Press “0” to Build Better Healthcare

My Uncle Joe died in 1993 at the age of 70. The last few years of his life, he lived alone in a mobile home in Sturgeon Bay, Wisconsin. After he passed away, his kids — my first cousins — were going through his bills only to find that he was calling the same two phone numbers every day. One turned out to be the number for the time. The other was the number for the weather.

His kids, most of whom lived close, visited my Uncle Joe all the time. But in between visits, he called the numbers to hear a human voice tell him the time and tell him the weather. It’s not like he didn’t have a TV or radio or a clock. He did. But there was something about dialing a phone number, having someone answer and then hearing a human voice that made him feel good when no one else was around.

I thought of my Uncle Joe and his mystery phone calls when I read a new study in JAMA Network Open. The study is about how patients respond to automated text messages from their providers with limited response options. In this case, it was about how nearly 30,000 patients responded to about 40,000 text messages from Kaiser Permanente Colorado from Jan. 1, 2022, through Dec. 31, 2023. More than 40% of the patients in the study were age 65 or older, like my Uncle Joe.

Kaiser sent secure text messages to patients to remind them of their appointments and recommended preventive care. Patients had four options to reply:

• Stop
• Start
• Cancel
• No Action

Of all the patient responses, 743 were “unique,” meaning the patients typed a personal response that the automated system didn’t recognize, because it wasn’t one of the four preprogrammed response options.

In other words, the patients who sent those 743 messages wanted to tell Kaiser something that the text-messaging system wasn’t set up to hear. They wanted to talk to the automated text-messaging system as if it were a real person.

The researchers found patterns in the unique messages, and they teased them out into eight categories. Among the eight were requests for help and information and expressions of frustration with the health system or their care experience.

“Patients often use automated messages as opportunities for bidirectional communication, sending replies that extend beyond expected opt-out commands,” the researchers said.

Further: “Rather than providing predefined or easily classifiable responses, patients frequently used these messages to communicate diverse needs, preferences, and concerns.”

The researchers made a number of recommendations to address the mismatch between what providers ask and what patients want to say via secure text messaging systems. Those recommendations included building more responsive and personalized systems.

Patients are telling us what they want. They’re telling us they want to talk to someone, not press “1” for more options.

Thanks for reading.