Handling patient bumps – SMS blast

Here’s how we handled patient bumps / rescheduling 2150 appointments with 1 click. If you were using our EzWebTexting tool – this would be done in a single click. However, you can put this solution together yourself as well

No one likes patient bumps – we lose revenues and patient experience is not guaranteed to be good or great. However, we all have to deal with patient bumps from time to time.

If you were using our EzWebTexting tool – this would be done in a single click. However, you can put this solution together yourself as well. We use Amazon Pinpoint for our patient mass communications.

Here’s how you can handle patient bumps / rescheduling text message blasts using a combination of twilio, Google Sheets and zapier. Twilio lets you reach people via SMS in mass and Zapier allows you to automate tasks. Zapier is not HIPAA compliant and Twilio just started taking HIPAA workloads (only recently).

Zapier is not HIPAA compliant so you cannot send any PHI to Zapier.

Even though Twilio is taking HIPAA workloads, you cannot quite send any PHI data over SMS anyway. So, you would have to send minimally identifying information via SMS while attaining the same goals.

The entire process is this:

  1. Add patient first name and phone number to your google sheet
  2. Zapier picks up this info and sends this data to Twilio. 
  3. Twilio sends SMS to patient
  4. Patient responds back and Twilio gets that SMS response.
  5. Twilio sends out an email with the SMS response to your patient contact center team
  6. Use our email filters to move the email to specific folder
  7. Zapier picks up the email from this folder and adds the body of the email / SMS to another google sheet
  8. Your staff looks at responses and cancels/reschedules appointments.

Preparing Google Sheets 

Export all appointments from your EMR for the date range that you want to reschedule (e.g. 2 weeks) as a CSV file.

Next step was to remove all identifiable information from that CSV file. You are left with just phone numbers and the first name of the patient.

Doing this is pretty simple. Delete all the columns from the CSV and used the “split data to text” function of Google sheets to get the first name of the patients into 1 column, the phone numbers into another. The only formatting you have to do is done using the “Search and replace” function of Google Sheets for the column “Phone”. Make sure that instead of a phone format of (123) 123-1234, you convert this into 11231231234 (the country code at the beginning).

Internally, keep another sheet that identifies the chart number associated with the phone number. This way, when the patient texts your patient contact center back, they would be ready to update their appointment in your EMR by searching for that chart number.

Set up sendgrid to send emails upon receiving SMS on Twilio

FYI, you do not need an intermediate step of email. We needed to have it because we also send out satisfaction surveys using this SMS number as well.

Tie this with Sendgrid to send emails upon receiving SMS on Twilio. Sendgrid does a splendid job of sending transactional and mass emails as well.

For this particular purpose, all you need is to send email when a fax comes in. If you’d like (we had already done it), you can authenticate your domain as well (this part is a little technical)

Make sure you get the API keys from this page on sendgrid

Set up Twilio to send and receive messages

There are very few steps to take and they all are very simple to do.

Open up a twilio account

Buy a phone number – make sure that it can receive phone calls and SMS as well. This is very cheap to buy at twilio.com

Our advice is to use a local phone number so that patients don’t think it is a spam message.

Buying a phone number for your medical practice is so easy and so cheap

Make sure when patients call back on this number (trust us, patients will call), forward this to your main phone number.

To do this, all you have to do is to create a simple Twilio function. See this blog to learn how to forward your incoming calls to your office phone number (or numbers)

We have a centralized healthcare call center, so we only had to forward it to one number.

Use Twilio to forward your incoming calls to your office phone number

Make sure that when an SMS comes in, you forward this to your email

This is also very simple to do. Just follow this blog and copy/paste the code into a Twilio function.

This is where you are going to need the Sendgrid API Keys.

Twilio function – copy/paste it to convert incoming SMS to email

You can (and should) test this out by sending an SMS to the phone number you purchased from Twilio. If all works well, you will get an email with the SMS you sent.

You should also test this call forwarding by calling the twilio phone number to verify that it actually forwards to your office phone number.

Set up Zapier

Next step was to set up Zapier. This is very simple as well.

Open up a zapier account. 

Add your google sheets account to it.

Add your Twilio account to it.

After doing that, all you have to do is to pull data from Google sheets every time a new row is added there

This is how we did it.

Zapier can be used with google sheets without disclosing PHI

We set up the SMS blast for rescheduling by tying in Twilio to this as well.

Use zapier and Twilio to do a mass SMS blast to patients

Our personalization was limited to the patient’s first name. Our message was simple as well “Considering the current conditions, can we cancel/reschedule your appt at <practice name>? Please reply YES or NO. Stay safe!”

— that’s it !

So, each time a new spreadsheet row is added to our appt rescheduling sheet, Zapier would pick it up instantly, send an SMS to the patient and if the patient responds to the SMS, Twilio will receive it, and send an email to your team. 

After that, Zapier will pick that response up and add this data to your spreadsheet so that your medical scheduling team can use this information.

We set up Zapier to write responses back to a spreadsheet as well. This way, each time an email came in and was labeled as “surveys”, Zapier would pick it up and send it to our spreadsheet.

BTW, you do not need an intermediate step of email.. We needed to have it because we also send out satisfaction surveys using this SMS number.


Then, you can start copying/pasting the patient phone number and first name into your main spreadsheet.

That’s it. 

Responses start coming in. Of course, there will always be patients that do not respond to the SMS. For those patients, your call center folks can dial and speak to them to reschedule their appointments. That’s pretty much all you have to do to get your patient bumps in order (again, technically speaking, this was not a patient bump situation)

Hopefully this will help you get through these tough times.


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