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TEN STEPS TO MAXIMIZE SECURE
TEXT MESSAGING ADOPTION
Jason Stanaland
Mobility Solutions Expert
spok.com
Texting among clinicians is a convenient way of sharing information and coordinating care for patients.
As a communication method it allows members of a care team to send detailed information such as pain
medication requests, test results, and discharge questions, and receive alerts in real time. The challenge for
hospitals is that much of the value in texting comes from the inclusion of detailed patient information, which
is required by law to be secured.1 In 2014, 96 percent of surveyed physicians reported using unsecured texting
to coordinate patient care.2
Aware of the need to address this risk to patient data, many hospitals are now supplying their staff with a
secure texting app for their mobile devices. However, this represents some significant modifications, and
clinicians may resist the change to their existing process, so hospitals must go beyond simply making the
technology available. In order to increase adoption and user acceptance of a secure text messaging app,
hospitals need to be proactive and encourage the desired new workflows with internal marketing campaigns,
solid IT support, a positive user experience, and more.
HOW TO MAXIMIZE ADOPTION OF A SECURE MESSAGING APPLICATION
1
OBTAIN SUPPORT: LEADERSHIP AND CHAMPIONS
Before implementing secure texting, it is critical for executive stakeholders to be on board for funding
reasons, as well as to enforce appropriate usage. To gain executive support and buy-in, the project leader
must be able to show (1) how a secure messaging solution addresses core business problems and (2) the
value that it can deliver to the hospital (compliance with HIPAA, improved communications among a care
team, improved patient satisfaction, faster bed turnover, etc.).
A successful adoption campaign also needs the sponsorship of key end users who have influence over
the clinical community and can help drive change by being champions of the new technology. Once
these solution advocates understand the benefits of the solution to their daily work (search and send to
anyone in the hospital directory, simple tap to call, launching their own pages, etc.) they will help spread
enthusiasm and adoption. It’s key to find the right physicians for this group: those who are tech savvy, IT
advocates, and supporters of the secure messaging project. They should also be in a position of political
and social influence, individuals whom many colleagues look to as their trusted source when forming an
opinion about the use of new technology.
2
CREATE ACCEPTABLE USE POLICIES
Acceptable use of ePHI (electronic protected health information) should be clearly outlined and
communicated to all employees with access to patient data. This important step may include new
guidelines as well as revisions to existing policies, such as smartphone security or ‘bring your own
device’ (BYOD) usage. Consider defining elements such as the rights and ownership of data, and
the proper configuration of devices and networks when sending and receiving secure messages. It
should also include a well-defined requirement that employees sending ePHI via text must use the
secure texting app—unsecured texting with patient details is unacceptable. Enforcing compliance with
the new security could be achieved by restricting hospital system access to within a mobile device
management (MDM) solution’s secure envelope. Or enforcement could be encouraged by applying
penalties for non-compliance, such as fines, or most severely, termination.
1
2
http://www.hhs.gov/hipaa/for-professionals/security/index.html
Spyglass Consulting Group. (November 2014). Healthcare without Bounds: Point of Care Communications for Physicians.
3
PROVIDE A RELIABLE AND REDUNDANT INFRASTRUCTURE
Perhaps the most critical component of a secure messaging solution is the wireless infrastructure that
supports it. There is no amount of policy, marketing, or effort that can make up for a lack of wireless and
cellular signal. Poor coverage is not only frustrating for users, but it will delay or thwart the acceptance
of the user community. It can also have a detrimental impact on the quality of care if critical messages
are delayed. Degraded service levels are unacceptable from the perspectives of business stakeholders,
end users, and patients. Providing comprehensive Wi-Fi and mobile coverage throughout all hospitals and
hospital affiliate locations is essential to securing adoption and delivering a technology that is trustworthy
and truly enhances user workflows.
4
DESIGN A SOLID INCIDENT MANAGEMENT PROCESS
Many things can affect the functioning of a secure messaging app and cause poor performance. Problems
could be related to the app itself, accuracy of data in the contact directory, wireless networks, device
settings, and more. The first line of defense troubleshooting incidents is a comprehensive knowledge base
with common FAQs offering self-service for the simplest of cases. Next, establish a service desk to handle
more complex cases when users are unable to resolve issues on their own or may require assistance from
IT to resolve. Give users multiple avenues to contact the service desk, including a way to do so within the
app itself. The service desk can prompt qualifying questions, like “Can you access a website from your
device in the location where you missed messages?” and “Have you enabled push notifications?” to triage
problem severity and help route incidents appropriately. If users struggle to get help they are more likely to
give up and revert to tried-and-true (but unsecured) texting to communicate.
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MARKET THE BENEFITS
Beyond policies and champions, adoption of secure
messaging also requires marketing. Ideally with help
from the marketing team, your hospital should plan and
execute a marketing campaign to promote awareness
of the app’s availability, rollout schedule, training options,
and especially the benefits for the end-user community.
Generate buzz in advance of the launch by creating
newsletters, blogs, posters, business cards, banners,
and web call-outs for the service. Remember to include
those clinical champions you’ve identified and
leverage their support to promote the benefits
to your user base.
Integral to marketing the upcoming change
is the rollout event itself. During the event,
support staff from the IT department and from
the vendor should be onsite and dedicated
to assisting users with the transition. Having
people available to answer questions and
provide the initial training in person will ease
the change and help generate acceptance
when end users perceive the solution as
simple and advantageous.
“The customer made the rollout
a full-fledged event, with
promotional emails and signage
around the facility. Emails included
key details to help ensure the
rollout went smoothly.”
Gerard Shallo
Director of Product Marketing
Learn how one hospital
in Oklahoma made their
secure texting rollout event a
success.
Read Now >>
6
ENCOURAGE A CULTURE OF TECHNOLOGY CHANGE
One way to promote change is by easing the transition and removing barriers that prevent adoption of
the unknown. For secure texting this can be as simple as emphasizing the workflow similarities to regular
texting and that many of the features are the same: click-to-call, group messaging, and contact search.
Calling attention to how a new process will benefit the individual is also key: Will it save time for that
person? Will it mean better care for patients? Integrating the secure messaging app with clinical
communications like nurse call, critical test results management, and code calls
can offer users additional workflow improvements to make communications faster
and easier, increasing the likelihood of adoption. Also, integration with the online
directory is vital; if users can’t quickly and easily find the person they want to send
a message to within the secure app, they will not use it. Make it intuitive, and they
will be more likely to come on board.
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MAKE IMPLEMENTATION EASY
Implementation and getting set up is often the first experience an end user will have with a new
technology provided to them. As we all know, first impressions are important, and technology
is no exception. Getting this process right out of the gate is imperative for long-term adoption. To increase
your chances for success, streamline the process as much as possible, including the use of automation
and self-service when applicable. Users’ expectations for the sign-up procedure will mirror what they have
experienced as consumers: fast, easy downloads and simple sign-up with the touch of a finger.
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TRAIN BEYOND THE APP
Adoption of technology is largely fueled by user
experience. A good experience requires users
to understand the behaviors of an application,
their device’s operating system, and how their
device interacts with wireless networks. It is
very important to expand the scope of end-user
training beyond simply the application because
app performance can be heavily impacted by
other variables. As part of a rollout, IT should
prepare training resources regarding application
usage, acceptable use policies, wireless network
management, device operating system behaviors,
and the applicable online download site (the App
Store® or Google Play™). Providing end users with
reference resources will help enhance the user
experience and perception of the technology. And
be prepared to offer a range of training options,
from minimal training for tech savvy users, to fully
guided installation for staff with more questions.
APPLICATION USAGE
1. Signing in
2. Setting and options
3. Sending and receiving messages
ACCEPTABLE USE POLICIES
1. Device and network configuration
2. Rights and ownership of data
3. Policy enforcement
WIRELESS NETWORK MANAGEMENT
1. Cannot use guest networks
2. Mobile versus Wi-Fi
3. Wi-Fi assist
DEVICE OPERATING SYSTEM BEHAVIORS
1. Enabling / disabling push notifications
2. Features such as Apple® DND
APP STORE BASICS
1. Setting up Apple® / Google® accounts
and IDs
2. App downloads
9
GAIN USER TRUST
End users will not use technology that they do not trust. Pagers remain important in healthcare
environments because the service and devices are reliable—users trust them to work. Smartphones are
heavily used, but they do not always hold the same trust for clinicians because coverage is notoriously
spotty in some areas of the hospital. Patient-related questions and information can be time-sensitive
and impact the quality of care, so a reliable and redundant infrastructure for cellular and wireless
coverage throughout the campus is vital to securing trust, acceptance, and adoption. Also make sure
that IT resources and process are in place to support users, and that IT staff convey empathy and an
understanding of the severity of missed messages. Aligning IT with the expectations of the clinical
community can go a long way when establishing trust early on.
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DELIVER AN EXCELLENT USER EXPERIENCE
User experience (UX) is a person’s attitudes and perceptions toward a technology product or service. Much
of this is derived from the utility, ease-of-use, and effectiveness of a product. A good UX with secure
messaging means that a user should be able to look up any person/group in a hospital network, type or
say a message, reliably send that message to the intended recipient(s), and track the status of delivery.
In theory this sounds simple, yet the reality of a secure
messaging experience is heavily dependent on the
supporting infrastructure such as database integrations,
wireless networks, and correct contact information
for staff. All elements must work together seamlessly
to deliver the desired outcome. In most cases, users
blame any messaging failure on the application without
understanding the complexities behind the scenes. For
example, if there is poor network coverage users may
incorrectly presume the app is buggy. IT can proactively
take steps by extensively testing the app prior to a full
rollout to ensure as smooth an experience as possible,
educate users about common issues during registration,
and provide continuing support to field questions and
assist users when they experience difficulties.
BRINGING IT ALL TOGETHER
At the end of the day, an excellent user experience that your clinical champions will applaud
depends on all aspects of service delivery: cultural acceptance, tech infrastructure, policies, training,
request handling, support, marketing, and trust. Detailed planning and preparations will help set the
stage for a more successful rollout to maximize user adoption of your secure messaging application.
And in addition to complying with HIPAA security requirements, an easy-to-use secure texting
solution is a valuable tool to give your staff more efficient communications that can save them time
and speed the delivery of care.
ABOUT JASON STANALAND
Jason is a mobility solutions expert at Spok. He has 10 years’ experience in systems
architecture design, enterprise mobility management, IT service management, project
management, consulting services, and product marketing. This includes designing and
supporting the critical messaging system at a large hospital system. In that role he
developed business cases to justify the use of critical messaging systems and architected
an enterprise emergency notification system. While there he also implemented a secure
messaging solution and successfully deployed it to over 3,000 users. Jason is helping
Spok customers plan and successfully launch critical, secure messaging solutions in their
hospitals.
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ABOUT SPOK, INC.
Spok, Inc., a wholly owned subsidiary of Spok Holdings, Inc. (NASDAQ: SPOK), headquartered in Springfield,
Va., is proud to be a leader in critical communications for healthcare, government, public safety, and other
industries. We deliver smart, reliable solutions to help protect the health, well-being, and safety of people
around the globe. Organizations worldwide rely on Spok for workflow improvement, secure texting, paging
services, contact center optimization, and public safety response. When communications matter, Spok delivers.
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