Interested in using WTH as a tool to send reminder texts for prep steps and appointments for Penn Medicine patients who are scheduled for colonoscopies across the health system.

Shivan Mehta, MD, MBA, MSHP
Clinical Lead
Jesse Green, MD
Clinical Lead


Colorectal cancer is the second leading cause of cancer death in the US, yet there are effective screening and treatment strategies that allow for early detection and treatment. Colonoscopy requires a complex process to identify an escort, purchase the preparation, take a day off from work, adhere to a clear liquid diet, and complete the split-dose preparation as recommended. This results in a significant no-show and cancellation rate, along with suboptimal preparation quality, which can lead to non-adherence and incomplete screening.

Intervention and Design

The intent is to design, develop, and evaluate an automated colonoscopy engagement service that is integrated with routine clinical care. The researchers will evaluate the effect of this automated navigation program on show rate with adequate preparation quality. The initial user testing on 21 patients to evaluate feasibility and inform the design of the messaging content. The next step will be to conduct a randomized controlled trial comparing the intervention to usual care control. This proposal has the following aims:

Aim 1: To assess feasibility and conduct user testing for an automated text-message navigation program focused on colonoscopy preparation.

Aim 2: To compare the effectiveness of a text-message navigation program on show rate and preparation quality, as compared to usual care.

Way to Health Use

  • Enrollment through Epic EHR to simplify recruitment efforts
  • Outbound and bi-directional text messaging to engage patients four days prior to colonoscopy appointment with preparation guidelines and instructions.

Preliminary Results of Feasibility Pilot

Of the 21 patients enrolled in the pilot: - 19 showed up for appointments, 2 cancelled prior to the appointment, and zero patients were no shows. Current rate at the pilot site is around 40% no show rate. - 84% came to the appointment with good to excellent prep quality by following instructions administered in the text messaging.