SMS Best Practices in Healthcare

PART ONE

Pick a number (not just any number)

It’s time to choose a number type. For the sake of simplicity, this report focuses on number types used in the US and Canada.

Match your number to your use case

Assess your use cases and determine whether you (or the customers you’re serving) are sending notifications, or if they’re opening up conversations. Then compare number types to find the best match for your customers’ use cases.

Identify message senders

The sender of a messaging campaign must be clearly identified in the following places:

• Within the opt-in disclaimer shown to users detailing the nature of the messaging program.
• In the introduction of the first message sent in an interaction. This is evaluated when sample messages are submitted with a campaign brief.

Example: “Hi [NAME], this is [DOCTOR/MEDICAL CENTER] reminding you about your appointment on [DATE/TIME]. To reschedule, reply R; to cancel, reply C. “

Fully disclose the messaging frequency

Engagement exhaustion is being reported as the top reason for end-user complaints. Carriers have implemented a requirement to disclose to the end user how often they will be contacted. One reason for this was engagement exhaustion due to receiving too many messages in a short amount of time. Consider how many messages a recipient would like to receive from a candidate and/or cause in a single day. For most people, one a day is enough – and for some, even that may be too much.

Example: “By selecting this checkbox you are agreeing to receive appointment reminders from [OFFICE/DOCTOR]”

Clearly state opt-out instructions

Engagement exhaustion can also drive recipients to complain to carriers or report messages as SPAM to get them to stop, so it’s critical to provide the opt-out language conspicuously and frequently. Since recipients have the option to opt out of messages even if they have originally opted in to receive them, message senders must use the following guidelines:

• Ensure that recipients have the ability to opt out of receiving messages at any time.
• Support multiple opt-out methods (e.g., phone call, email, text).
• Acknowledge and honor all opt-out requests by sending one final opt-out confirmation message per campaign to notify the recipient that they have opted out successfully. No further messages
• Clearly state in the message how and what words can be used to opt-out. These should include the standard “STOP” command, but similar words and phrases (i.e., stop, end, unsubscribe, cancel, quit, “please opt me out”) should also be honored unless a specific word can result in an unintentional opt-out. The validity of opt-outs shouldn’t be impacted by any capitalization, punctuation, or letter-case sensitivities.

Don’t send unwanted messages (or those that look unwanted)

Unwanted Messages (or Unwanted Messaging) include but are not limited to:

• Unsolicited bulk commercial messages (i.e., SPAM)
• “Phishing” messages intended to access private or confidential information through deception
• Messages that required an opt-in but didn’t obtain it (or had it revoked)
• Unwanted content, including other forms of abusive, harmful, malicious, unlawful, or otherwise inappropriate messages

We recommend customers follow best practices for Toll-Free (A2P) messaging and the CTIA messaging principles and best practices, as well as check out the CTIA Short Code Monitoring Handbook. Though this handbook is about text messaging short codes, the same basic principles and rules apply. We also recommend customers follow these additional industry-sanctioned Short Code guidelines.

Here are the best practices that customers can follow to prevent the flow of Text Messaging SPAM on their messaging campaigns.. This type of SPAM traffic runs the risk of being BLOCKED by either Bandwidth or by a downstream provider:

Never send text messaging content related to S.H.A.F.T.-C.:

• Sex
• Hate
• Alcohol
• Firearms
• Tobacco
• Cannabis

Text messages with content that’s directly or remotely related to these categories will most likely be blocked as SPAM by either Bandwidth and/or one or more Tier 1 Mobile Network/Handset operators in the U.S.

Make sure users explicitly say they want messages from you

The single most important practice is ensuring you have accurate, reliable opt-ins specific to the type of messages you’re sending consumers. Generally, opt-out rates are consistently low when you have obtained reliable and clear consumer opt-in consent. At any time, Bandwidth or other wireless carriers may request evidence of documented opt-in consent for a particular message sent from you (or your customers).

Don’t use publicly available URL shorteners

These same “free-public” URL shorteners are used by bad actors to evade detection and get their SPAM messages passed through text messaging platforms. Bandwidth encourages you to build custom URL shorteners that relate to your company or product name. They’re still free. If a custom URL shortener is found to be used for fraudulent purposes, Bandwidth can and will block messages containing them.

Bandwidth and partnering “downstream” carriers will block text messages that contain these publicly available URL shorteners:

Be sure your users can opt out of receiving messages

Consumer opt-in and opt-out functionality is enforced at the network level via the STOP and UNSTOP keywords (this is available on toll-free only). This functionality can’t be disabled for service providers or message senders.

Message senders have obligations to process the opted-out consumer phone number, so it’s removed from all distribution lists and logged as “opted out” from SMS communications. This ensures that the withdrawal of consumer consent is honored and future messages aren’t attempted. As you track opt-out responses, it is best practice to keep a log of how many STOP responses you receive and monitor for increasing percentages of opt-out responses. Should a high number of end users begin opting out of your campaigns, carriers can note this behavior, draw the conclusion that your campaign is sending unwanted content, and begin blocking your content.

Examples of valid opt-out messages:

• STOP
• Stop
• stop
• STop

Don’t spread your campaigns over several numbers

Using a single number for both text and voice calls is not only a best practice but also a better overall user experience, since patients can call and text the same number.

More importantly, you should avoid spreading messages across many source phone numbers, specifically to dilute reputation metrics and evade filters. This is referred to as “snowshoeing” and can result in your content being blocked. If your messaging use case requires the use of multiple numbers to distribute “similar” or “like” content, please discuss it with your Bandwidth rep (or other carrier rep).

Identify your brand

Application, service, or business name should be included in the content of the body of your message(s).

Example:
“[Your Business Name]: You have an appointment for Tuesday, 3:00PM. Reply YES to confirm, NO to reschedule. Reply STOP to unsubscribe.”

Use a single domain for URLs in your messages

Each campaign should be associated with a single, specific web domain owned by the customer. Although a full domain is preferred, a custom URL shortener may be used to deliver custom links.

YOUR NEXT STEP

Celebrate the wins