Objective:

To characterize the range and diversity of patient communications in response to automated text messages and inform more responsive message handling, emphasizing the importance of patient engagement.

Key Findings:

• Patients often responded in unanticipated ways that fell outside the limited reply options of automated systems, such as expressing confusion or providing additional context.
• Misinterpretations of patient responses could lead to accidental removal from messaging lists and unaddressed needs, highlighting the need for clearer communication.
• The study identified a range of patient communications, including important but infrequent messages, such as notifications of significant life events.

Interpretation:

The responses reflect gaps in how automated systems engage patients as active participants in their care, suggesting a need for redesign to accommodate diverse communication styles.

Limitations:

• The study focused on a single integrated health care system, limiting generalizability to other contexts.
• Messages from other systems were excluded, potentially omitting relevant data, and there may be biases in the types of responses collected.

Conclusion:

The findings highlight the need for automated systems to better accommodate unstructured patient input, suggesting strategies such as expanding response options and improving system understanding of varied patient communications.