CHAPTER ONE

Unlock human-centered communications

Increase access and connect through people’s preferred channels

Access to healthcare can be hindered by any number of obstacles, including physical location and mobility, medical literacy, finances, and technical ability and access. Increasing access in healthcare means addressing the many ways these obstacles can be reduced or removed.

No single answer

Simply establishing and maintaining easy ways for a provider and patient to talk can have a major impact on accessibility. In practice, establishing that functional channel of communication between provider and patient can be an ongoing process that can change not only from patient to patient, but from interaction to interaction for the same patient. 

 

While an email reminder might be perfect for sending an appointment date in the far future, the patient might prefer the immediacy of a text message while waiting for lab results to come in. If those results are particularly sensitive, maybe a phone call would be best. And if the patient is at work when a call comes in and is unable to speak freely, she might want to reply to the missed call via text message. Honoring preferences for how people are contacted and with what frequency is fundamental to delivering personalized care and service.

 

The power of omnichannel

Personalized omnichannel communication is what allows you to meet patients’ shifting preferences with every interaction and make that seamless switch between phone call, text, video, webchat, and email between conversations—or even within a single conversation—while keeping the context intact. Particularly in healthcare settings where there may be a sense of uncertainty, fear, or urgency, people don’t want to have to repeat information with each new interaction. 

 

WELL Health wanted to change the public’s perception of customer service in the healthcare industry. To do this, they found a way to allow patients to communicate with their hospital, doctors, pharmacies, and any other organization crucial to their care while using the channel of their choice. Employing a combination of SMS, IVR, email, and chat through the Twilio platform, WELL Health customers benefited from streamlined, two-way customizable communication, improving both clinical outcomes and patients’ relationships with their providers. As a result of this effort, more than 200,000 providers now use the platform, with an average of 1.1 billion messages sent to 37 million patients annually. Additionally, more than 100 use cases have found support through the WELL Health journey

US HIPAA-compliant security and privacy by design

In US healthcare-related fields, any communications dealing with protected health information (PHI) must meet requirements of the HIPAA Privacy Rule. Twilio products are now HIPAA-eligible across SMS, voice, and video. Along with APIs, Twilio provides architectural guidance for using these tools to build solutions that meet HIPAA guidelines and regulations.

Reaching people reliably

In an era when few people will answer a call from a number they don’t recognize, text is the most immediate and effective way to reach people. It’s no accident that SMS text messaging remains a valuable channel for contact. Regulation has prevented it from being overrun with spam and unwanted messaging: Strict rules govern the types of messages that can be sent by text message and how consumers opt in and out of them. 

 

This means having the flexibility to engage with people 24/7 and across the most preferred, as well as HIPAA-eligible, customer channels. However, legacy systems can have a very hard time sorting out not only people’s contact history and preferences, but details like whether a particular phone number is a landline or mobile phone. Modern APIs improve message deliverability by making sure that text messages are sent to mobile phones and people with landlines get phone calls.

 

Patient self-service

Increasing self-service allows patients to take care of scheduling and rescheduling appointments. A robust two-way SMS scheduling system can empower patients to confirm, cancel, and reschedule appointments at their own convenience with no hold time for the patient and with increased time for office staff to complete other work. Patients can fill out intake forms before they come to the office. On arrival, they can check in from their phones—perhaps even without setting foot in the building until it’s time for their appointment.

Virtual care

The adoption of telehealth surged in many medical disciplines during the in-person restrictions of COVID-19, and it continues to change how patients interact with healthcare organizations. Telehealth gives patients options to meet with providers how and when they want, regardless of distance or time of day. Younger consumers are particularly likely to choose a provider based on their telehealth capabilities, and older patients with less mobility or who live far from healthcare have found it to be a lifeline.

Patient outreach

Automating reminders for appointments and follow-up visits also saves time and frustration for patients and staff, as well as helping to keep important preventive care and screenings on track.

 

Patient education on the platform of their choice can increase understanding and compliance. With a world of vetted, frequently updated information and resources online for a provider to share digitally, that stack of pamphlets can be a thing of the past—unless paper is what the patient prefers.

 
 
CASE STUDY

Increasing vaccination through simple, thoughtful technology

Increasing access can mean making medical treatment available to people whose primary obstacles are hesitance and lack of access to technology. At the beginning of the vaccine rollout, Black Americans were statistically under-vaccinated for COVID-19 and faced a greater risk of hospitalization from the disease than their white counterparts. This is due to both poorer structural access to vaccines and less willingness to get the shots due to a historical mistrust of the healthcare industry. In Philadelphia in early 2021, the Vaccine Collaborative ran an initiative to increase vaccine equity. It was a joint effort among academic health system Penn Medicine, community teaching hospital Mercy Catholic Medical Center, and Black community leaders, which sought to put no- or low-tech-enabled clinics in the heart of Black communities. Instead of filling out lengthy web forms, individuals were able to make appointments by calling or sending a text to trigger an automated voice system that collected the necessary information. Wait times for the shot were less than one minute for each person, and each clinic saw hundreds of people per day. These clinics represented a successful case study for the use of inclusive planning, multiple channels of engagement, and simplified technology like Twilio’s cloud-based Programmable Messaging and Programmable Voice.

 

St Luke’s University Health Network created an automated scheduling and reminder system that lets patients self-schedule vaccine appointments over the phone and receive reminders in the channel of their choice. Despite increasing staffing to five times the original headcount, the 12-hospital system struggled to notify all the pre-registered people who were eligible for a shot each day. Every dropped or unreturned call represented a person in medical need who might not get their vaccine. In only two weeks, St. Luke’s set up the “Shot-Line,” which uses Twilio’s Programmable Messaging and Programmable Voice to create an automated messaging system. The combination of voice and text allows flexibility to improve consistency and efficiency of communications, regardless of preference or technological access. The automation took the system from abandoning 5,000 calls per day to having the capacity to reach 60,000 people per day, dramatically increasing vaccination rates without significant impact on staff workloads.