038: Using Text Messaging To Grow Your Practice





Ronda Nelson: Well, hello, my friend. Welcome back to The Clinical Entrepreneur podcast. I’m your host, Ronda Nelson. It’s great to have you with me today. I always love being able to sit down and have these conversations with you, even though you’re on the other side of the screen because I feel like I’m talking to a whole bunch of “me” because we’re all in this together. We’ve got practices and people that we need to serve, and bodies that need help, and health conditions that need solutions. We are perfectly poised to be able to do all of that, but part of being a clinician means that we also have to kind of switch over often and be calm or be the CEO.


That CEO role can be a little bit unnerving for a lot of practitioners, it was for me for a long time, until I kind of figured out that I needed to think about my business in the way that a CEO would. I was making decisions as a business owner and then as a clinic owner rather than the clinician, even though I play both of those roles. So, as I began to make that mental switch, just a mental game, but that’s when things really began to take off. One of the things I found was that my ability to make decisions about what I wanted to do or the things that were going to help my business grow was much easier coming from a CEO standpoint rather than a clinician. The clinician is like, “ah, I don’t know what to do, I don’t know what to do. I’m just here taking care of people minding my own business, why do I have to mess with all this business stuff? I don’t even want to do all this.” Well, sorry, friend, you got yourself into this when you decided you wanted to open a brick and mortar, you just walked yourself right into a job as a CEO and a clinician.


Now, the thing I’m going to talk to you about today is using text messaging in your clinic. This is definitely going to be a CEO-type decision, but I want to break it down for you because I love using text messaging. Now, the first concern that everyone has is, what about HIPAA? I totally get it, but before we do HIPAA, let’s go back and talk about why we even want to consider text messaging at all.


First, it’s important that you maintain regular contact with your patients, right? We know this. Email rates, open rates hover around 25% or so. And so, when we communicate via email, only 25% of people are going to open them and it can be days before somebody checks their email. So, if it’s something urgent that you need to communicate, you’re doing something in your office, or you’re communicating about an appointment, or whatever it might be, email may not be the most efficient way to connect with your perfect patient. However, video consumption, on the other hand, is much higher, but how do you deliver that video? Via email or on your social media channel.


Now, when you write an email, the truth is we are all skimmers. My hand is in the air. If you ask my team, they would all just roll their eyes because it’s so true, I am a skimmer. I skim everything, and it’s because there’s so much information coming at me all the time, and you’re no different, and your patients are no different. We tend to look for the high points. So, bullet points work very well in written communication, but if your patient is a skimmer, they’re going to miss the point of your email. Therefore, videos are a little bit better consumed, and you can send a video in an email or just use a video on social media, that’s great.


Phone calls are another way that you can stay in touch, but your patients don’t want you calling them once a week. That’s not going to work. The phone calls are typically answered about 52% of the time. The last way that we have to communicate is via text messaging. And texting is pretty amazing because as a general rule for most people, their phones don’t leave their sides. We’ve been trained like Pavlov’s dogs to salivate, so to speak, when that dang ding ding goes off, we have to look. Have you ever been in line at the grocery store, and somebody’s phone, ding ding, it just got a text message, you watch, you’ll see five, six, eight people pull their phones out to see if it’s their phone. Even though your brain tells you it was far away, they’ll still check their phone. Phones don’t leave our sides, 99% of all text messages are read within three minutes of receipt. Now, they may not respond, but they’re read within three minutes.


Now, I would call that a pretty high consumption rate. They can be very friendly, they’re non-obtrusive. It doesn’t gum up an inbox, and they’re not obnoxious, they’re not super long, it’s really the fastest and easiest way to communicate. When they did a survey of health patients in some kind of a healthcare clinic, 38% said they appreciated the reminder text message for appointments, and that’s 14% more than those that requested phone calls, or 19% more than those who said they want email reminders. Clearly, text messaging is winning the race as it comes to a good way to communicate with patients. But now, let’s talk about HIPAA.


So, texting, if you set it up correctly, texting is not and should not be for sharing health-related information. We are all clear about that. That is a HIPAA violation. Their personal information is private. However, during the period of COVID, at the time of this recording, there’s still some of this going on, but they’ve lifted some of those restrictions. However, they’ve not come down as much on texting. The other thing is that when they wrote HIPAA way back a long time ago, there was no text messaging. So, it’s not specifically in those guidelines. And there have been some additions and modifications to the HIPAA guidelines that have accounted for the fact that this is just how many people communicate. So, the risk is that it’s not secure end to end. That means that when you send it, it has to go through a relay station to their carrier and then to their phone. So, technically, someone could read that and intercept that information. And that’s where the HIPAA violation comes in.


However, if you have scheduling software that uses text reminders for appointments, have you ever noticed that those appointments never say the person’s name, they also don’t say the person’s condition or anything about their health? It is just a reminder, that’s all. It just says, reminder, your appointment is coming up tomorrow at ______ time at Dr. so and so’s office. That’s all it says. So, texting reminders is completely legal. And a lot of most scheduling software do have texting included in their packages which can be great. What you don’t want to do is wish them a happy birthday, because that would be PHI. You wouldn’t want to mention their supplements, you wouldn’t want to mention a condition or their diagnosis, or even your specialty, that’s a no-no.


You can’t mention anything that you would otherwise know as a provider, but text messaging reminders is a great way to stay in contact with them. And it’s not obtrusive, it’s very noninvasive. They don’t have to check an email. It’s easy. Usually, those text messages say, confirm Y if yes, and if no, very easy for the patient to confirm the appointment. You want to keep your messages very succinct and easy to read. Include the date and the time of the appointment, and then ask the patients as I mentioned to reply with a Y or an N to say yes or no. You may need to remind them to bring paperwork if you have some form you want them to fill out or something. And the best time to send these messages, I get asked this all the time, is between noon and 5pm.


A lot of texting apps will say, we’re going to send it 24 hours before. I tend to see if I can tweak that a little bit and get them to come out between noon and five. It doesn’t always work that way, but think about it, you send a text message early in the morning and they may forget by the end of the day, and then they no-show. So, between noon and five are the best times to send those messages. Now, you can send like a link in there, a secure link with results or forms, you can do all that stuff. Anything that has to do with that appointment is completely fine, but now there are two types of text messages that I think we need to make the distinction about. There is transactional texting, and there’s promotional texting. So, let me make this distinction because this is where we can really make texting work on to our benefit, as far as staying in touch with a patient, and then some additional marketing.


The transactional has to do with the transactions they’re having at your business, easy to understand, right? That would be appointment reminders, intake forms, test results, that sort of thing, confirm yes or no. Those are transactional things. They have to do with kind of your business relationship with them. Does that make sense? It’s the transaction that’s happening between you and the patient. The promotional emails, on the other hand, always require opt-in. So, an opt-in can be asking them for their cell phone, their first name, and their last name, and then some kind of a disclaimer that says something like, you agree to receive automated promotional messages, you also agree to the Terms of Service, etc. You just have to make that little legal disclaimer, and I’ll leave that for you in the show notes, but you want to make sure that they understand that if they opt-in, that they may be getting some promotional messages from you.


So, when you’ve got your number that you want to text, how do you get the word out? How do you get them to (A) opt-in, and (B) be able to start interacting with you? Well, the first thing you can do is you can email them, and 25% of your people open those emails. You can also have some kind of a display on your front counter or on a wall in your office or in the treatment room, while they’re sitting and waiting for you. You can just have a nice little sign on the wall that just says, Text, and then say who, or text this number to receive additional updates from our office. You can absolutely do that. You can tell them about new services, you can give them health tips. Keep them short, though, because nobody likes to read a mile-long text message. So, short little health tips, or maybe you found a sale at a local business, and they have good quality stainless steel pans on sale, you may want to let your patients know that, or cast iron or whatever it might be.


You want to be able to separate the transactional. They don’t have to “opt-in for” because it has to do with your doing business, but if you’re going to use texting, let them know about certain services, or talk about new services that they need to opt-in for. So, you want to promote your texting number in as many places as you can. There are two options that I really like for texting services. Don’t text them from your phone, this is not the best way for you to be able to communicate with them. In fact, you should not give them your cell phone number at all, but what you want to do is sign up with a company that manages texting, and what they can do, what these companies will do is you can send group texts. So, that means that you send out one text, it goes to a whole bunch of people, but when those people reply back to you, they come to you singly. It’s all managed inside an online portal.


There are two of them, and I use both. The first one is called, and the other one is called I have one company using Community and one company using Simple Texting because I wanted to compare the two. And in the essence of what they do, it’s the same thing. They allow you to segment your population of the people that opt-in into groups or categories. For instance, you sent out a quick survey about would you rather have this or that? And you get all the messages back. It’s easy. They interact with you. Would you rather have this or that? And they respond back and now, you know if they raise their hand that they like red apples and the other ones like green apples, then you can put all your red apple people into kind of a bucket. And now, you know that anything you’re going to be talking about that has to do with red apples, in my example, you would be texting that group. You don’t need to text the green apple group because they don’t like red apples.


If you’re going to talk about red apple things, then you would only message that red apple group, but it’s not like a group message, like on your cell phone. We’ve all had that happen where somebody sends a group message, and then every response and your phone is blowing up. No, no, no, this is not like that. One message can go out to everyone, but the replies come back singly. You can invite them to a special event. You can let them know that like it’s your birthday, come to a birthday party with us. You can ask them a question, red apples or green apples? What’s your favorite grocery store, Whole Foods or Sprouts? What’s your favorite restaurant in town? This one or this one? What’s your favorite cleaning product for the bathroom? This one or this one?


Now, you don’t want to be texting them all the time, but this is such a great way for you to be able to communicate and get good information about what your patients are interested in. You can ask them to share their recipes, like what’s your favorite guacamole recipe or salsa or lentil soup, whatever it is? You can promote a local charity event that you might be at, or a community event, say, “Hey, I’m going to be down at the blood bank or the fairgrounds or the community center, and I’m going to be doing this, just want to let you know, come if you can, it’s going to be a lot of fun.”


You can also coordinate a scavenger hunt. I saw someone do this with texting. It was so much fun. They actually organized a scavenger hunt around the city. It was a summertime thing. And they got all their patients involved. It was a really big practice. And they put the little QR codes, you know how you scan them at a restaurant. They put these little QR codes, there was like six of them, I think, and they like put them on the side of a tree, and they had someone posted at each of the places. So, these little QR codes didn’t get lost, but they gave clues. And the patients and their families loved it, it was so much fun. And as soon as they got the QR code, they had to text back that they got it, and then they got their next clue. Someone was manning the texting, letting them know where to go next, where to go next. The execution required a few people, but it was so much fun, and they did the whole thing with text messaging. You can ask them for a picture of their pantry or something that’s relevant to them about a stretch. You could film yourself doing a stretch or some posture-related something, how to get your shoulder stretched out, or how to put your hands if you’re going to want to breathe and calm down in the middle of the day. And you just video yourself, and then post that video on YouTube and send them the link. It’s so easy to communicate via text messaging.


So, here’s how you get started. I would recommend checking out either or When you go there, they’re basically going to do the exact same thing. I will say this, I think Community is a little easier to use, in my opinion, because I’ve got both. Community is a little easier to use, but Simple Texting has a lot more resources on their site. What you could do is you can go read all of their resources on Simple Texting, they’ve got some articles on HIPAA, they’ve got some case studies on how to use it, as does Community, and then make a decision about which one you want to use, but before you pull the trigger and pay the $25 a month, it’s roughly that, get yourself a document that will help you execute your text messaging. 


In the show notes, your homework is to text me and follow the instructions. Text me and tell me, then you can opt-in and you can see what the process is, and then tell me where you’re from. I just want to know the city that you’re from, city and state. And then, now we can start a little bit of a conversation. That’s how easy it is. So, try it out.


Now, I’ve got a resource for you in the show notes. You’re going to go and look for the resource that’s all about how to execute and get your text messaging strategy, your rollout strategy going. I have all that written out for you. It’s a step-by-step guide. You’ll be able to just go through and check each one of the things off, make the decision about how you want to do it, how you want to announce it to your patients. I highly recommend adding this to your new patient intake forms for them to opt-in. You give them a number, and they can text it right while they’re at your office. Your front desk person can manage this, but they just can text you, and they’ll just have their opt-in, that’s it. That’s how easy it is.


So, to wrap it up, I love texting. I probably would prefer texting over a phone call because it’s faster. And I think most people are like that. There are a few people who don’t like texting, but as a general rule, most people really do like it. What I would say is this, don’t text spam, people. So, if you think they can text you about a supplement question or you’re going to be texting them an answer to their question because you don’t want to call them or write out an email, that’s not a good plan. Texting, remember, is for promotional things, inquiring about what they love, what they don’t love. It’s not for you to diagnose or anything like that, it’s not for that. If you get those kinds of inquiries in, that’s a hard no. You need to respond back and say, we aren’t able to diagnose or have any kind of a medical conversation at this time on texting, please call our office, or we’ll reach out to you or something like that. That’s what you have to do. Otherwise, you’re going to get yourself into trouble, and I don’t want to be responsible for you getting a HIPAA fine.


Okay, that’s all I have for you today. I’m so glad that you took some time out to spend it with me to talk about adding texting to your office. I think you’re really going to like it. Go check out that free guide. You can go to the show notes and grab it, and then go have yourself a great time and let me know which app, you can DM me, you can always find me on Instagram. You can DM me, let me know which one you like better. I’d be really interested to know.




Lastly, your first task is to go check out one of those two texting options, check those out. Number two, text me. Here’s my number 702-478-2359. When you text me, you’ll be able to see the process, you’ll be able to experience what that’s like. I created a custom response back to you that meets with all guidelines, and that means you’ve then opted into my list. Now, you can opt-out anytime, and I’m not going to spam you. I promise that I won’t blow up your text messages. But I want you to be able to see what it’s like.


Number three, if you go to the show notes, you can download a Texting Playbook that I created just for you to help you get started. It’s going to walk you through the exact steps that you need to take that will let your patients know how they can now text you, and how you can manage it internally. Because what we never want to do, as we’re talking about this is, have a patient text you, have it go somewhere, to a random desk somewhere where no one’s watching the app, and then they don’t get a response. Because remember, texting is quick. You text a message, you expect to get a response back pretty quickly. We want to set up those systems internally so that we know how to track the texting. I’m going to walk you through that. It’s the Texting Playbook. Go to the show notes, you’ll see the link there. 


Otherwise, if you would be so kind, I’d love it if you’d leave a review for The Clinical Entrepreneur podcast and let me know how this has impacted you and how much you love it because I think this podcast is pretty awesome. I think you’re pretty awesome too. Thanks for hanging out with us again this week. We love having you part of our community. I love having you part of my community. Take care of my friend. I’ll be back next week.




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