Joining the mobile revolution

Abstract

How can communication between general practi-tioners and patients be improved? E-mail and theInternet are often mentioned, but even in rich andIT-aware Norway the Internet penetration rate is stillonly around 50% (1).Then again, the communication tool of choice formany is not the Internet but the mobile telephoneand particularly text messaging (SMS). Growth inmobile telephones has been large in Europe, withNorway and Sweden having penetration rates of over70% (1). This increases to around 90% for youngerage groups and falls off around 55, although inNorway 55% of 65 to 74-year-olds own a mobile (2).Could users of electronic medical record systems takeadvantage of the popularity of SMS to improvepatient care?Two related possibilities come to mind. The first isreminders. Systematic reviews have shown that re-minders have a positive effect, particularly for pre-ventive care and immunisation (3,4). The size of theimprovement varies, but is generally in the range 5%to 30%. The second application would be to providebooking services so that patients can make appoint-ments using their mobile. SMS-based booking ser-vices are already being used for cinema tickets. Userscheck availability by sending an SMS to a serviceprovider, e.g. Scan Mobile (5), which then sends backan SMS offering to sell tickets if these are available.Now, what if the medical record system was capa-ble of sending and receiving SMS messages? A pa-tient could receive an SMS-reminder about, say, animmunisation together with a list of appointmenttimes. He then selects an appointment, or suggests anew one, sends an SMS back and the medical recordsystem books the appointment. Moreover, this couldbe done when the patient has time, which is notnecessarily during office hours.SMS has the advantage of being cheap. Bulk ratesare around NOK 0.75 per message for 1000–5000messages. Sending a postcard would cost four or fivetimes this, telephoning the patient even more. Inte-grating SMS reminder systems with the medicalrecord would be one way of maintaining the positiveeffect of reminders over a long period at low cost.Security is an issue, but it need not prevent the useof SMS. A simple reminder or appointment requestdoes not need to contain sensitive information, so thefact that mobile telephones do not currently supportencryption ought not to be a problem. An SMSmessage would also be sent directly to the patient’smobile telephone to be read, generally, by only thatindividual. A postcard on the other hand can be readby a whole household, perhaps raising unwantedquestions.Why should medical record suppliers add SMSsupport to their products? It is because patients wantto communicate with their doctors in more conve-nient ways and doctors will need a product thatallows them to do this. A recent survey by HarrisInteractive (6) found that 90% of American Internetusers want to communicate with their doctors online.An electronic medical record that supported newcommunication methods such as SMS would allowgeneral practitioners to provide services that patientsalready want.Sending SMS reminders would use existing tech-nology, open up a new way to communicate withpatients and be relatively cheap. It is true that somepeople do not have a mobile telephone, includingmany that could benefit most from reminders. But is100% coverage necessary for a benefit to be seen? Idoubt it. It is estimated that over 80 billion SMSmessages will be sent every month by the end of 2003(7). Perhaps some of them should be sent by generalpractitioners’ medical record systems.REFERENCES