In 2016 some 497,399 patients were seen at the out-patients department at the various clinics at Mater Dei Hospital. Government is committed to continue reducing waiting lists for these clinics, as part of a larger strategy to address this challenge across the National Health Service. 

Up to a third of appointments at Mater Dei Hospital out-patient clinics are missed, resulting in wasted time and clinic resources, disruption of work schedules, increased administrative burden and longer waiting lists. 

Non-attendance at out-patient clinics, not unique to Malta, may be due to a number of reasons such as logistical issues, other commitments, having subjectively improved or sometimes having doubt appointments. Scheduling, communication and timing of the appointment may also contribute to this; however several studies point to patients citing forgetfulness as one of the most common reasons for no-shows.  

Several studies in various countries and across cultures have shown that text message reminders significantly improve attendances in various out-patient clinic settings as opposed to no reminder being sent, and also contribute to higher rates of patient satisfaction and better outcomes.  

Reminding patients of their appointments by text message has been shown to improve attendance rates significantly. Reducing the number of no shows results in better continuity of care, enhances earlier diagnosis, treatment and follow-up of would be non-attendees, and improves patient compliance. Related additional staff work and associated costs are reduced or eliminated and quality of life enhanced.  

Today most people across different ages and social groups own a mobile phone. According to the Malta Communications Authority statistics, 592,923 mobile telephony subscriptions were registered in 2016, resulting in a mobile penetration rate of 135.14%.

In early July, Mater Dei Hospital embarked on a pilot project through which SMS reminder notifications are being sent daily to between 1,000 and 2,000 patients. A text message, with details of the appointment is sent 10 days and then 2 days before the outpatient appointment respectively.  All out-patient clinics are now part of this project, which was rolled out to include more clinics over three weeks. 

Text messaging is personal, respecting privacy and instant, reaching the intended person directly in a short time. Mobile phone details are documented on registration of patients and are being updated, with some 3,000 mobile number changes occurring on the Health Information System at Mater Dei Hospital during the last month. 

The SMS system is the first step in this direction towards consolidating the hospital appointment system with the aim of improving efficiency and reducing waiting times - in terms of the time to the appointment and actual time spent waiting to be seen on the day. 

The next phase, which will be implemented early next year, will allow individuals to respond to confirm or decline scheduled appointments being notified. 

This, together with extension of outpatient services to afternoons and weekends, as agreed with the Medical Association of Malta (MAM) is another step in government's strategy to tackle waiting lists.   

A new Outpatients Department is planned to be built to cater for the large demand and further reduce appointment waiting times; and more clinical specialists are being appointed.  

The public is encouraged to contact Mater Dei Hospital on 25450000 if they are not receiving notifications or would like to cancel appointments. All patients will still be receiving details of their appointments through the usual channels on scheduling of the appointment. 

mHealth services may be expanded to cover a myriad of services such as health promotion, treatment compliance, patient monitoring, surveillance and more. This year has been a positive one in terms of the implementation of various eHealth initiatives, such as the innovative myHealth IT platform. 
In the coming months Malta's Digital Health Strategy 2017-2021 will be presented, this will leap forward our technological services.  

Chris Fearne is Deputy Prime Minister and Minister for Health