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Two-way text messaging can solve many patient engagement challenges

CE Publish Date: 12/07/2020
CEU (Continuing Education Unit): 2 Credits

Educational aims and objectives

This article aims to discuss the benefits of implementing a texting protocol with patients.

Expected outcomes

Orthodontic Practice US subscribers can answer the CE questions by taking the quiz to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can:

  • Identify the texting habits of various age groups in a health setting.
  • Realize how texting habits have changed during the COVID-19 crisis.
  • Realize that certain aspects of text messaging are particularly attractive to certain patients.
  • Realize how text messaging can be used for various aspects of the patient’s experience.
  • Identify some ways to stay HIPPA compliant.

Lea Chatham describes ways that text messages can update and connect patients

Since the COVID-19 pandemic began, dentists have faced office closings and challenges to reopening. Dentists have had to work diligently to communicate with patients effectively and within HIPAA guidelines. As patients increasingly depend on technologies such as the internet and social media for their information and connections with others, many also seek technology options for communications with their medical personnel. Every change and update needs to be communicated to patients so they are prepared and know what to expect when they return to the office or appear for a TeleVisit. Since medical and dental providers may be the only source of accurate information for patients, they are in the unique position of being able to reach out to patients with accurate, up-to-date information. When done effectively, texting can offer updates, connection, and appointment information that builds trust and loyalty.

SR Health by Solutionreach commissioned a recent study, which showed that during the COVID-19 crisis, patient satisfaction in communication was reduced.1 The study noted, “Patients’ responses indicated less timely communication with their providers, a tougher time getting questions answered, and not being ‘heard’ as well during the pandemic.” Before the pandemic, phone conversations with a live person were the most desirable form of communications across baby boomers, Gen Xers, millennials, and Gen Z-aged patients. However, during COVID-19, patients’ interest in live phone calls dropped 14%. Even before the pandemic, interest in phone calls had already started to wane. A study quoted by CBS News MoneyWatch noted that only 18% of people listen to a voicemail from a number they don’t know.2 Even if they do recognize the number, often busy lives don’t allow for time-consuming communications. Ron Kinkade, senior marketing manager at eVoice® j2 Global, which conducted the survey, said that voicemail often, “requires some sort of action,” and people are reluctant to add to an already busy schedule. Also, while the person can skim to relevant parts of an email, listening to someone leave a slow voice message can be incredibly frustrating.2 However, interest in digital communication is up with patients believing that text and email are more effective for communication across their journey.

Text is particularly appealing. A patient-provider relationship study by Solutionreach found that 73% of patients desire the ability to text their dentist and 79% want to get texts from their provider, especially about appointments.3 The study also found that 70% of Gen Xers favor appointment reminders by text, and 67% appreciate texts to remind them of the need for follow-up care or treatment. Both automated and real-time, two-way text messaging is of interest to patients. At Solutionreach, where approximately half of the clients are dentists, 50 million messages were facilitated in March with updates about COVID-19 and closures. The company has continued to see high volume whenever there have been substantial changes to protocols, openings, or closures.

Extremely or very appealing touchpoints averaged across the four specialties Table

Right now the combination of the two types of text messaging can be very effective. They can be used across the entire patient experience.

  • Appointment reminders and instructions: Automated texts can be used for appointment reminders and can include instructions for things such as park and text waiting or what to do if the patient has COVID-19 symptoms.
  • Real-time pre-screening: Two-way text can be used to reach out to patients who haven’t confirmed to not only confirm the appointment, but also to pre-screen patients with a few questions about COVID-19 symptoms such as whether they have a fever, sore throat, or cough, or if they had contact with anyone who has tested positive for COVID-19.
  • Answer questions: Patients have many questions now about safety protocols in addition to the usual questions about insurance coverage or directions. Encouraging patients to text questions is more convenient, and responses can be preset for many common questions to save It can be helpful to designate a staff person to regularly check incoming text messages and respond.
  • Digital intake: No one wants to be picking up a clipboard right now. Send digital intake forms through text to make it easy for patients to complete them at home. You can add COVID-19 pre-screening and other forms to your usual packet. Depending on the system you use, the forms can be embedded in the text, or you can send patients a link to wherever your digital forms are available (i.e., website, portal, etc.).
  • Patient follow-up: Use real-time text to check on patients after a procedure. It just takes a few seconds to send a note asking if they feel OK or have any questions. It’s a good way to remind patients what to do if they have any complications. The real-time text can be facilitated by the doctor or assistant, whoever can most effectively help the patient.
  • Communicate changes quickly: Anything can happen right now. If there is an unexpected closure or a change to the process for check-in, sending a group text to all the patients being seen that day (or week) is much faster than trying to call. Some patient communications software allows the practice to text a large group so it appears to be an individual text, and the patient can respond as an individual just to the practice. Because it is done through the software, others in the group cannot see individual responses.
  • Surveys and reviews: Automated or real-time text can be used to request reviews or ask patients to complete a post-visit survey. It’s fast and easy, and patients are often logged into Google or Facebook on their phone already.
  • Recall: Automated recall is an incredibly effective tool for filling the schedule, and recall reminders can be sent via text or email. As practices work to recover revenue, real-time text can also be effective. Reach out directly to patients who are overdue or haven’t followed through for high-profit margin services like crowns or Invisalign® to try to boost revenue quickly.
  • Address barriers: If patients are canceling appointments or not responding to outreach, consider texting directly to ask why. Is there something you can do to help? It may be fear about COVID-19 or problems with insurance coverage or transportation. A simple, friendly chat over text may be enough to help address the issue or problem-solve to get them in.

Clearly, there are a lot of ways to use text messaging to connect with patients and keep the lines of communication open. Providers often worry, however, that they can’t manage being compliant with text messaging. It’s surprisingly easy to stay compliant with a few simple rules.

  • Know the difference between a healthcare message, which you can send to patients without written consent, and a marketing messaging, which requires written consent. Healthcare messages are those that relate to patient care like reminders, recall, follow-up messages, education, test results, etc.
  • Know the basic requirements for compliant text messages. Patients do not need to consent to receiving healthcare messages. If they are a patient of record and have given their cellphone number, you can text them healthcare messages. However, there must be a clear opt-out. You need to regularly update and verify patient contact information. Texts can’t be more than 160 characters long.
  • Adhere to the minimum necessary standard if sending texts through a third-party service. Provide only the information required to get the message delivered with the correct information. And always have a business associate agreement (BAA) in place. HIPAA requires all covered entities to sign a BAA with any third party that will have access to patient data. That includes private message (PM) and electronic health records (eHR) vendors, patient communications vendors, and billing companies, among others. Basically, a third party that might come in contact with patient information needs to sign a BAA.
  • Finally, if any patients want to discuss protected health information over unsecure text or email, be sure to ask them for consent first. It’s as simple as letting them know that text is not secure, and that you need their permission to continue. Once patients give consent, you can discuss protected health information (PHI) and be compliant.

Research from OpenMarket that polled 500 millennials cites that 75% of millennials would forego the call function on their device as long as they were still able to text. Most patients would like to have text as an option because they believe it is more convenient.4 Currently, it can also provide a better experience by letting patients stay in touch, be prepared, and  get questions answered.


Disclaimer: Consult your attorney to ensure you are compliant before instituting a texting program. This article is intended to provide general information and is not intended as legal advice. Laws may vary by state.

Kenneth Burke also discussed the topic of text messaging with patients. Read his article, “How to improve your orthodontic practice by texting with patients”:

Author Info

Lea Chatham is the Director of Content Marketing at Solutionreach, the leader in patient engagement solutions and innovation. She is responsible for developing educational resources to help dentists stay connected to patients throughout the care journey. Lea spent over 5 years leading engagement at a small integrated health system and has 15 years of experience developing educational content for leading patient engagement, practice management, and EHR companies.


  1. The COVID-19 impact. SR Health website. Accessed October 1, 2020.
  2. Vanderkam L. Are you still checking voice mail? CBS News MoneyWatch web site. Published April 11, 2013. Accessed October 1, 2020.
  3. The Patient-Provider Relationship Study: The Ripple Effect Starts with Boomers. Solutionreach website. Published 2017. Accessed October 1, 2020.
  4. Cawley C. Study: Millennials would rather text than talk [press release]. Published June 23, 2016. Accessed October 1, 2020.

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