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Software and Hosting Options

​Level 3: Advanced Customization

​Solution for interventions involving secure information or electronic health record interface

Interventions that require interfacing with patient electronic health records or other health IT systems may need to be completely customized or built from the ground up to ensure compatibility and security. These systems can be extremely expensive and time consuming to build, but offer the benefit of being able to draw upon and add to patient electronic health records. Storing all data on internal servers may also provide assurance regarding security. It is possible to have an internal gateway server; however, they will usually be external. Most agencies that use this type of system have in-house IT personnel that can help build a text messaging application and implement the system.

Elements in a custom integrated system. The research staff uses in-house software to interact with an external SMS gateway, which then interacts with outside cellular service. The cellular services sends messages to users’ phones.

  • Completely in-house system built from the ground up; requires programming resources; highly customizable
​Common Uses
  • Integrated with electronic health records, personal health records
​Features and Customizability
  • High customizability 
  • Allows complex conditional branch logic design of interactive messages for highly personalized and tailored messages (aka dynamic application logic)
​Hosting/Data Storage
  • Data are stored internally, and may pass through an SMS gateway or may be sent directly to a cell service provider
​Cost Considerations
  • High up-front development 
  • In-house maintenance costs
  • Opportunity to add customized features 
  • Allows greatest flexibility for integration with other systems


​C​ase Study
Customized, Interactive SMS
​A large vertically-integrated safety-net health care system in Denver, Colorado tested an intervention to remind adult patients with diabetes to monitor their blood sugar levels and attend medical appointments. Blood sugar testing reminders were sent 3 times per week and appointment reminders were sent 7,3, and 1 day(s) prior to appointments. The text message interactions were integrated with the facilities electronic health information systems. 

In this scenario, the goal was not only to test the intervention but to develop a patient outreach platform that was integrated with clinical and administrative IT systems and supported text messaging in addition to other methods of communication.  The text messaging application was an integrated feature of Microsoft’s Customer Relationship Manager application (Microsoft Dynamics CRM), which was rebranded as a "Patient Relationship Manager"​ application for health care specific applications.   The text message application supported 2-way text messaging with customization of delivery scheduling to an individual’s preferences, as well as basic branch logic capability. The PRM databases was integrated with clinical and administrative datasets to enable automated triggering of outreach (such as texting appointment reminders) as well as the flow of patient-generated data collected at home into the clinical database. The entity currently contracts with an outside SMS gateway vendor, Twillio. Data and software are hosted by and at Denver Health.


Fischer HH, Moore SL, Ginosar D, Davidson AJ, Rice-Peterson CM Durfee MH, Mackenzie TD, Estacio RO, Steele AW. (2012). "Care by cell phone: text messaging for chronic disease management". The American Journal of Managed Care (1088-0224), 18 (2), p. e42.

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