The Journal of Bone & Joint Surgery recently published a study outlining the benefits of text messaging communication with patients undergoing total joint arthroplasty.
The study examined 159 patients as part of a randomized controlled trial, comparing 83 patients who underwent traditional perioperative education to 76 who were educated through a text messaging bot. The patients in the text message group exercised 8.6 minutes more per day on average than the traditional group, and the text messaging group had an improved mood and stopped narcotic use 10 days earlier, on average.
STREAMD was the software company managing the automated text messages used in the study. Here, Co-founder of STREAMD Kevin Campell discusses the technology and where he sees the best opportunities in the future.
Question: Describe the process of incorporating the text notifications into your practice. How does it change the way you practice?
Kevin Campbell: We intentionally set out to design a turnkey solution that would garner high physician buy-in and wouldn't burden the clinical staff. By using a physician's existing surgery instructions and our library of content, we can create a custom chatbot tailored to the physician's treatment preferences and care culture within a few days. As soon as the physician approves the content, patients can begin enrolling in the program and receive text messages soon after. STREAMD is entirely automated, so providers aren't spending any of their time monitoring inbound patient messages or having to hire someone to manage the software.
STREAMD changes the way physicians' practice in many ways, not the least of which is offloading their workload by giving their patients a digital version of them. At a time when physicians wish they could contact their patients on a daily basis, STREAMD makes that possible by automating the communication and offering patients access to an unprecedented breadth of information about their care and recovery. No longer are patients having to call the office for that information. Because all of the content is specific to the physician, patients feel even more supported by their physician that he/she took the time to create these messages to help guide their recovery. This enhances the doctor-patient relationship.
Q: What has been the patient response to the automated texts? Were there any surprises?
KC: We continue to be inspired by the incredible amount of positive patient feedback. There's something really unique about our messages that provokes a lot of inner energy within the patient. It's really unlike anything I've seen.
Being able to deliver the right information at the right time has been key. Patients commonly say they felt like there was a camera watching them because the very information they were looking for would pop up as a text message on their phone at the same time.
Near the end of the messaging program, we notify patients that the messages will be coming to an end, and we get a lot of patients telling us they don't want the messages to end and that it's become something they look forward to every day. That took us by surprise to realize how instrumental and meaningful this is for them during this chapter of their lives.
Q: Where do you see the biggest opportunity to further perfect automated text communication with patients during the postoperative period?
KC: We think of STREAMD as a patient's digital version of their physician. When we started, patients were able to get more information about their recovery by responding with single keywords like 'pain,' 'bandage' and 'shower.' Now we're using artificial intelligence and natural language processing to create a more conversational experience for patients who are using STREAMD. Building on these processes is the biggest foreseeable opportunity for us.
Q: What clinical and economic impact do you see this type of technology having on total joint replacement patients and the healthcare system?
KC: In our latest study published in the Journal of Bone & Joint Surgery, we reported that patients enrolled in STREAMD after hip and knee replacement stopped their opiate medications 10 days sooner than a matched group of patients who were not in STREAMD. We're very encouraged by this finding and are inspired to explore it further, given the profound clinical and economic impact of decreasing opiate consumption after joint replacement surgery.
Other related findings in our study were increased patient satisfaction scores, VAS mood score and minutes spent on home therapy exercises, plus decreased emergency room visits and calls to the surgeon's office, all of which highlight the opportunity we have to improve the patient experience and decrease the cost of care.