Supercharging Text Messages to Support Patients

Just waking up each morning is hard enough. My back felt cramped from having to elevate my legs all night. It’s the best way to keep the swelling down, my heart doc had so calmingly assured the other day. I started to get out of bed, already dreading the long list of tasks staring back at me, and glanced at my phone.

Happy morning! Hope you have a great day!

Aww, that was sweet. It was this texting program I had signed up for to help me with my diabetes. It had only been a week so far, but I was really starting to warm up to this guy, Felix. The reminders were a bit overwhelming for me at first to be totally honest, but I liked that there were some sweeter messages mixed in.

Remember to start your day off with a good breakfast! Try two scrambled eggs and sliced avocado on whole wheat toast. It will help give you steady blood sugar levels and keep you from overeating later in the day.

Alright, alright. It was already ten minutes to 8, and I was definitely thinking about skipping out on breakfast today. Felix might seem pushy sometimes, but he was right.

I quickly put together some toast and gulped down my morning dose of Metformin with a cold glass of OJ. I was ready to start my day. Felix reminded me about that too, but you already knew that.

Say Felix, what’s my medication adherence been this week?

That’s 100% over three weeks and counting Beth — great job!

The rest of the day was no different than usual. I walked my way over to my office job. I was slowly getting those steps up and trying to meet all my goals for the week. Definitely a challenge with these legs. But I already knew that Dr. Smith and my eldest son were watching me every day — Felix kept them posted on my progress behind the scenes. Sometimes that last bit of motivation helped me go the extra mile.

Beth* is similar to many of the patients I see. They live challenging lives. Unfortunately, the only way to meet lifelong conditions like diabetes are with stable, persistent lifestyle changes, and these changes are particularly difficult for those that need them the most.

Without a doubt, the medical system has become better than ever at responding to acute complications of these conditions — ketoacidosis, HHS, cellulitis, even sepsis — but there remains a massive gap at meeting patients halfway on these lifestyle changes. Moreover, readmissions rates are significantly higher amongst patients with poor health literacy and lower socioeconomic backgrounds.

We built Memora Health with the precise vision of meeting this gap.

A friendly virtual health coach, named Felix, provides gentle nudges in the right direction via text message. Felix partners with patients in this difficult journey, helping offload a lot of the stress of managing their condition — the right foods to eat, exercises that fit their busy schedule, remembering to take medications, keeping friends and doctors updated, answering questions about side effects, all on their schedule. Most importantly, Felix provides comfort and support, instead of adding extra steps to a patient’s life. The number of digital health interventions in recent years has skyrocketed — but many of these tools have made the time and energy patients take to take care of themselves harder. Having to customize apps, sync and troubleshoot wearables, or stay on top of appointments with online health coaches has simply made things cumbersome by virtue of the number of moving pieces. Many of these patients are already exhausted or have trouble navigating layers of technology.

Our goal was to remove as much of that friction as possible, to deliver sophisticated artificial intelligence via a simple, familiar medium–text message.

The Data Agrees

SMS messaging has shown a significant positive impact on fostering desired behavior change among patients. A 2016 meta-analysis of academic studies pooling over 2700 patients showed that SMS reminders nearly doubled both short- and long-term medication adherence and patient motivation in various acute and chronic diseases, including Type II Diabetes, cardiovascular disease, HIV, and schizophrenia, across the socioeconomic spectrum. Additionally, SMS reminders significantly improved patient satisfaction, with 93 to 100% of patients finding messages ‘very helpful’ in regards to improving their adherence, 90% claiming they would like to continue receiving messages, and 92% mentioning that they would recommend SMS-based interventions to family and friends. Including health literacy advice in conjunction with medication reminders further improved adherence, patient satisfaction, and the perception of feeling ‘cared for’ outside the hospital.

SMS-based health interventions such as ‘Text2Move’, which reminded patients with diabetes to maintain an active lifestyle over six months, resulted in a 1% reduction in hemoglobin A1c, the clinical measure of blood sugar control. Clinically, a 1% drop in hemoglobin A1c is considered medically significant and reduces the risk of heart attack by 14% and diabetes-related death by 21%. In comparison, the standard drug for diabetes, metformin, gives an average of 0.5% drop in hemoglobin A1c, meaning this SMS intervention was at least as effective as an oral pharmaceutical.

While mobile interventions introduce a natural selection bias, using SMS as a mode of communication is inclusionary of all demographics relative to other technological solutions. In 2013, mobile phone penetration had been estimated at 86% among American households earning less than $30,000 per year, 93% of which regularly send text messages. In the same demographic, only 59% have access to a desktop or laptop, while just 47% have broadband at home, supporting text messaging as the best method for automated interventions. SMS interventions have a 98% read rate, better than any smartphone app on the market.

The highest-risk patients don’t keep fitness apps on their home screens, but we guarantee that their messaging icon will be front and center.

The Secret is Behind the Scenes

Although the aforementioned text messaging interventions have shown success in clinical domains such as medication adherence, the technology has generally been limited to one-way reminders. There’s only so much intelligence that was originally paired to text messaging. We’ve taken a proven concept in medical quality improvement research and supercharged it by applying principles of behavioral economics and natural language processing to deliver personalized messages and parse SMS responses into clinically relevant insights for caregivers and clinicians.

More involved digital interventions employ wearables, mobile apps, and telemedicine-style health coaches, but for many patients these have become more cumbersome—as described, and are inherently more difficult to scale.

Felix is every bit as smart and reliable as those technologies, but all of our AI is behind the scenes — users only engage over text message, and it feels every bit as natural as texting a friend. We employ advanced technology in an entirely automated workflow with the ability to text thousands of patients at a time, and are continuously learning and improving from user behavior.

Even my grandma sends me text messages these days.

• For their privacy, Beth’s and Dr. Smith’s real names and identifying details have been changed.

Visit https://memorahealth.com and reach out to let us know how we can help your practice and patients. We’d love to hear from you!.

Memora Health is building the operating system for care delivery that implements intelligent, streamlined workflows and revolutionizes the patient experience outside the care setting. We offer a smart end-to-end platform that unifies fragmented health care data to enable providers, payors, and life science companies to automate care delivery operations — from patient communication to documentation to reimbursement. We uniquely use artificial intelligence to digitize existing care delivery workflows, giving clinicians infrastructure that learns from every encounter they have. Memora supports a full suite of virtual care systems from automated patient intake and scheduling to remote monitoring and care pathways to billing and documentation. Memora is backed by Andreessen Horowitz, SV Angel, Kevin Durant, Martin Ventures, and several healthcare strategic groups.