2-Way SMS vs. Live Chat: Which Is Best for Bi-Directional Patient Communication?

Author: Ravi Kalidindi
Person on phone engaging with patients.

With so many bi-directional patient communication methods available, choosing the right one can be a challenge — especially with new options like chatbots and 2-way SMS texting entering the fray.

Understanding the benefits and downsides of each will help you determine which is most beneficial for you and your patients.

2-Way SMS vs. Live Chat: Which Is Best for Bi-Directional Patient Communication?

The Rundown: All Your Healthcare Communication Options

Healthcare communication involves both messages from the facility to its patients and from patients to the facility. In general, these communications fall into two categories:

  • Clinical communications (telemedicine, remote patient monitoring, etc.)
  • Non-clinical communications

In this post, we’ll focus on non-clinical communications.

Phone Calls

While phone calls are certainly a tried-and-true form of bi-directional communication, they have some significant downsides in a modern healthcare setting.

On the facility’s side, the ever-present games of phone tag with patients lead to inefficiency and wasted labor hours. On the patients’ side, wading through an organization’s phone triage system is frustrating and inefficient, as are long hold times and difficulties in contacting the right staff member for their specific need.

In smaller practices, front office staff often bear multiple responsibilities. During high-volume periods, they’re often too busy to answer phones promptly and address caller needs right then and there.

Even when facilities have a dedicated call center, difficulties arise. Call center employees frequently can’t address detailed questions in areas like scheduling, billing, or medical care.


Email offers an asynchronous alternative to the phone communication model, but with its own drawbacks. While email eliminates long hold times, it also typically comes with longer waits for responses. Staff members have to sift through and respond to each individual email, leading to increased workload and greater frustration for all parties.

Patient Portals

Patient portals are great for communicating sensitive medical information, but they aren’t the best method for non-clinical (administrative or logistical) conversations.

Patients tend not to use portals as much as facilities would like. Requiring login and password information creates a big hurdle since patients likely don’t use the portal often enough to remember their credentials. Learning to use a new system — again, one they’ll use infrequently — on the correct browser and device also makes portals far from the most seamless way to communicate. 

Online Contact Forms

While online contact forms make it easy for patients to quickly submit requests, responses usually come via email or phone — leading to the same issues mentioned above. Also, this does provide a new avenue of communication when staff need to reach patients.

Chatbots and 2-Way SMS Texting

Live chatbots and 2-way SMS text messaging have emerged as popular alternatives to more traditional forms of bi-directional patient communication.

With the fast pace of digital innovation and changes in business culture, patient behaviors have changed. When they contact a business — including a medical business — they expect a quick, thorough, and accurate response. The conventional communication methods don’t meet these modern expectations.

By offering nearly real-time responses, chatbots and 2-way SMS offer a more engaging and satisfying patient experience. Each method has its own unique benefits and drawbacks, which we’ll discuss next. 

Web-Based Live Chats

Live chatting involves a website or app popup that gives patients access to a live agent. Live chats often use AI or a similar technology to triage questions before connecting the patient to a live agent.


Live chatting removes certain obstacles that come with phone communication, like long wait times and phone tag. It offers a secure channel of communication, which helps providers stay compliant with HIPAA regulations. 


If you employ web-based chat, patients will expect immediate, real-time responses. You have little ability to influence this expectation since it’s formed by the nature and history of the tool itself, not by your business.

Fulfilling this expectation can be resource-intensive, as it requires around-the-clock staff to answer questions. Front office staff may be busy with other tasks and unable to answer questions immediately — similar to the phone system issue. And similar to the call center problem, dedicated live chat staff may not have the expert answers a patient needs when they initiate a chat outside of office hours.

Chatbots are also vulnerable to user frustration that results when patients lose the chat session. For example, if a patient accidentally closes the chat popup, gets busy on a different browser tab, or exits their browser, the entire chat may have to be restarted.

Further, when chatbots use AI or similar technology to auto-respond, you need to be aware that your patients may miss the human connection.

2-Way SMS Chat

Alternatively, 2-way SMS texting allows practices and patients to communicate through standard text messages. For patients, it’s a simple matter of using a tool they already use all the time. On the staff side, it’s done through a web-based dashboard on their computer (so, no, your staff doesn’t have to be on their phones all day).

Patients usually initiate SMS chats through a contact form on the practice’s website or by texting a dedicated number. Staff can also initiate SMS chats to reach patients when needed.


Since patients already know how to text, SMS chats decrease the likelihood of user errors that interrupt communication. Unless the patient intentionally deletes the chat thread, they can pick the conversation back up at any time they want. It’s never lost, and they can always see the chat history.

SMS texting doesn’t carry the same expectation of immediate answers as live chat. While some form of real-time response is necessary, texting behavior allows for more buffer in reaching a resolution.

This is helpful in triaging SMS texts and routing them to the appropriate parties, as well as in removing the need for 24/7 availability. A message that lets patients know the appropriate staff member will reach out in X hours is adequate, and it leaves them free to go about their lives instead of being tied to their phones on hold.

When managed through a proper dashboard, 2-way SMS chat is more efficient for staff than traditional communication methods. Staff members receive a notification when a message comes in, and they can view it when their responsibilities allow. They have the full context and history of the conversation available right in front of them, making responding simple.

When front office staff need to reach out to patients, SMS texting is a far more natural method than a chatbot. It allows staff to contact patients in a way that’s comfortable and familiar to them, while also increasing the likelihood of productive responses. 

Quote Card: 2-Way SMS vs. Live Chat: Which Is Best for Bi-Directional Patient Communication?


While SMS messaging enhances communication, it comes with a few limitations, particularly regarding data capture. For instance, images, forms, and screenings can’t be sent over SMS chat.

For this reason, it’s critical to integrate SMS chat with a data capture service, such as a digital forms platform. As an example, Simple Interact’s 2-Way SMS Chat integrates with our full suite of tools, including digital patient forms, to seamlessly capture patient data during a 2-way SMS conversation.

Price is another factor to consider. Because SMS messages are charged based on character count, they’re usually more expensive than a live chatbot. Some vendors also mark up the price more than others, so be sure to compare services.

HIPAA Compliance and Security

While SMS chat is a more natural form of communication than live chat for non-clinical communication, it requires taking some specific steps to ensure messaging remains HIPAA compliant for you and your patients’ protection:

  • Ensure that there is a business associate agreement throughout the chain of all the technology vendors used to implement SMS functionality.
  • Publish your SMS messaging policy on your website for complete transparency.
  • If needed, include additional consents in the chat request form for your patients to accept.
  • Train staff to not share protected health information (PHI) in the clear over SMS, as the tool should be used for administrative communications only, not telemedicine.
  • Use integrated tools like secure digital forms to gather PHI data when needed during a conversation.
  • Use a system that saves and stores completed conversations in the patient’s record.

It’s important to strike a balance between patient convenience and security-related constraints. While web-based chats offer more innate security, you miss out on the high patient participation you get with 2-way SMS chat, which can be just as secure with the proper training and precautions.

Using 2-Way SMS Chat for Patient Referrals

When a patient is referred, you have a limited timeframe to reach out to them before they move on to another provider. That’s why it’s important to contact, qualify, and schedule them in a timely manner. With proper usage, 2-way SMS chat is a great way to open this line of communication and quickly book referral appointments.

Some EHRs classify referred patients as “prospective” patients in the EHR system. Simple Interact’s 2-Way SMS Chat is able to pull from this prospective list, even though they aren’t yet official patients, and allow staff to begin conversations with them.

Moving Forward: Bi-Directional Communication in the Future

For healthcare organizations struggling with time wasted playing phone tag, long phone hold times, patient frustration, and staff burden, 2-way SMS chat is an excellent way to reduce inefficiencies and improve the patient (and staff!) experience. Of course, 2-way SMS doesn’t completely replace other means of communication, but it’s a strategic addition that significantly reduces reliance on less efficient methods.

Moving forward, we’re excited to enhance our existing secure data capture with secure messaging. We’re also providing practices with the ability to conduct deeper real-time analysis and reporting on SMS chats, facilitating improved training and tracking. Additionally, we’re leveraging AI technology to continue reducing the burden on staff with templating and auto-correct capabilities.

Contact us to learn more about how our solutions can improve the efficiency and reliability of your practice’s bi-directional patient communications.

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