New Publication in AMGA Group Practice Journal: The Information Advantage with CareSignal


Challenges of Remote Patient Monitoring Technology: When and How to Use SMS Texts and Phone Calls for Patients

July 29, 2020 at 6:30 AM

Automated SMS- and phone-based communication can satisfy pertinent regulations and solve common patient engagement issues. Here’s how.


For health systems to build the best possible relationship with their patients and improve clinical outcomes, they need to introduce methods of communication that are highly engaging, universally accessible, and compliant with health and telecom regulations. The COVID-19 pandemic — which has prevented patients from attending in-person appointments — has provided a new impetus for creating an engaging, cost-effective, and easy-to-implement touchpoint between provider and patient.


Texting as a method of remote patient monitoring (RPM) provides an avenue through which health systems can leverage their full capabilities under the law to reach out to patients and monitor their conditions. This type of lightweight solution requires no investment in hardware or tech support and is best described as deviceless RPM.


The Multifaceted Pain Points of Engaging Patients

Achieving short-term, sporadic communication with patients isn’t particularly challenging for many health systems, but the goal of sustained patient engagement in healthcare remains elusive. The root causes of this engagement problem can be traced to three major contributing factors: cost, adoption, and retention. While some patient engagement solutions reasonably solve for one of these issues, they often fall short in the others, which greatly reduces their ability to improve patient care and outcomes. Let’s break down each factor a little more.

  • Costs are prohibitive. One of the significant challenges that providers need to tackle as they move into value-based care is matching cost with the needs of the patient — essentially matching the right cost of an engagement strategy with the right patient. Rotating nurses to different patients’ homes or implementing dedicated connected devices are engaging and non-exclusionary options. Unfortunately, the costs associated with such options make them unrealistic for all but the highest-cost populations — and they’re particularly untenable when dealing with large patient populations.

  • Patient adoption of communication channels is low. Technologies such as mobile apps or web portals are lower cost, but engagement rates are stubbornly anemic, with such media failing to achieve widespread patient adoption. Providers would be lucky to get even 5% of their population to use such a platform, and only a fraction of those folks would use it reliably and consistently over many months. Adoption rates for these engagement methods can be misleading because patients generally use those channels to engage around urgent, one-time issues such as lab results. For most patients, unfortunately, the hassle of remembering or resetting login credentials dissuades them from adopting the tool for the long term.

  • Retaining patients is perhaps the most difficult. Even if cost and initial engagement can be solved, providers must facilitate long-term engagement in a way that integrates seamlessly with patients’ lifestyles. While passive monitoring solutions (e.g., in-home devices or wearables) might negate lifestyle challenges, they can be expensive and aren’t native to someone’s day-to-day experience, making it hard to retain patients long enough to see clinically relevant improvements.

Regulatory compliance in healthcare and telecommunications — specifically HIPAA and the Telephone Consumer Protection Act (TCPA) — add further confusion to the mission of creating engaging, clinically impactful patient communication. Understanding the subtleties of these laws falls well outside the purview of a chief medical officer. These regulations, however, serve as productive design constraints to inform and guide the development of a patient engagement strategy in the hands of a trusted partner.


The key to managing HIPAA and TCPA concerns lies in selecting a partner and solution that’s been implemented by similar trusted organizations — and then having legal and compliance teams vet the solution. Truly dedicated partners will readily embrace your organization’s policies and make sure the solution drives ROI while aligning with any unique compliance constraints.


How CareSignal Overcomes Challenges of Patient Engagement


As a medium for communication, text messaging stands more as a means than an end. By itself, SMS doesn’t possess an innate ability to solve the cost, adoption, and retention issues or the regulatory compliance issues in healthcare. It needs content, logic, algorithms, and standard operating procedures to achieve its full potential.


With the right infrastructure and approach, however, automated SMS- and phone-based communication can satisfy pertinent regulations and solve all three pain points better than just about any other technological intervention. Here’s how.

  1. It’s a low-cost, high-value interaction that benefits a wide range of patients.

CareSignal leverages existing SMS and cellphone technology to strike a balance between the cost of technology and the level of care a patient requires. Automated messages are sent daily to large populations, and providers need only intervene in particular cases (e.g., when a patient reports worsening symptoms).


Contrast the costs involved and value derived here with expensive wearables or passive monitors appropriate for only a select segment of the population. Or consider passive web portals, which are low cost but provide minimal long-term value, as patients utilize them only to check lab results or occasionally schedule appointments.

  1. The technology is accessible for just about everyone.

CareSignal relies on ubiquitous technologies like cellphones and landlines. (Even 86% of older Americans communicate using text messaging.) Doing so makes it simple for patients to initiate and regularly engage with the automated SMS or IVR phone calls that ask them to report relevant disease biometrics. CareSignal also has the unique capability to bring free text messaging to patients who might not have unlimited minutes, further improving accessibility and inclusivity.

  1. Low-barrier touchpoints promote long-term engagement.

Online patient portals or applications can easily discourage people from sustained engagement due to low-value interactions coupled with unintuitive customer interfaces. However, CareSignal’s automated SMS or IVR phone calls provide low-barrier touchpoints that facilitate prolonged engagement and lead to clinically relevant improvements.


Solving Compliance Issues in Healthcare


When it comes to the compliance issues in healthcare and telecommunications, CareSignal errs on the side of caution. This is especially true concerning TCPA, where ambiguity is more common.


Some healthcare companies are willing to really bend what it means to send non-marketing communication, but we have the capability to develop a specific implementation road map for each of our partners. We’ve established enough internal expertise to sit in the driver’s seat and show our partners the path that will work through detailed discussions with their compliance teams. We’re there with them to make sure that we can work hand in hand with their legal departments.


To remain HIPAA-compliant, providers must capture consent from patients. Beyond legal obligations, however, consent is fundamental to forming strong, trusting relationships. Patients can communicate however they want — they just need to consent to whatever form that communication takes. CareSignal’s Patient Enrollment Specialists provide this crucial service of educating, gaining the consent of, and enrolling patients in our automated SMS or phone system to satisfy HIPAA guidelines at scale. All providers must do is provide a list of eligible patients.

To learn more about how CareSignal provides engaging, universally accessible, and compliant patient communication, download our case study with Mercy to see how deviceless RPM allows providers to scale to tens of thousands of patient populations, delivering clinical and financial outcomes within the patient populations that need it most.