for accountability continue to evolve, from coordinated care to personal health outcomes; so too must the dialogue among the fully engaged clinic staff develop in order that patients’ expectations are met. Patients already have their own expectations for what asynchronous communication means to them, and the reality is they are likely to be quite different from the formal definition.
Robert Green is the author of Community Healthcare: Finding a Common Ground with New Expectations in Healthcare. Through his physician client relationships, Bob has gained substantial insight regarding the daily challenges that medical professionals and their staffs face, such as regulatory issues, financial management, and clinical collaboration through the use of health IT. His process of making both interpersonal and purposeful connections within the organization results in improved employee performance and confidence and enhanced client experience.
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