What is this tool?

This application (app) is a tool you can use to send condition-specific general self-care instructions by text message (SMS message).

With patient consent, you enter the patient's Canadian mobile (cellular) phone number, select a condition, optionally add up to 200 characters of custom instructions, tap the "Send Instructions" button, and the patient receives an SMS message (a text message) with a link to the instructions and any custom instructions you wrote. The communication is one-way (instructions are sent, patient cannot reply).

The app is designed to support the discharge conversation but does not replace it. Having this conversation is still your responsibility as a medical provider, as is obtaining consent to send the patient instructions using this tool. Please see the Canadian Medical Protective Association (CMPA) guidance on informed discharge.

Use of this application should be in accordance with CMPA advice and your institution's policies. Questions? Contact us.

How should this tool be used?

We recommend you:

1. Get patient informed consent to send instructions by text message.
2. Ask for the patient's Canadian mobile number.
3. Go to the main page of our website and choose a condition.
4. Optionally add custom instructions (up to 200 characters).
5. Use the "Preview Instructions" button to review the instructions prior to sending.
6. Repeat steps 3-5 to make any required changes and then use the "Send Instructions" button to send the instructions while the patient is present.
7. Confirm the patient received the text message and can open the instructions.
8. Go through the instructions with the patient on their mobile phone in accordance with CMPA guidance on informed discharge.

To understand what to discuss with the patient as part of the informed consent discussion, please read this privacy page in full. If you have questions, please contact us before using the app.

What does the SMS message (text message) a patient receives look like?

The text message the patient receives will read:

Doctor's instructions:

[link goes here]

Removed after 14 days.

Questions? Ask your doctor. Replies not monitored.

except that "[link goes here]" will be replaced by a link that will load the instructions you have selected. These instructions will include any custom instructions (up to 200 characters) that you wrote.

Who does the SMS message (text message) come from?

The message comes from a Canadian phone number we have reserved for the purposes of this app. It does not come from your phone, even if you use this app on your mobile device.

When the patient clicks on the link, what will the instruction sheet they see look like?

Sample sheets:

• Condition "Nosebleed (Epistaxis)".
• Condition "Nosebleed (Epistaxis)" with custom instructions.

How do I review or preview the instructions before sending them out?

From the main page, select a condition and use the "Preview Instructions" button. This will open a preview window that shows the instructions, including any custom instructions you may have added.

Can I print the instructions and give the patient the printout instead of sending the instructions by SMS message (text message)?

Yes. From the main page, select a condition and use the "Preview Instructions" button. This will open a preview window that shows the instructions, including any custom instructions you may have added. After reviewing the instructions, you can print the instructions from the preview window and give this printout to the patient.

Why do some conditions not have custom instructions?

Some of our instructions are simply links to external websites and so we cannot insert custom instructions on these sites.

What sources do you use for your instructions?

We use a variety of sources. One source in particular is the Canadian Discharge Instruction Set (CDIS), a nascent project aimed at providing a high-quality collection of public domain instructions doctors can give to patients who are sent home (discharged) from hospitals in Canada. CDIS instructions are given for a specific condition, general in nature, written at a grade 5 reading level or below, kept concise, and aimed to be relevant to the Canadian context.

In general, all of our instructions are condition-specific (i.e., general self-care and return-to-care instructions for a given medical diagnosis) and do not contain details specific to the individual patient, unless you provide such details in custom instructions.

What patient information does this app collect or store?

Very little. The app has been purposefully designed to avoid storing personal health information. It does not collect or store:

• patient name, date of birth, health number, or medical record identifiers;
• patient email address or home address;
• health history, diagnoses, or free-text clinical notes.

What is recorded per visit:

• which condition sheet was sent;
• a short encrypted custom note, if you added one (up to 200 characters);
• SMS delivery status (e.g., delivered, failed);
• a randomly generated visit token used to track delivery of the SMS message;
• the site that was used (e.g., "Saskatoon Emergency Departments"), if a site-specific version of our app was used (see more on this below).

Is the patient's phone number stored?

No. The phone number is used only to deliver the SMS message (text message) and is not saved in the app's database.

How long is visit data kept?

Visit records are automatically deleted after 14 days. No manual action is required. Note that patients will no longer be able to load their discharge instructions from the link sent to them after the visit is deleted. The patient can print the instructions at any time prior to this.

Is the data encrypted?

Any custom instructions you add are encrypted before being stored in the database. All communication between your browser and this server requires an encrypted secure (HTTPS) connection. All communication between the app and our third-party SMS provider is also encrypted.

Who can access the discharge instructions?

The patient receives an SMS message (text message) with a link to their instruction sheet. Anyone with that link can view the instructions; there is no password protection. This is appropriate for general discharge handouts, which is the kind of instructions that this site provides.

Is a third-party service involved in sending the SMS message?

Yes. SMS delivery is handled by a third-party messaging provider. The patient's phone number and the contents of the SMS message (text message) are passed to that service to deliver the message. Our system instructs the SMS provider to delete records of the message when the message delivery status reaches a final status (i.e., delivered or failed to be delivered), and, as a precaution in the event the initial request failed, once again when the corresponding visit record is deleted from our system.

If you or the patient have concerns with the use of third-party messaging services, whether in general or in a specific situation, consider printing the instruction sheet instead.

Does my data stay in Canada?

This app's code, server, and database are all hosted in Canada. The third-party SMS provider may process messages outside Canada. No identifiable patient data is stored in the application database, so the data residency risk is limited.

Is this a replacement for the doctor-patient conversation?

No. As the Canadian Medical Protective Association (CMPA) notes in their guidance on informed discharge:

Handouts support the informed discharge discussion but do not replace the personal interaction. It can be very helpful to give the patient (or the person taking the patient home) written instructions. These are supplements to personal interaction, but cannot replace it.

Discharge instructions sent through this app should accompany, and are not a replacement for, a direct conversation with the patient as per CMPA guidance.

What is my responsibility as the provider?

You are responsible for ensuring instructions are provided as per CMPA's guidance on informed discharge. This includes but is not limited to you confirming that the instructions you send are appropriate for your patient's specific condition before sending. Review the content of the selected handout. If the standard instructions do not fully apply, use the custom instructions field to add or clarify, or print the sheet and annotate it by hand. Do not send instructions you have not reviewed.

If you delegate sending to a nurse or other healthcare professional, the CMPA recommends considering whether that person has sufficient knowledge and experience to provide adequate instructions, knows the patient well enough to determine their discharge needs, and is aware of the patient's specific risks. If you do choose to delegate sending to another professional, be aware that you are still ultimately responsible for the informed discharge process.

Should I use this app for sensitive diagnoses or instructions?

Use your professional judgment. The link sent to the patient is not password-protected and is viewable by anyone who receives it. For sensitive content, consider whether a link sent by text message (SMS message) is an appropriate delivery method for that patient and situation. Printing and handing the sheet directly to the patient remains a valid option.

What if I notice an error in or other issue with the instructions after sending?

If you realize the instructions contain an error or are otherwise deficient or not appropriate for this patient in this situation, address it directly with the patient before they leave. Custom instructions can be added at the time of sending to supplement, clarify, or otherwise revise the instructions in the standard handout. If in doubt, print the sheet and correct it by hand before giving it to the patient.

If the patient has already left once you realize the instructions contain an error or are otherwise deficient or not appropriate for this patient in this situation, it is your responsibility to contact the patient to supplement, clarify, revoke, or otherwise revise the instructions.

How do I document that I have used this tool to help me provide discharge instructions to a patient?

For documentation purposes, you may consider something such as:

Or, if you print the handout:

Do you track or use physician information?

No. The app does not collect, store, or use physician names, phone numbers, or credentials.

While there are currently no physician accounts, we may add this feature in the future. In so doing, we will minimize data collection and update this privacy page with further particulars.

Are there any analytics or third-party trackers?

No. The app does not use third-party analytics, advertising trackers, or any external monitoring services.

What happens when I select a site by clicking on the maple leaf-prefixed "dchome.ca" logo at the top center of the page?

This moves you to a "site-specific" version of our website. Think of a "site" as a hospital or clinic, a group of hospitals or clinics, or a practice group that may be based at one or more physical addresses. For example, the "Saskatoon Emergency Departments" site consists of the emergency departments in Saskatoon.

When you send (or preview) instructions while using the site-specific version of our site, your site's name will appear at the bottom of the instructions along with the physical addresses of the facilities associated with your site. For an example, load and then scroll to the bottom of this instructions sheet on "Nosebleed (Epistaxis)" for the Saskatoon Emergency Departments site.

If you have selected a site but later decide you do not want addresses or other site-specific information to appear in instructions you send to a patient, select the "General" site at the top of the site selection list. You can then send instructions without the site-specific information.

Note that when you print instructions, the site-specific information is always omitted; this is to minimize the number of pages printed.

Can sites have their own custom instruction sheets? Can sites override the default sheets for various conditions with site-specific sheets?

Yes to both. Each site can have custom instruction sheets that will show up in the list of conditions when the site-specific version of the app is used for that site. For example, the "Saskatoon Emergency Departments" site could have its own "Cast Care and Clinic" instruction sheet that has specific instructions on cast care and follow up information that is particular to the group in Saskatoon.

A site can also override the default instructions. For example, the "Saskatoon Emergency Departments" site could override the default asthma instruction sheet if this site has its own specific instructions or processes. Then whenever a user is using the site-specific version of our app for this site, choosing the asthma condition would show the site-specific asthma instruction sheet and not the default one.

Note that site-specific custom sheets or site-specific overrides are only present when using the site-specific version of our app for the site in question. For example, to see the "Saskatoon Emergency Departments" site custom sheets or custom sheet overrides, you have to be using the "Saskatoon Emergency Departments"-specific version of our website. To revert to the default collection of sheets, select the "General" site at the top of the site selection list.

To have custom sheets or custom overrides added for your site, please contact us. In the future we may add functionality so that sites can manage their own custom sheets and overrides directly through the app.

How do I get my hospital or site listed among the list of available sites?

Please contact us. Note that we only list accredited sites based in Canada.