News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Could clinical laboratories use texting to improving patient compliance with the medical laboratory test orders given to them by their doctors?

California’s largest physician-owned medical practice has employed text messaging to reduce patient no-shows. Just as other innovations such as same-day walk-in clinical laboratory testing and patient at-home self-testing made it easier for patients to comply with physicians’ lab test orders, text messaging appears to help get more patients through the doors and into doctors’ exam rooms.

At least that’s the experience at Riverside Medical Clinic (RMC) in Riverside, Calif. The multi-specialty practice has more than 170 providers who see more than 400,000 patients annually. After struggling to lower its 15% baseline no-show rate using a phone-only reminder system, RMC turned to a two-way texting appointment reminder system from Santa Barbara, Calif.-based WELL Health (WELL).

According to a case study, prior to the texting system implementation, no-shows were costing RMC more than $3 million per year. “The problem we were trying to resolve was getting a hold of our patients in an expedient manner without having to do redundant work,” Diego Galvez-Ramirez, Associate Vice President, Patient Business Services at Riverside Medical Clinic, told Healthcare IT News. “We wanted to give time back to our staff. A big frustration was not having enough time for staff to accomplish their duties.”

After RMC implemented WELL’s HIPAA-compliant text-based reminder system, front office efficiency and productivity improved, and the practice experienced a 33% decrease in appointment no-shows.


  • No-shows decreased from 15% to 10% within the first month of going live across the enterprise.
  • Confirmed appointments rose from 29.45% to 94.45%, translating to a savings of more than $40,000 in two months.
  • 91% of patients who confirmed via WELL presented for their visit.
  • Phone volume at RMC’s two call centers decreased by 4% to 6%.

Galvez-Ramirez suggests that healthcare providers—including clinical laboratories and anatomic pathology groups—keep pace with the realities of today’s connected world. “Most of the time, the cell phone is not used to make phone calls,” he told Healthcare IT News. “You have to adapt to the new ways that your patients want and are used to communicating.

“In our environment,” he continued, “you also have to be quick to respond to your patients. No patient wants to spend unnecessary time on a phone call. Being able to send them their appointment to their phone is not a new concept, it’s an expectation.”

Based on an Axway survey of 1,200 smartphone users aged 18-60, the graphic above supports the view that text messaging is now the preferred method of communications for most people. Could clinical laboratories employ text messaging to lower patient no-shows and increase the proportion of patients who actually show up at a patient service center to provide a specimen in response to the medical laboratory test orders given to them by their physicians? (Graphic copyright:

The WELL messaging app draws a patient’s information from the physician’s electronic health record (EHR) system to configure the appointment reminder. This includes appointment type, date/time, and location. Based on the patient’s preferred method, the system sends reminder messages via phone, text, or e-mail.

As Healthcare IT News noted, WELL’s competitors in the patient communication space include:

Texting Reduces No-Shows at Other Healthcare Networks

Other healthcare organizations also have replicated RMC’s success in reducing its no-show rates by moving away from telephone-based reminders.

An Athena Health study examined 54.3 million patient visits in 2015 and found no-show rates dropped to 4.4% when patients received a reminder text from their provider. By comparison:

  • Athena patients who received a phone call instead of a text failed to show up 9.4% of the time;
  • E-mail reminders resulted in a 5.9% no-show rate; and,
  • 10.5% of patients who received no form of reminder message missed their appointments. 

Is Texting Secure and HIPAA Compliant?

A 2018 poll conducted by the Medical Group Management Association (MGMA) found that 68% of healthcare organizations used text messaging to communicate with patients about appointments. But is it secure?

An MGMA article notes that according to HIPAA Journal, “Recent changes to HIPAA have introduced new rules relating to how Protected Health Information (PHI) should be communicated and many healthcare organizations and other covered entities are now at risk of financial sanctions and legal action should an avoidable breach of PHI occur.” The MGMA goes on to state that, “As text messaging is not typically a fully-secure channel for the communication of PHI, practices must be vigilant when sending information via text messages.”

With proper training and precautions, clinical laboratories and pathology groups might want to add text messaging to their patient outreach programs. Data indicate that doing so could improve patient compliance with the medical lab test orders given to them by their physicians. Industry experts estimate that for every 100 medical lab test requests written by providers, only about 60% of patients show up to provide the specimens needed for a lab to perform those tests. Improving on those numbers would help clinical laboratories and patients alike.

—Andrea Downing Peck

Related Information:

Text-based Tool Reduces Patient No-Shows by More Than Two-Thirds

Case Study: Largest Physician-Owned Practice in California Sees a 33% Reduction in No-Shows in One Month

MGMA Stat Poll Indicates Most Organizations Use Text Messaging to Communicate Appointments

Getting No-Shows to Show Up

Not Texting in Healthcare? Here’s Why You Should

Text Messaging Remains an Effective Tool for Patient Appointment Reminders

To Get Patients in the Door, Try Texting

5 Ways Home Healthcare Providers Grow by Texting Clients, Employees