
<p>I talk with a lot of practices about texting patients, and one belief comes up more than any other: "Our texting vendor signed a BAA, so we can text PHI." It's an understandable assumption, and it's wrong. A BAA is a contract. It doesn't change what happens to a text message after you hit send.</p><p>Here's what a BAA covers, where plain texts still make sense, and how we built BloomText so your team can send PHI by text without putting it in the text.</p><h2 id="what-a-baa-covers">What a BAA covers</h2><p>A <a href="/what-is-a-baa/">Business Associate Agreement (BAA)</a> sets out the legal obligations of a vendor that handles PHI for you. HIPAA requires one, and BloomText includes a signed BAA for free.</p><p>What a BAA doesn't do is change how a plain text message travels. HHS makes a similar point in its <a href="https://www.hhs.gov/hipaa/for-professionals/special-topics/health-information-technology/cloud-computing/index.html">guidance on cloud service providers</a>: besides signing a BAA, you still have to understand the service and run your own risk analysis.</p><p>A plain text message (SMS) leaves your vendor and goes through the mobile carriers to the patient's phone. Along the way:</p><ul><li>carriers and the patient's phone store it unencrypted;</li><li>it stays in the phone's messages, readable by anyone who picks up or unlocks the phone, for as long as it's kept;</li><li>once it's sent, it can't be recalled.</li></ul><h2 id="plain-texts-are-still-useful">Plain texts are still useful</h2><p>Plenty of messages have no PHI in them, and for those a plain text is simpler for the patient: they read it right in their messages, with no link to tap. HHS defines PHI as health information that <a href="https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html">identifies the patient</a>, including their health, the care they receive, and payment for that care. A text goes to the patient's own phone number, so it's already tied to them. The question to ask is whether the message reveals anything about their health, their treatment, the kind of care they get, or their bill.</p><p>These are fine as a plain text:</p><ul><li>"You have an appointment tomorrow at 2 pm. Call us with any questions."</li><li>"Our office is closed Monday for the holiday."</li><li>"Please call our office."</li></ul><p>These are not:</p><ul><li>"Your appointment with Dr. Lee in oncology is tomorrow." It reveals the kind of care.</li><li>"Your lab results are ready: your A1C is 7.2."</li><li>"Your prescription for sertraline is ready for pickup."</li><li>"Your balance for your MRI is $240."</li><li>Any file, such as a referral, a record, an image or a form.</li></ul><p>For reminders, HHS suggests including <a href="https://www.hhs.gov/hipaa/for-professionals/faq/198/may-health-care-providers-leave-messages/index.html">only the information needed</a> to confirm the appointment, or asking the patient to call back. Keep plain texts that short. If your practice's name alone reveals the kind of care, as it can for a specialty clinic, follow your organization's policy on whether plain reminders are acceptable.</p><h2 id="send-phi-by-secure-link">Send PHI by secure link</h2><p>If a message has PHI, the PHI shouldn't be in the text. Send a text that holds only a link, and let the patient read your message somewhere secure.</p><figure class="kg-card kg-image-card kg-card-hascaption"><img src="/blog/images/baa-doesnt-make-texting-phi-safe-secure-vs-insecure.webp" class="kg-image" alt="Two iPhone screens compared. Top: an insecure text, where the message itself, an appointment reminder from Sunnyvale Primary Care, sits in the patient's Messages app. It can't contain PHI because the carrier and phone store it unencrypted, it stays on the phone, and it can't be recalled. Bottom: a secure text with link. Step 1, the text reads 'Dr. Maya Chen from Sunnyvale Primary Care just sent you a secure message. Click the link to read it' followed by a blm.care link. Step 2, tapping the link opens the conversation in BloomText in the phone's browser, where the patient reads 'your lab results are ready' and replies." loading="lazy"><figcaption>What the patient sees. Example messages, with no real patient information.</figcaption></figure><p>That's how a Secure text with link works in BloomText. The patient gets a text that says someone from your practice sent them a secure message, with a link. Tapping it opens the conversation in their browser over an encrypted (HTTPS) connection. Your message never goes through the carriers or sits in their message history.</p><p>Each link expires after 7 days, and the patient can get a new one with a tap, sent to the phone number on file. If someone on your team sends a message they shouldn't have, they can recall it.</p><h2 id="why-bloomtext-is-different">Why BloomText is different</h2><p>Most secure messaging asks the patient to do work first: download an app, create an account, remember a password. In my experience, a lot of patients never get that far, and staff drift back to plain texts and phone tag.</p><p>With BloomText, the patient taps the link and they're in the conversation. There's no app to download and no account or password to set up. They can read your message, reply, and attach files from their phone's browser.</p><p>It works for group conversations too. One secure chat can include several patients or family members along with your staff, and each patient gets their own link.</p><p>We also make the choice explicit. When your staff start a chat, they pick <strong>Secure text with link</strong> ("Can contain PHI") or <strong>Insecure text</strong> ("Can't contain PHI"). Insecure chats are labelled in the inbox and in the chat header, and the message box reminds staff not to include PHI. Nobody has to guess which kind of conversation they're in.</p><h2 id="a-quick-checklist">A quick checklist for your practice</h2><ol><li>Set one rule: PHI goes by secure link, never in a plain text. If a patient asks to get PHI by plain text, follow your organization's policy or ask your privacy officer. <a href="https://www.hhs.gov/hipaa/for-professionals/faq/2060/do-individuals-have-the-right-under-hipaa-to-have/index.html">HHS guidance on patients who ask for unsecure delivery</a> doesn't address texting specifically.</li><li>Share the examples above with your front desk.</li><li>When in doubt, send a secure link. It works for every message.</li><li>Send files, such as referrals, records, images and forms, by secure link.</li><li>If a patient texts back with PHI, answer by secure link, not in the plain-text thread.</li><li>Check the patient's phone number before you send a secure link. Anyone who has the link can open the conversation until it expires.</li><li>If PHI goes out in a plain text by mistake, tell your privacy officer right away and follow your reporting process.</li><li>Get a signed BAA from every vendor that handles your PHI, and run your own risk analysis.</li></ol><p>For step-by-step instructions in BloomText, see our help article, <a href="https://www.bloomtext.com/how-to/messaging/secure-vs-insecure-texting/">Secure vs. insecure texting and HIPAA</a>.</p><p><em>This post is general information, not legal advice.</em></p>


A BAA Doesn't Make Texting PHI Safe


<p>After experiencing the challenges of getting patients to pick up the phone, MRI Associates turned to BloomText's broadcast text messaging to reduce the number of outbound calls by 70%.</p><blockquote><em>I literally took the job of 20 employees and I can do it by myself in three and a half hours.</em></blockquote><p class="quote-attribution">Amanda Maple, Chief Administrative Officer<br>MRI Associates</p><h3 id="the-problem"><strong>The Problem</strong></h3><p>MRI Associates is an industry leading provider of radiology services with over seven different locations in southern Florida. Over 60% of their scheduled appointments require calling out to the patient. This process is often time consuming and inconvenient for both the scheduler and patient, requiring multiple phone calls before they are successfully connected.</p><p>Additionally, MRI noticed that there were capacity bottlenecks for their scheduling team. At some times, the scheduling team had extra capacity to take incoming calls, and at other times they would experience an influx of calls, resulting in a longer than desired waiting time that impacted the patient experience.</p><h3 id="the-challenge"><strong>The Challenge</strong></h3><p>To improve the efficiency of reaching out to patients, MRI began evaluating texting based software services for reaching patients. During the evaluation process, the challenge they encountered was that other text message-based systems lacked an ability to send out messages in a bulk format. </p><p>Furthermore, the software systems that did offer this feature were only capable of sending all messages out at the same time, overwhelming the schedulers and leading to long wait times and a poor customer experience. As a result, MRI had not yet been able to proceeded with a SMS texting solution.</p><h3 id="solution"><strong>Solution</strong></h3><p>To realize the convenience of text messaging without overwhelming their scheduling team, MRI turned to BloomText's broadcast messaging campaigns solution. With BloomText, messages could be scheduled over time intervals or batches, giving managers full control over the amount and timing of the text messages being sent out.</p><figure class="kg-card kg-image-card kg-card-hascaption"><img src="/blog/images/mri-associates-of-miami-broadcast_messaging_border-1.png" class="kg-image" alt="Screenshot of the BloomText broadcast messaging interface, showing a campaign being scheduled in batches"><figcaption>The BloomText Broadcast Messaging interface</figcaption></figure><p>Switching to BloomText let MRI Associates reduce the number of outbound calls their schedulers had to make by 70%, and also improved the utilization of their scheduling team by strategically launching texting campaigns when scheduler utilization is low, all while improving the patient experience.</p><p>For more information about BloomText schedule a demo via the link <a href="https://calendly.com/tyler-bloom/bloomtext-homepage-demo-request?month=2022-01&ref=blog.bloomtext.com">here</a>. <br></p>


MRI Associates of Miami


<p>Grant Cluxton ARNP, is the owner and CEO of Onsite Healthcare and Wellness, a South Carolina-based group of licensed practitioners that provides medical care to geriatric patients in long term and post acute care facilities. Nurses in theses facilities rely on Grant and his team of providers to keep their residents healthy and out of the hospital.</p><p>In this article, we'll explore how Grant and his team leveraged BloomText to save two hours of time per day for each of his providers, and reduce the average response time to nurse requests from two hours to fifteen minutes.</p><figure class="kg-card kg-embed-card kg-card-hascaption"><iframe src="https://www.youtube.com/embed/nG5_juGsuO4?start=7&feature=oembed" title="Grant Cluxton on BloomText" loading="lazy" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><figcaption>Grant Cluxton on BloomText</figcaption></figure><h3 id="challenges-in-communication">Challenges in communication</h3><p>Most post acute and long term care facilities use their shared phone systems to communicate with providers. These calls often result in a game of phone tag between nurse and provider, costing the provider an average of 30 minutes of time per request, with an average response time of two hours.</p><p>In emergency situations, when a two hour response time is not enough, nurses will typically reach out to an on-call provider instead of a resident's primary provider. While it is good that the nurse can get quick support, the on call provider usually doesn't know the patient, and as a result is more likely to admit that patient to the hospital out of caution, even if that admission is ultimately unnecessary.</p><h3 id="improving-access-to-providers">Improving access to providers </h3><p>To improve the efficiency of communication and reduce provider response times, Onsite introduced the BloomText app to each the facilities they work with. Nurses were able to download the BloomText app onto their personal phones, establishing a direct line of communication with each provider. Now, if a nurse has a question, they can simply send an instant-message, and the provider can easily respond during their next free moment.</p><blockquote>By allowing us to speak directly to the nurse - that's how we're able to keep residents out of the hospital. So it's significantly increased quality, and BloomText has a direct impact on that.</blockquote><h3 id="results">Results</h3><p>For the past two years, Onsite has been using BloomText to communicate quickly and effectively with all the facilities they work with. Since implementing BloomText, pro response times have decreased from two hours to ten minutes, and also save each provider an average of two hours of time per day.</p><p>BloomText has also empowered nurses to reach the resident's primary care provider in emergency situations, decreasing the risk of unnecessary hospitalizations, and improving the quality of care that each resident receives.</p><blockquote>BloomText literally improves the quality of care that we give to our patients. Furthermore, it improves the quality of life of my providers, my nurse practitioners and my physicians.</blockquote>


Onsite Healthcare and Wellness


<p>Aaron Moon is the Marketing Manager of PSJ Discount Pharmacy in Florida. As the former Delivery Manager, Aaron plays an important role not only customer satisfaction, but in operations as well.</p><p>As PSJ continued to grow across it's 12 locations, Aaron turned to BloomText to help save over 2 hours of time per day for each of his drivers, while simultaneously maintaining high quality relationships with their ever-growing base of customers. </p><p>Below are the highlights from my interview with Aaron, recorded in January 2021. I hope you enjoy! </p><figure class="kg-card kg-gallery-card kg-width-wide kg-card-hascaption"><div class="kg-gallery-container"><div class="kg-gallery-row"><div class="kg-gallery-image"><img src="/blog/images/psj-discount-pharmacy-aaron-moon-psj_three.jpg" alt="Pharmacy counter at PSJ Discount Pharmacy with the 'Fast & Friendly Service' sign and staff helping customers"></div><div class="kg-gallery-image"><img src="/blog/images/psj-discount-pharmacy-aaron-moon-psj_two.jpg" alt="Interior aisles of Port St. John Discount Pharmacy lined with shelves of supplements"></div></div><div class="kg-gallery-row"><div class="kg-gallery-image"><img src="/blog/images/psj-discount-pharmacy-aaron-moon-psj_on1.png" alt="Exterior of a PSJ Discount Pharmacy storefront with cars parked out front"></div><div class="kg-gallery-image"><img src="/blog/images/psj-discount-pharmacy-aaron-moon-aaron_moon_profile-1.jpg" alt="Aaron Moon, Marketing Manager at PSJ Discount Pharmacy"></div></div></div><figcaption>Some photos of PSJ Discount Pharmacy, with Aaron Moon on the lower right</figcaption></figure><h2 id="who-are-you-and-what-do-you-do">Who are you and what do you do?</h2><p>My name is Aaron Moon and I'm the marketing manager for Port Saint John Pharmacy Group in Florida. Right now, we have 12 locations and were looking at expanding further. <br><br>Generally what I do day to day is interact between each business location and do a little bit of work with the customers and deal with Facebook, Google, and also BloomText.</p><h2 id="what-s-special-about-your-organization">What's special about your organization?</h2><p>One of the best things that I like about the company is the fact that we treat everybody, all of our customers, like our own family. It's very common in in other pharmacies to just be a number.</p><blockquote>We treat everybody, all of our customers, like our own family.</blockquote><p>At our pharmacy, we can always find coupons to benefit the customer. We can charge their meds as cash pricing if our cash price is cheaper than what their insurance copay would be; we try to go above and beyond and help the customer find an alternative or maybe a generic versus a name brand.<br><br>Little things like that can really make a huge impact and we definitely enjoy doing that sort of thing at the stores. </p><h2 id="how-does-psj-utilize-bloomtext-today">How does PSJ utilize BloomText today?</h2><h3 id="logging-deliveries">Logging Deliveries </h3><p>When making deliveries it's very important to make sure that every step of the process is thoroughly documented.<br><br>We have between six and 10 delivery drivers out for 12 hours each day, and some of them are long distance, some of them are local. So especially for the delivery department, it is a huge benefit because then the delivery driver can simply report their delivery on BloomText and move on versus having to write it down or call the pharmacy and report it...<strong> </strong>On average, our drivers save 2 hours of time each day using BloomText. It really adds up.</p><blockquote>On average, our drivers save 2 hours of time each day using BloomText. It really adds up.</blockquote><h3 id="receiving-prescriptions">Receiving Prescriptions</h3><p>We prefer to receive prescriptions electronically. That's one of the areas where BloomText is really good because we already have an established method of communication that is HIPAA compliant. So any time we we need to receive a prescription and for some reason our fax machine is not working or it's just more convenient, they can send it over via BloomText. And that's really been beneficial for us.</p><h3 id="working-with-assisted-living-facilities">Working with Assisted Living Facilities</h3><p>What will generally happen is the doctor from an assisted living facility will send in the prescription electronically or via fax, and then we'll just talk with the nurses or the staff at the facility on BloomText and make sure everything is in order.<br><br>For example, we can let them know that a medication needs special ordering, that it'll be in the next day or hey, we notice that there's a mistake on this prescription. <strong>So we can get that corrected immediately versus waiting and trying to get a hold of the doctor later.</strong> It's much easier.</p><h2 id="who-should-use-bloomtext">Who should use BloomText?</h2><p>Any organization that has to deal with HIPAA compliant information, whether it's the provider or it's the patient themselves or the pharmacy, even the the drug manufacturers really.  <br><br>We're trying to get everybody on board with Bloom. So that way it's standardized and it's easy to manage versus all these different apps, because that's one of the issues that we're having now, is that there are too many different forms of communication and we want to standardize that. </p><blockquote>We're trying to get everybody on board with Bloom.</blockquote><p>That way it's it's much easier to understand both through less time consuming. I don't have to spend all day going over dozens of reports. I can just look at one or two reports that are more condensed.</p><h2 id="how-did-covid-19-impact-your-business">How did COVID-19 impact your business?</h2><p>The easy answer is it increased business. It really caused us to take a look at how we're interacting with the customers and redesign our practices. So that way, especially with the deliveries, we're going to people's houses, and we're going to hospice facilities. <br><br>People are getting sick, they're getting tested positive and they come right to the pharmacy. So we just we we kind of redesigned everything from the ground up. And I feel like it really benefited us.</p><blockquote>We redesigned everything from the ground up. And I feel like it really benefited us.</blockquote><h2 id="how-does-the-industry-need-to-improve">How does the industry need to Improve?</h2><p>The area of communication is is something that needs improvement, and there's really there's a bit of a space to be filled, so to speak, because there's not really a lot of information about good tools that are not only affordable, but easy to understand and easy to use. <br><br>I think that a lot of other people are just doing the bare minimum, whether they're they're sending emails or they're just speaking over the phone. It really takes a lot of extra time to do that. And it's not as secure.</p><h2 id="are-you-excited-about-the-future">Are you excited about the future?</h2><p>I am. Progress is definitely good and I feel like that as a country, we're going to emerge stronger than we were before, and it can be a little bit challenging at times, but if anything, it's it's really showing us what's important. And it can be a little bit difficult to take that initial step. Sometimes being coerced into that step can can help out a little bit. And then you'll realize this actually works a lot better and it can be more comfortable for you.</p><blockquote>I feel like that as a country, we're going to emerge stronger than we were before</blockquote>


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A BAA Doesn't Make Texting PHI Safe

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