By Brandon Daniell, President and Co-Founder, Dialog Health
In early May, I went on my latest patient journey: my first colonoscopy appointment. Having worked in healthcare for many years, I had a good idea of what to expect from the prep and procedure. If you have never had a colonoscopy, you will find the prep part of the patient journey more challenging than the procedure itself — and by challenging I mean uncomfortable. Very uncomfortable. I'll spare you the lovely details.
What are also challenging are the number of steps one must complete and the timing for many of those steps — timing for everything from picking up the prep kit, to moving through the prep, to getting dropped for the procedure. Any missed steps or timing mistakes leading up to the colonoscopy could require cancellation and rescheduling, or even missed polyps.
With that said, one would hope for a procedure which was first performed in the late 1960s and is now performed million times a year, providers would have developed a highly effective mechanism for helping patients comply with the multitude of directions required for a safe, successful colonoscopy. After 11 years of working with clients to improve patient activation during the patient journey, and given we have many clients who perform colonoscopies, I am well versed at how text messaging — particularly two-way texting — is being used by providers to notify, educate, support, and guide patients along their journey while helping reduce the number of cancellations, no-shows, and no-goes.
Unfortunately, this is not what I experienced, and what I experience made this uncomfortable journey much more difficult than it needed to be.
My Overly Complicated Patient Journey
On a positive note, the surgery center in Denver where I had my colonoscopy uses text messaging for communication with its patients. As the preferred communication mechanism for a growing number of patients, the ability to text has become must-have for any healthcare provider.
But on a much less positive note, the ASC sent me a single text message across my entire journey. It was a basic appointment reminder that only provided the day and time of the appointment and asked for a response to confirm I would be attending — which I gave. And yet even after texting back my confirmation, for some reason the center's email system still insisted on sending me not one, not two, but three (!) email reminders … which I only found a week after my procedure. I also received two phone calls reminding me of the appointment — which I didn't answer since I did not recognize the number. I only learned that it was the ASC calling when I finally got around to listening to the messages left on my voicemail … after my procedure.
I also received from the center a very detailed and complex list of instructions on a piece of paper summarizing all of the dos and don'ts for my procedure starting seven days before the procedure. These dos and don'ts covered foods to avoid, medicines to take, medicines to stop taking, what to drink, what not to drink, when to start the prep, how much to drink after the prep, when to drink the second prep, when to stop drinking all together, and much more. There were so many moving parts and precise times to do — or not do — things that I must have reviewed the paper 20 times. The last thing I wanted to do was to mess up the process and be forced to do it all again because my scheduled appointment would need to be rescheduled or to undergo a suboptimal colonoscopy that could miss something potentially life-threatening. Despite a lack of prompting, I was fortunate that I remembered to go to the pharmacy to get my prep kit. I have heard stories from patients who forgot to do so and realized they could not start the prep only when they went to start the prep.
I believe this paper also mentioned I needed a driver to accompany me to the ASC. I cannot recall if I was told an arrival time. I was arriving early regardless because I wanted to get the whole process done without delay and didn't want to risk being late. I recall needing to look up the address of the facility myself. Without clear information on parking, this was going to require a "find-out-when-we-get-there" approach.
I arrived at the facility with my wallet, which included my license (as my form of identification), insurance card, and a means of payment — all of which the ASC required but had not reminded me to bring. Since my father was accompanying me and he is a retired surgeon, he encouraged me to leave my watch, phone, and bracelet at home. He also advised me to wear shorts, T-shirt, and slip-on shoes (nothing that needed to be laced up) — all of which would help me get dressed and ready for discharge more easily as I came out of the anesthesia.
Fortunately, my procedure went well, largely because I had not lost the paper with the prep instructions and double-and triple-checked them as I moved through the steps required for compliance. As I was being discharged, I was told I would get a call from a nurse the following day. What the ASC failed to mention was that the call would come early in the morning. Sure enough, I had a phone call from a number I did not recognize show up on my mobile phone at 7:15 am the next day. I did not answer it since: 1) Who calls at 7:15 am in the morning?!? and 2) I didn't recognize the number. I eventually listened to the voicemail … five hours later when I checked voicemails while eating lunch.
Thus completed my nowhere-as-easy-as-it-could-have-been colonoscopy journey.
In Appreciation of Text Messaging
Looking back on my journey, I was reminded about the effectiveness and convenience of the two-way texts our clients send to and receive from patients. I wish I had received texts reminding me to pick up the prep at the pharmacy, reminding me to not eat anything with seeds or nuts starting three days before my appointment, and reminding when to stop drinking fluids. It would have been great to receive a text the day I needed to start the prep with a reminder to start it at 6:00 pm. The text could have included a link to an electronic version of the piece of paper I was using, which I assume many people lose. A text letting me know there were emails needing my attention would have been a plus. A text the night before that provided my arrival time, a link to a map to the facility, suggestions on where to park, and a reminder of what to bring and leave at home would have all been really helpful and better ensured I did what I needed to do — for me and the ASC.
Going back to that phone call at 7:15 am the day after my surgery: If it had been a text asking me if I needed a call from the nurse, I would have read it and replied with a "No." I looked at my phone at 7:15 am and ignored the call, but the text message would have been read as soon as I saw I had a new text.
As I write this a week following my procedure, I have not been asked to provide any feedback on my experience. If I had been asked, I would have said the staff were fantastic and I would happily recommend their facility to others — with a recommendation that they communicate more through texting. The ASC could have texted me and asked me to rate my experience and then followed up to my reply of "excellent" with a text thanking me and inviting me to leave a 5-star review on one or more of the review websites the center is using to help market itself to its community.
Looking back on my whole experience, I cannot help but realize just how great the patient journey is at our clients' facilities. Communication in healthcare is so important, and two-way texting is such any easy way to activate, engage with, and guide the patient.
When it comes to something like a colonoscopy, effective communication throughout the journey takes on even greater importance. With my background in healthcare, I knew how important it was to undergo the procedure and do whatever I needed to so I could keep my appointment and best ensure an optimal screening. But I worry about those patients who may struggle to follow and stay compliant with the complex prep directions and ultimately need their appointment canceled. Will they even want to reschedule it, especially if they are concerned about their ability to follow the directions to a T? Will they be able to take more time off for the prep and procedure, having already done so once without success? Can they arrange transportation again? One bad experience may be all it takes to deter someone from getting the "gold standard" for decreasing colon cancer risk.
While the use of text messaging does not ensure compliance, it undoubtedly helps. I hope the ASC where I had my colonoscopy, and all others, look more closely at the ways two-way texting can improve the patient journey. We'd love Dialog Health to be the platform they use, but even if it's not, what matters is that texting becomes the communication mechanism relied upon for those patients who prefer it. And as we know, that's most patients these days. By using text messaging, providers will help their patients get the care they need, when they need it. Texting does a lot more for the organizations but improving patient care should be justification enough for adding it as a communication mechanism and exploring opportunities to leverage it.