Can text messages be used to monitor health?

text-messageMobile phones are possibly one of the most ubiquitous pieces of technology in the 21st century.  In 2003 the Office of National Statistics reported that 75% of all adults in the UK owned or used a mobile phone, and Wikipedia estimates that the UK now has more mobile phones than people.

Text messaging has been the surprise success of mobile phones – who would have thought that people would prefer to write out a message to their friends rather than simply give them a quick call?  The latest statistics record that 4.7 million messages are being sent every hour in Britain, with 72% of women and 70% of men texting regularly.  These days, however, text messages are being put to much worthier use than simply catching up on last night’s gossip.

Earlier this month the BMJ reported that the ability to send a text message was a sure sign of recovery from a faint or a panic attack.  The authors of the study had spent several years working for the charity Festival Medical Services, helping out in the first aid tents at large British music festivals.  They noticed that teenagers who were brought in for medical attention would send a text message to their friends as soon as they were feeling better.  Given that sending a text message requires “a Glasgow coma scale score of 15 (fully conscious), an adequately functioning ‘executive system’ in the frontal lobes, and a high degree of manual dexterity and psychomotor coordination”, they concluded that this ability was reasonable grounds for discharge and successfully employed ‘the text test’ during busy times at this year’s Reading Festival.

Text messages have also been employed by heathcare trusts to monitor the medical status of patients.  Oxfordshire and Buckinghamshire Mental Health and Oxford University’s Department of Psychiatry have been using a daily text message to monitor the mood of mental health patients.  Patients receive a text message every morning and  respond with a letter in the range of A to E, which corresponds with mood on a scale from depression and euphoria.  This technique allows doctors to to plot mood swings in real time, monitor medication efficacy and assess whether a face-to-face appointment is needed, and removes the need for unreliable retrospective assessments.  The system is current being used with 150 patients and is due to be rolled out across Oxfordshire and Buckinghamshire in the new year.

In a similar vein, London’s Hammersmith & Fulham Primary Care Trust has been using text messages to establish the current smoking status of patients and, accordingly, their risk of developing cardiovascular disease.  As many as 49% of patients responded to texts enquiring whether they were active smokers, a much higher response rate than other methods of communication previously used.  Doctors were then able to quickly and efficiently update medical records.  The system that the Trust used, iPlato, began as a means of reducing missed GP appointments within the NHS and has now been adopted across 40 NHS organisations, including 36 Primary Care Trusts.  As well as monitoring smoking status, iPlato also uses text messages to establish methadone compliance, keep tabs on patients on weight management plans and helps patients stay up to date with prescriptions.

And it’s not just in the UK that healthcare providers are exploiting text messages to monitor patients.  The Infectious Disease Clinic at the University of Virginia is piloting a text messaging system to improve contact with HIV patients living in rural parts of the state. In the programme, patients are given a mobile phone that only receives texts about medication regimens and pending medical appointments, and can only call emergency and medical contacts.  Organizers hope that this initiative will help patients adhere to their treatment for longer than 6 months, the current drop off point.

Stanford University in California and the Centers for Disease Control and Prevention even held a conference on text messages and healthcare in February this year – Texting 4 Health.  The event “showcased applications, ideas, and insights on using mobile text messaging to improve personal and public health”.  Speakers from as far afield as Denmark and Scotland presented the text messaging strategies that are currently in use in their regions – HandyMentor for asthma self management and SweetTalk for diabetes reminders if you’re wondering – and techniques to provide health information and instigate healthy lifestyles via text messaging were presented (the full conference program and slides can be found here).

Given the widespread use of mobile phones, text messages could certainly be a cheap and far reaching way to monitor patients and disseminate public health information.  What do you think?  Are text messages the future of health management?  Are text messaging programmes going to be widely adopted for public health purposes in 2009?  Or are text messages good only for personal affairs and not for important medical information?

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5 Comments

  1. Just to followup on Euan’s comment about SMS messages.
    True. SMS is not the ideal delivery method for medication reminders – because it’s not as reliable or private, as other types of reminders. However, any reminder is better than none, and if teens prefer texting, then use it – Do whatever it takes to improve adherence .

    I don’t believe that many medical personnel will be sending these messages, for the reasons Euan pointed out.

    In our experience, it’s the patient himself or the caregiver, who sets up the phone, SMS or email reminders at http://www.ontimerx.com.

    One solution is rarely suitable for all situations, but I say… Whatever works… Go for it!

  2. Technology ROCKS!!! But only if people know how to use it and use it properly.

    Very nice blog piece on using text messages for health. My company has automated email reminders that can be used as text messages for exactly this purpose. We can hope the adoption of this technology will really kick into high gear in 2009, because everyone benefits from improved adherence.

    Big pharma definitely has the mo$t to gain. I do not understand why reminder programs and other patient-empowering tools are not being provided free to the patient by big pharma. $o much potential – so little downside. Unfortunately, text messages are pretty expensive in the US, so they are not used here as much as in Europe and Japan.

    As the pharmacist and developer of OnTimeRx, a patent pending patient-focused suite of solutions for medication and health care management. I get emails from users all over the world telling me they cannot live without OnTimeRx, so I know that these tools can truly be a lifesaver for patients on complex medication and treatment regimens.

    OnTimeRx is simple, inexpensive, and very effective software that works on a variety of platforms: Palm and Windows Mobile smart phones and PDAs, and Windows PCs. We also utilize the OnTimeRx reminder concept to deliver an automated alert service to phones, pagers and email. The email/text message reminders can be used anywhere, but our phone reminders are currently only supported in the US.

    Interestingly, patients create barriers for themselves by resisting or rejecting the idea that they need such reminders.

    *Forgetting to take medications not a “sign of old age” *
    It happens to all ages. Empowered patients are able to accomplish their treatment goals with ease and with much less stress. IMHO – Using reminders is a sign of an intelligent, organized, and health-conscious person!!

    OnTimeRx has been around since 2000 and there are 30-day free trials of all software products and services. We’re here to help.

  3. The Lancet has today published an article about using text messages to ensure tuberculosis drug compliance – looks like I hit on a hot topic!

    The most interesting technology discussed in the article is SIMpill:
    “One reminder product is a small pill bottle made by London-based SIMpill that contains a SIM card and when opened, the SIM card delivers a SMS with a unique pill box identification number to a central server. The central server receives the incoming SMS and stores the data, but if no SMS is received at the designated time, the server contacts the patient via phone alerting them to take their medication. If the patient does not respond, the server contacts a caregiver who can follow-up with the patient.”

    Check out the article, it’s really interesting
    The Lancet, Volume 373, Issue 9657, Pages 15 – 16, 3 January 2009
    doi:10.1016/S0140-6736(08)61938-8

  4. My concern is that people think these technologies are spread across > society equally. While Telstra claims it reaches 96% or so of the population with mobile coverage it only covers about 50% of the land mass. So remote people, and even those travelling do not have access.

    Unfortunately the rural/remote and most disadvantaged tend not to have these technologies, and tend to be the sickest. So farmers in Australia with one of the highest suicide rates in the country will not have access to such a service you described. The most disadvantaged miss out on health now and these new technologies are not designed with them in mind.

    I work in a very remote area and we still have to physically jump in a vehicle and travel long distances to see how our patients are getting on.

    Great writing. I have just discovered your blog (through twitter) and am enjoying it.

    Robbo

  5. > Or are text messages good only for personal affairs and not for important medical information

    You can fake the sender of an SMS message and they’re not terribly reliable, so I’d be worried about medical staff using them to relay anything particularly important without a more formal followup!

    Using it to prompt patients to track their daily mood is a great idea, though.

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