Texting and emailing patients

Three of the tabs on a patient's conversation are written channels: SMS, Email, and In-App. They share one composer and one history, so the choice between them is about the message, not the tool. This article covers what's specific to each. For the inbox itself, see Omnichannel — one inbox for every conversation.

Choosing a channel

• SMS is immediate and gets read. Use it for anything short and time-sensitive — a confirmation, a "we're running ten minutes late", a link. It's also what patients reply to fastest.
• Email carries detail. Use it for anything with a document attached, anything the patient will want to find again, or anything too long to be a text.
• In-App is the secure channel. Use it for anything you wouldn't put in a text or an email — it never leaves the portal, and the patient reads it after signing in.

Nothing stops you from mixing them. A text saying "I've emailed you the instructions" is a perfectly good use of two tabs.

Texting

Open the person's SMS tab and write. Your practice number is the sender; the tab's subtitle shows the number you're texting.

As you type, the composer counts characters and segments. A text longer than 160 characters is sent as several segments joined back together on the patient's phone — it still arrives as one message, but each segment counts, and very long texts read badly. If you're past a couple of segments, it's probably an email.

Replies come back to the same tab, from the same number, and show up wherever the conversation is open — the Chats page, the floating messenger, the patient's row in the list.

Consent and opt-outs

Patients should only be texted after giving express consent — recorded on their profile when they're added, or by the patient in their portal — and Ona keeps the opt-out side compliant for you. Every automated patient text carries "Reply STOP to opt out". A patient who replies STOP (or UNSUBSCRIBE, CANCEL, END, QUIT) is opted out immediately and receives a confirmation; their SMS tab stays readable, but no further texts are sent until they reply START or YES. HELP returns a short explanation of the number. These keyword replies are handled before they reach the conversation, so nobody has to act on them.

Automated texts — appointment reminders, confirmation requests, form links — travel over the same number and appear in the same SMS thread, so your team sees what the patient was already sent before writing to them (Notification settings).

Emailing

Open the person's Email tab. A new thread asks for a subject; replies keep it. Change it later from the conversation menu with Edit subject.

Messages send from your practice address and replies land in the same tab, attachments included. A patient can also start the conversation by writing to the address directly; if the sender matches a patient or lead on file, the thread opens under them, and an unknown sender becomes a new lead.

Email is the right channel for anything with a file: a consent PDF, a lab result, instructions. Attachments the patient sends show inline in the thread and can be opened or downloaded from there.

Messaging in the portal

The In-App tab is the patient's secure thread — the same conversation they see under Chats in the patient portal. It's available for every patient with a portal account, and for a lead only once they've been converted to a patient.

On the patient's side there are no tabs and no internal tooling: one thread with their care team, and a notification when someone writes (The patient experience).

In-App messages never leave Ona, which makes the tab the right home for anything clinical. It's also the channel that appointment and form notifications point patients back to when they sign in.

Keeping notes off the channel

Every one of these tabs has the Message / Internal toggle. Switch to Internal before writing and the message stays with your team, whatever the tab — the patient never receives it by text, email, or portal. That's where "call back after 3pm" and "@Dana can you take this one?" belong, and it's covered in Internal notes and mentions.