32 Modern Healthcare | August 19, 2019
Cut the calls: Ortho surgeons use texting
to follow up with patients
By Jessica Kim CohenTHREE YEARS AGO Goshen (Ind.)
Health, which operates a 123-bed hos-
pital, began looking at secure text mes-
saging as a way to improve clinician
communication—and now, it’s taken
on a patient-centered twist.
In 2016, Dr. David Koronkiewicz, then
Goshen Health’s medical director of
quality, was given a task: look into text
messaging for clinicians and staff. Th e
hospital soon selected a service and im-
plemented it systemwide for clinicians,
nurse case managers and nursing su-
pervisors. But Koronkiewicz realized the
product could prove useful for checking
in with patients, too.
“I started using secure messaging with
my patients, even before I brought it up
to my partners” at Goshen Orthopedics
& Sports Medicine, the hospital-em-
ployed orthopedic group at Goshen
Health where Koronkiewicz practices as
an orthopedic surgeon, he said.
Koronkiewicz began experimenting
with enrolling his patients and their
caregivers into an app—Backline, a se-
cure messaging app from software pro-
vider DrFirst—on the day of surgery.
Th rough the app, Koronkiewicz could
chat with patients via direct messages,
similar to texting.
During the patient’s procedure,
Koronkiewicz would use the app to keep
the patient’s caregiver updated on when
the surgery would be over. Th en, in the
days following, Koronkiewicz would
message the patient directly to check in
on their recovery. Patients are alerted of
a physician’s Backline message through
a text message, which directs them to a
secure chat webpage—and for 72 hours
after Koronkiewicz sends a message on
the app, patients are able to respond
with their questions or concerns.
It was a hit. “I’ve had patients text
us that say, ‘I need new pain medi-cine,’ or ‘I’m nauseated,’ or
‘Can I (take) a shower?’ ”
Koronkiewicz noted as exam-
ples.
So last year, Koron-
kiewicz proposed imple-
menting physician-patient
messaging throughout Gos-
hen Orthopedics & Sports
Medicine. His colleagues,
understandably, had some
concerns—including a worry
that patients would reach out
to them with “every little single
question,” Koronkiewicz said.
But they agreed, and in January,
Koronkiewicz conducted a monthlong
pilot study of 38 patients for a deeper
look at this type of messaging. Seven-
ty-eight percent of the patients said the
ability to message their physician im-
proved the overall care process, while
83% said it helped to make them feel at
ease, according to Koronkiewicz’s fi nd-
ings. Ninety percent said they would
recommend the practice to others.
And over-communication wasn’t
a problem, Koronkiewicz said. Only
two patients enrolled in the pilot study
messaged their physician four or more
times, and there was only one case
where a physician expressed frustration
about a patient texting multiple times in
the middle of the night.
Dr. S. Luke Webster, a consultant with
Maestro Strategies who has experience
implementing secure messaging systems
for providers and patients, said it’s im-
portant to address providers’ concerns
about added workload at the outset.
Careful integration of such a system
should include having other clinical
staff , such as nurses and physician assis-
tants, triage messages and answer ques-
tions that don’t require physician input.
Dr. Lew Schon, who joined the Insti-
tute for Foot and Ankle Reconstruction
at Mercy Medical Center in Baltimoreas director of orthopedic innovation this
spring, said he has used direct messag-
ing to check in on patients after surgery
for the past fi ve or six years, though on
a less formal level. “It wasn’t something
that the hospital had adopted, but it was
something that I was doing,” he said.
Schon uses WhatsApp to set up group
messages with some patients and mem-
bers of the care team, and is considering
working with Zimmer Biomet’s myMo-
bility app, which includes a direct mes-
saging capability. Schon doesn’t set up
messaging for routine cases, but said he
will sometimes off er the capability to pa-
tients with more complex needs or who
are based out of state or internationally.
He agreed patients have not mis-
used the capability in his experience,
but stressed the importance of setting
expectations, both in terms of timeli-
ness—explaining that he won’t be able
to respond to most messages immedi-
ately—and setting boundaries on what
types of issues warrant a message.
Th e key for hospitals considering this
type of program is starting slow, Schon
added. “Implement it for certain patients,
with certain diagnoses, with certain pro-
cedures and learn it—become more
comfortable with it, test drive it, and fi g-
ure out what’s best for your unique set of
doctors and your hospital.” Dr. David
Koronkiewicz78% of the patients
said the ability
to message their
physician improved
the overall care
process, while 83%
said it helped to
make them feel at
ease, according
to Koronkiewicz’s
fi ndings.