Appendix F—Examples of Policies to Support Using Text Messaging, Social Media Websites, and Mobile Applications for Partner Services

Text messaging

The goal of text messaging by DIS is to enable the DIS to expedite contact with a client to schedule a time/date to meet. Text messaging is particularly applicable in situations where a client or partner is not responding to traditional means of follow-up, e.g., phone calls and/or field visits. The purpose of sending a text message is to engage the individual in a voice call. Sending a text message carries the same risks as leaving a voicemail on a home answering machine, a note at a home, or a message with a friend/family member. Because text messages may be viewed by people other than the intended recipient, make sure the content of the text message follows the approved text messaging guidance below. No protected health information will be permitted in text messages.

• When conducting partner notification via text, messages must be sent from a work phone or a work computer; personal cell phones or computers should not be used to communicate with clients or their partner(s). All cell phones or smart devices used to send or receive text messages must be password protected. Confidentiality is of the utmost importance regardless of the tools used for communication.
• All messages should be as professional as possible and spelled correctly. Avoid abbreviations and acronyms. Remember that you are sending a message on behalf of your program and all your communications should reflect professionalism. Do not send smiley faces or symbols, or use SMS or multimedia message service (MMS) to send photos or other media.
• If the individual responds with a text message, you may respond with another text message asking the individual to call you.
• Be aware of the tone of your text, as it is extremely difficult to discern tone in text messages. Remain professional at all times.
• Texting should not be used to conduct any interview or counseling sessions.
• Text messages sent to and from a client must be documented in the MAVEN event record.

Example 1 – Language to use when texting clients for partner services, courtesy of South Dakota & Tennessee.

• I am Jane Doe with the xxxxxxx Department of Health and I need to speak with you. Please call me as soon as possible at 999-999-9999.
• I am with the xxxxxxxx Department of Health and I have important information regarding your personal health. Please call me as soon as possible at 999-999-9999.
• I am with the xxxxxx Department of Health and I have information regarding an urgent health matter. Please call me at 999-999-9999.
• I have made numerous attempts to contact you. It is very important that we talk. Please call me at 999-999-9999.
• Your appointment with Jane Doe is at 3:00 p.m. today. Call me if you have any questions 999-999-9999.
• You missed your appointment. Please call 999-999-9999 to reschedule.

Responding to text messages

If a client responds to your text message with another text message instead of calling, use an approved message to encourage the client to call you. Never respond to a text message from an individual that contains protected health information. Instead, send a new text message to encourage the individual to call you. The following examples are courtesy of Tennessee:

• I am not able to give you specific information in a text message. Please call me at 999-999-9999.
• I can tell you more when you call. Please call me at 999-999-9999.
• This is urgent and needs your immediate attention. Please call me at 999-999-9999.
• The information I have for you is confidential. I can tell you more when you call. Please call me at 999-999-9999.

Your first text message/instant message should identify who you are and/or where you work and provide a brief message and your contact phone number.

First attempt

I am < > with the [fill in agency name] and I need to speak with you. Please call me as soon as possible at ###-###-####.

I am with the [fill in agency name] and I have important information regarding your personal health. Please call as soon as possible ###-###-####.

Hi _______, I am with the [fill in agency name] and I have information regarding an urgent health matter. Please call ###-###-####.

Second attempt

If the person does not respond to your initial text within 24 hours, a second message urging the person to call you may be sent. It should read:

This is < > again with the [fill in agency name]. I need to talk to you regarding an urgent health matter. Please call me at ###-###-####.

This is < > again with the [fill in agency name]. I have urgent health information for you. Please call me at ##-###-####.

Third attempt

I have been trying to contact you as it is very important that we talk. Please call me at ###-###-####. This is my last attempt to help you.

When more information is requested

I am not able to give you the specific information in text message/instant message. This is urgent and needs your immediate attention. Please call me at ###-###-####.

This is a serious matter. I can tell you more when you call. Please call me through a private line at ###-###-####.

The information I have for you is confidential. I can tell you more when you call. Please call me through a private line at ###-###-####.

Example 2 – Text messaging policy for partner notification, courtesy of North Carolina Department of Health

Text messages may ONLY be used to set up appointments or request a return phone call. Texts may NEVER be used to provide any kind of health or partner information.

The goal of text messaging by DIS is to enable the DIS to expedite contact with a client to schedule a time/date to meet. Text messaging is particularly applicable in situations where a client or partner is not responding to traditional means of follow-up, e.g., phone calls and/or field visits.

Text messaging can be an effective method of contacting individuals who are difficult to reach or only have access to texting service, and it is particularly applicable when an individual has not responded to phone calls, letters, or field visits. However, text messaging is not a secure method of communication. Further, telecom providers are not required to protect the content of text messages and may make these records available to external parties, such as law enforcement, when requested, even without a court order. Therefore, staff should ensure that no confidential information is ever transmitted via text message. The purpose of sending a text message is to engage the individual in a voice call. Identifiable health information must never be sent via text messaging. (Identifiable health information is information that relates to the past, present, or future physical or mental health or condition of an individual; that relates to the provision of health care to an individual; that identifies the individual; or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.)

Protocol for field services staff

The text messaging feature on cell phones will only be used for partner notification activity. It is not to be used for intrastate communications between staff or personal business. The DIS must strictly adhere to the text messaging protocol at all times.

Confidentiality is of the utmost importance. Sending a text message carries the same risks as leaving a voicemail on a home answering machine or leaving a letter at a client's residence. Because messages may be viewed by people other than the intended recipient, make sure the content of the text message follows the approved text messaging guidance below. No protected health information will be permitted in text messages.

Conducting partner notifications through text is applicable in situations where a client or partner has not responded to phone calls and/or field visit attempts. A text message should be sent in order to prompt the person to respond. Caution must be taken to ensure that the DIS has the correct number and that the correct number is being entered. Ideally, the DIS will confirm that the contact number on file is a number that is connected to a mobile phone through internet tools such as a reverse phone number search (e.g., http://www.reversemobile.com). It is important to note that information obtained through a reverse lookup may not be the most current information. It is possible for a cell phone subscriber to retain a cell phone number that has been assigned by one carrier when switching cellular providers. In this case, the previous cellular provider may be inaccurately listed as the current provider.

• Text messages should be sent when you are in a space that offers privacy.
• Clients must be informed to never send protected health information to the DIS via text messaging. If a client does send protected health information to the DIS via text messaging, the message must immediately be transcribed and then immediately deleted from the phone or smart device. Copies of other text messages sent or received should be retained in the mobile device and/or email account during the investigation and deleted upon case closure.
• Text messages should be utilized after attempts to contact the client by phone have failed. The DIS should then send the standard public health text to the client (see below) to encourage them to call back. If there is no response to the text message within one hour of sending, DIS should attempt a field visit for clients with a documented address.
• Text messages should be sent to clients, their partner(s), or members of their social network only during the course of a public health investigation when clients have failed to respond to phone calls, when location information is unknown, or when the client and/or partner states that texting is the preferred method of communication.
• When conducting partner notification via text, messages must be sent from a work phone or a work computer; personal cell phones or computers should not be used to communicate with clients or their partner(s). All cell phones or smart devices used to send or receive text messages must be password protected. Confidentiality is of the utmost importance regardless of the tools used for communication.
• As you are attempting to initiate contact, you may not send more than a total of three text messages as described below. The final message should indicate that it is your last attempt at contact.
• All messages should be as professional as possible and spelled correctly. Avoid abbreviations and acronyms. Remember that you are sending a message on behalf of the NC DHHS and all your communications should reflect professionalism. Do not send smiley faces, symbols, or use SMS or multimedia message service (MMS) to send photos or other media.
• Text messaging is a rapid means of communication and timely response should be anticipated. Be prepared to respond immediately.
• If the individual responds with a text message, you may respond with another text message asking the individual to call you.
• Be aware of the tone of your text, as it is extremely difficult to discern tone in text messages. Remain professional at all times.
• For unsolicited messages: Respond to the incoming messages with a message such as: “Please avoid these types of messages, as I cannot respond to you by text. Please call me at _______. Thank you.”
• Texting should not be used to conduct any interview or counseling sessions.
• All communication/interaction should be documented in detail on the appropriate forms and retained in the investigation case file.

Approved text messages

1. Your first text message should identify who you are and/or where you work and provide a brief message and your contact phone number.

• This is (insert DIS Name) with the xxxxxxx program. I need to speak with you regarding an urgent health matter. Please call me as soon as possible at (insert DIS number).

2. If the person does not respond to your initial text within 24 hours, a second message urging the person to call you may be sent. It should read:

• This is (insert DIS Name) again with the xxxxxxx program. I need to talk to you regarding an urgent health matter. Please call me at (insert DIS number).

3. If the person does not respond to either of your first two messages, a final text may be sent. It should read:

• This is (insert DIS Name) again with the xxxxxxx program. I have been trying to contact you regarding an urgent health matter. Please call me at (insert DIS number). This will be my last attempt at contacting you.

4. Should the person you are texting respond with a text message requesting more information, your response should read:

• The information I have for you is confidential. I am not able to give you the information in a text message. Please call me at (insert DIS number).

The use of text messaging to improve Partner Notification Services is a privilege that must be carefully implemented. Text messages sent from business cell phones will be closely monitored for content and appropriateness, and phone/text records can and will be audited by management at will. Misuse of or breaches to the text messaging policy may result in disciplinary action up to and including dismissal. Your signature below acknowledges your understanding of this policy.

DIS Signature _________________________________ Date____________

Example 3 – Using Google Voice for texting (SMS) clients for partner services, courtesy of Multnomah County, Oregon

MULTNOMAH COUNTY OREGON
HEALTH DEPARTMENT CLINICAL STANDARDS
SECTION: Community Health Services

CHAPTER: General

ORIGINATED: 05/17/2012

TITLE: Using Google Voice for texting (SMS) clients for Partner Services

Applies to: Disease Intervention Specialists (DIS) staff in the STD Prevention Program

Purpose statement

Text messaging can be an effective method of contacting individuals who are difficult to reach and do not respond to or answer phone calls.12 Text messaging is not a secure method of communication and text messages are subject to public records retention laws. Therefore, staff should limit the use of text messaging to those times when clients do not respond to phone calls.

The purpose of sending a text message is to engage the individual in a voice call or face-to-face conversation or to inform a client of an appointment time, meeting place, or missed appointment. Protected health information must never be sent via text messaging.

The texting guidelines are used to provide Disease Intervention Program partner services. Studies have shown that partner services are cost-effective and cost saving, and the many benefits extend to the people living with HIV or other STDs,3 their partners, and the larger community. Providing timely services is a core component of our program.

Procedure for texting clients via Google Voice

• Confidentiality is of the utmost importance. Sending a text message carries the same risks as leaving a message on voicemail or an answering service. Because messages may be viewed by people other than the intended recipient, make sure the content of the text message is appropriate (see below).
• Caution must be taken to ensure that staff have the correct phone number and that the correct number is being used for texting.
• All text messages must be sent using Google Voice Text via the account and number that is assigned to the user.
• All text messages sent or received will be documented and stored by Multnomah County in accordance with record retention requirements.*
• Clients must be informed to never send protected health information to Multnomah County via text messaging.
• Do not erase any text messages; the messages will be stored by Multnomah County in accordance with record retention requirements.*
• Text messaging is a rapid means of communication and timely response will be anticipated. Be prepared to respond immediately.
• If the individual responds with a text message, respond with another text message asking the individual to call you.
• Be aware of the tone of your text. It is extremely difficult to discern tone in text messages. Remain professional at all times.
• Text messages are limited to 160 characters (including spaces). If a message is over 160 characters, most cell phone carriers will split the oversized message into two messages.
• Be aware that some people do not have a text messaging plan as part of their cell phone service and they may be charged for each text message that is received.
• If text messaging is being used to contact an individual, texting should cease once contact is made with the individual or as soon as the case investigation is completed.
• If you are using text messaging to confirm an appointment time or meeting location or to inform the client of a missed appointment, you must first obtain the client's written consent (see Attachment) unless as part of a DIS case investigation.4
• Personal text messaging with clients is strictly prohibited.

Initiating text communication

▢ Log on to Gmail account XXX

▢ Log on to Google voice with phone XXX

Examples of language to use when texting clients for partner services:

• I am Jane Doe with Multnomah County and I need to speak with you. Please call me as soon as possible at 503-988-xxxx.
• I am with Multnomah County and I have important information regarding your personal health. Please call me as soon as possible at 503-988-xxxx.
• I am with Multnomah County and I have information regarding an urgent health matter. Please call me at 503-988-xxxx.
• I have made numerous attempts to contact you. It is very important that we talk. Please call me at 503-988-xxxx.
• Your appointment with Jane Doe is at 3:00 p.m. today. Call me if you have any questions 503-988-xxxx.
• Your appointment with Jane Doe is at 3:00 p.m. today at 92nd and Powell. Call me if you have any questions 503-988-xxxx
• You missed your appointment. Please call 503-988-xxxx to reschedule.

Responding to text messages

• If a client responds to your text message with another text message instead of calling, use an approved message to encourage the client to call you.
• Never respond to a text message from an individual that contains protected health information. Instead, send a new text message to encourage the individual to call you.

Examples are:

• I am not able to give you specific information in a text message. Please call me at 503-988-3780.
• I can tell you more when you call. Please call me at 503-988-3780.
• This is urgent and needs your immediate attention. Please call me at 503-988-3780.
• The information I have for you is confidential. I can tell you more when you call. Please call me at 503-988-3780.
• When you are unsure how to respond to a text message, ask your supervisor or manager for guidance.
• Managers and supervisors are responsible for ensuring that staff understand the proper use of text messaging.

*Documentation:

• Text messages sent to contact an individual must be documented in the client's/contact's record via the STD Database.
• Text messages sent to remind a client of an appointment time or location must be documented in the client's record via the STD Database.
• Text messages sent to inform a client that he/she missed an appointment must be documented in the client's record via the STD Database.
• Text messages sent from a client with protected health information must be documented in the client's record.
• Document all text attempts and results in STD Database.

Social media websites

Facebook will be used primarily to contact partners of patients, patients who have not received treatment and patients with HIV we are helping re-connect to care. Field Epidemiologists (FEs) will only use Facebook to contact patients who have been treated and who need an interview when all other means of contact have been exhausted (phone call, text, field visits).

Before the FE contacts the patient/partner, they must be certain it is the person they are looking for by matching some, if not all, of the following criteria: name, date of birth and/or age, race/ethnicity, address and/or town, place of employment, and physical description.

Once the FE is certain it is the patient/partner they are looking for, they can send a message through Facebook's messenger system. FEs are to never leave a message on the patient's/partner's "wall."

FEs can never send disease-specific information on Facebook. The goal of contacting the patient/partner on Facebook is to get the patient/partner to call or meet the FE face to face.

Example of message sent on Facebook:

Hi xxxx, My name is xxxx (FE). I am contacting you regarding an urgent personal health matter. Please be advised that this is not SPAM. I am contacting you via Facebook because I do not have a better way to reach you.

Please call me as soon as you receive this message. I can be reached anytime.

If I am unable to answer your call, please leave me a message on my voicemail with a call back number. My voicemail is confidential.

Also, I cannot discuss health matters through Facebook, so it is important that you call me directly as soon as possible. Again, this is not SPAM.

Phone: 999-999-9999

Thank you,

xxxx

Mobile applications

Contacting partners using geo-locating social networking applications, courtesy of Massachusetts Department of Health

• Do not send a message unless you are absolutely certain you are reaching out to the right person. You can do this by getting confirmation from the OP or by triangulating the information.
• Apps create an additional barrier to finding a particular person, because that person has to be both actively using the app and within the required radius in order for his or her profile to appear on the app.
• All messages on apps must be sent using the field epidemiologist's assigned work cell phone.
• All messages sent or received on apps will be documented in MAVEN via the Provider/Patient Interaction log and in the patient's event notes.
• No messages on apps will be deleted.
• If the partner responds with a message, respond with another message asking the individual to call.
• Be aware of the tone of your message. It is extremely difficult to discern tone in messages. Remain professional at all times.
• Personal messaging with patients/partners on apps is strictly prohibited.

Examples of language to use when messaging partners on an app:

• I am Jane Doe with Massachusetts Department of Public Health and I need to speak with you. Please call me as soon as possible at this number or 617-983-xxxx.
• I am with Massachusetts Department of Public Health and I have important information regarding your personal health. Please call me as soon as possible at this number or 617-983-xxxx.
• I am with Massachusetts Department of Public Health and I have information regarding an urgent health matter. Please call me at this number or 617-983-xxxx.

Responding to messages sent on apps:

• If a patient responds to your message with another message instead of calling, use an approved message to encourage the client to call you.
• Never respond to a message from an individual that contains protected health information. Instead, send a new message to encourage the individual to call you.

Examples are:

• I am not able to give you specific information in a message. Please call me at this number or 617-983-xxxx.
• I can tell you more when you call. Please call me at this number or 617-983-xxxx.
• This is urgent and needs your immediate attention. Please call me at this number or 617-983-xxxx
• The information I have for you is confidential. I can tell you more when you call. Please call me at this number or 617-983-xxxx

When you are unsure how to respond to a text message, ask your supervisor for guidance. Supervisors are responsible for ensuring that staff understand the proper use of messaging.

Documentation

• Messages sent to contact a partner must be documented in MAVEN in the Provider/Patient Interaction Log and in the patient's event notes.