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Leading up to her son's kidney surgery, new mom Jessica De Dios-Ramos was frantic.
Her one-year-old son, William Olmos De Dios, was born with a partially non-functioning left kidney, and was slated for surgery in January to treat his hydronephrosis. Every time the infant got fussy, she thought he might have an infection that could delay the operation.
In the past, when a health question arose, De Dios-Ramos would have brought William straight to the emergency department or urgent care near their Arlington, Texas home. But this time, her pediatrician, Julio Bracero-Rodriguez, M.D., introduced her to a new texting app called OhMD, designed specifically for communication between doctors and patients.
De Dios-Ramos took full advantage, texting as much as two dozen times a day in the six weeks leading up to the surgery — peppering the doctor with questions about William's diet, his bowel movements, and all the other new-mom questions that were made even more complicated by having a sick kid.
“As soon as I notice something coming up, I send him a message, and he responds, and I'm able to take control of it," De Dios-Ramos says. “The way you would when you go to the office, just in a shorter amount of time."
Bracero-Rodriguez is part of a cohort of doctors looking for the next step, beyond phone calls and patient portals, to connect with those in his care. Enter text messaging applications from companies like OhMD, TigerText, and Hale — which connect to electronic health records, and are made HIPAA-compliant through encryption and recipient verification.
Patients are already using their smartphones to further their health — a 2015 Pew Research study found that 62 percent of smartphone owners have used their phones in the past year to look up information about a health condition. So doctors are reaching patients where they already are.
And the benefits can extend beyond convenience. A 2011 study published in the journal Health Services Research found that chronically ill patients who communicated often with their physicians — especially outside of the office — were more involved in their own care. Indeed, Bracero-Rodriguez says his parents are more engaged and ask more questions when they don't have to wait on hold.
In the six months since Bracero-Rodriguez started using the app, he has made ample use of the technology. There were the three different children with possible pneumonia whom he monitored over Christmas weekend. And the mother who sent photos of her child's infected eye every three hours, so the doctor could make sure it didn't require a CT scan — imaging the mom couldn't really afford with her high-deductible insurance plan.
It's care that Bracero-Rodriguez says he couldn't give via any other tool.
“I was able to follow up with the patient directly almost every day, and it allowed me to manage a condition that most doctors would end up sending their patients to the ER for," he says.
Doctor-patient texting apps are so new that there isn't much data yet on adoption rates, or on how the technology is affecting patient outcomes. Adoption of web-based patient portals has been notoriously slow, particularly in rural areas, though data shows that portal use correlates with better clinical outcomes.
Some experts in patient engagement say they see both the promise and the pitfalls of doctor-patient texting. Helen Reiss, M.D., a psychiatrist who trains doctors to be more empathetic and engaging in the exam room, hasn't studied the effects of texting, but says technology can be a hindrance to creating the right connection.
“It can easily fall into just email and text, and then more than a year goes by and nobody's set foot in the doctor's office," Reiss says. “That's where we get into some dangerous ground, because we make a lot of assumptions … that everything's the same. But things could drastically change in a patient's life."
There's no substitute for in-person visits, Reiss says — though she sees the benefit of a parent sending a photo of a rash to ask if it's poison ivy, or asking about an over-the-counter medication.
“I think the balance has to be struck between being available and making things convenient, but not so convenient that you end up missing things," she says.
Reiss also worries that doctors could become overwhelmed with yet another task they have to do, or another channel they have to monitor. But Bracero-Rodriguez says he usually has his phone at arm's reach anyway.
“It cuts one minute into my personal time, but the investment is invaluable," he says. “Spending the 10 minutes out of the weekend [to answer a question] is a lot easier than spending 10 minutes during the workday, because the day is already so packed."
He doesn't offer texting to all his patients — just those he thinks would benefit, such as De Dios-Ramos. She was having issues getting through to him during the busy workday, and was needing to call so often that the office staff were starting to get annoyed with her.
So Bracero-Rodriguez told her to stop calling altogether, and to text him instead.
After hundreds of texts leading up to William's operation, he says, he got the best one of all: A message from De Dios-Ramos, telling him that William was doing well after surgery, and they were on their way home.
“That level of follow up makes parents feel like they're actually being followed and cared about," Bracero-Rodriguez says. “And the patients feel like they're a VIP."
Allison Manning is a writer based in Boston.