This article provides an overview of SMS Deliverability in relation to Artera messaging.

Artera SMS Deliverability Goals

At Artera, our goal is to ensure that every patient with a working phone number receives intended messages from our clients. We take considerable efforts to ensure SMS deliverability through our platform.

What is SMS Deliverability?

SMS Deliverability refers to whether an SMS message sent from the Artera platform is received by a patient. For most failed SMS messages, an undelivered Event Message appears in the Patient Channel within about 30 seconds of message failure. However, it may take up to 10 minutes to assign the final failed status to the message within Artera, based on when Artera receives a rejection from the patient's phone carrier. If no system message appears within 10 minutes, the message was delivered successfully to the patient's phone carrier.

Deliverability Efforts

There are many factors that may hinder the deliverability of a message, such as carrier outages or messages being marked as spam. Artera is deeply connected to messaging and carefully tracks deliverability across our platform. We take considerable steps to maximize deliverability wherever possible and keep our users informed.

Internal Monitoring Efforts

As message deliverability is a core function of the Artera platform, we employ many internal dashboards and reports to assess problems with phone numbers or carriers. Our internal monitoring enables us to quickly identify any possible issues and work with carriers to resolve them quickly.

By using automated alerts and flags, Artera provides the best possible functionality to our users.

SMS Deliverability Factors

There are various reasons for a message failing or showing as undelivered. Some are a result of the connectivity of a patient's phone, though there are other possible causes that Artera can work to resolve:

• Automation Length: Automations over 1,600 characters will fail to deliver.

• Prepaid Mobile Numbers: Prepaid phones that are either off or out of service when Artera tries to send communication will fail to deliver. 

• Carrier Opt-Outs: Aside from opting out of communication from the Artera platform, most mobile users have the option to opt-out of SMS at the carrier level. Although the number appears as SMS-enabled in Artera, the carrier cannot deliver SMS messages to the patient.

• Bad Phone Numbers: Sometimes the phone number provided is incorrect, out-of-date, or entered incorrectly. When messages fail to deliver, we recommend making a note on the patient’s chart in the EMR to verify their contact information on their next visit.

• Carrier Filtering: Carriers have the ability to filter mass messaging as spam. This causes the carrier to cancel the transaction and may impact the deliverability of similar messages to patients using the same carrier. Unwanted messages can result in complaints, fines, or outright disconnection by carriers. Mobile users who receive lots of spam or other unwanted messages may decide to start opting out of or ignoring all messages from businesses, even legitimate ones who follow all rules and best practices. We suggest including patient names in messaging by using the appropriate Smart Phrases to avoid this issue as personalized messages have a lower overall rejection rate.

Carrier Relationships 

Artera has a very interactive relationship with our patient’s phone carriers that includes 24-hour support and a dedicated communication channel between Artera employees and carrier representatives. Artera is always working on increased deliverability with each carrier. Artera has Carrier Programs specific to each carrier that allow our phone numbers to be whitelisted within their system which largely prevents carrier filtering. Each carrier is configured differently, therefore Artera's approach to each Carrier Program varies. 

• AT&T and Verizon: Artera is whitelisted within their systems which allow us to send messages without them getting filtered out or marked as spam. Artera works directly with these carriers whenever we see low deliverability rates in our reporting or when there is a carrier-specific issue to maintain the relationship.

• T-Mobile and Sprint: We rely on API calls for T-Mobile and default to sending messages from toll-free lines due to potential false "delivered" statuses. To improve deliverability and avoid false statuses, patients with T-Mobile will not receive any messaging from long code numbers (these are the phone numbers (s) associated with your Practice). Sprint, under the ownership of T-Mobile, follows the same procedure. 

• Non-major Carriers: Smaller carriers have fewer resources to collaborate on deliverability methods, though Artera whitelists whenever possible. These carriers may be more prone to issues with links or carrier filtering, but we are constantly monitoring these cases to make improvements in the process wherever possible. We achieve this by reverse-engineering any issues that may arise.

Registering customers on a new framework, working to get rid of spam via carrier filtering, and whitelisting Artera phone numbers takes time but ensures better deliverability. Artera also uses a Fallback Process when sending messages to ensure the highest percentage of deliverability.

Artera's Fallback Process

Our fallback process is designed to ensure the highest rate of message delivery possible.

Although most patients use major phone carriers such as AT&T, Verizon, and Sprint/T-Mobile, Artera partners with more than 50 providers to deliver SMS messages.

Two-Step Delivery Process

Before an SMS message is sent to a patient, Artera determines whether the phone is text-enabled. If the phone number is text-enabled, Artera attempts to deliver the message through two methods in the following order:

1. The message attempts to send from your Practice Line (Long Code number);

2. If the carrier does not accept the message, then the message will attempt to send from the High-Volume Toll-Free Number associated with your Enterprise.

In the event that these two methods fail, users will be notified in the Patient Channel that the message was not delivered. Click here to learn more about failed message notifications. 

Long Code 

Long Code numbers are the standard format for most phone numbers. Your Practice Line(s) are examples of long code: (xxx) xxx-xxxx.

• Pros: Sending with a long code provides the ideal patient experience, as they receive messages from your Practice's phone number.

• Cons: Some carriers, such as T-Mobile, may filter long code numbers and mark them as spam.

Toll-Free

Any outbound SMS/MMS message that fails to deliver using Long Code will be sent from a dedicated Toll-Free Line specific to your Enterprise. To identify the toll-free line tied to your Enterprise, navigate to Enterprise Settings > Default Settings > High Volume Number.

Toll-free phone numbers typically start with 1-800 or 1-833 and do not correspond to a specific identity within CallerID.

• Pros: T-Mobile has a higher delivery rate with toll-free numbers. Toll-free numbers also allow Artera to retain the original phone number, even if you change your service provider.

• Cons: Some patients may be wary to respond to a toll-free number, especially concerning medical information. If the patient does not save the number as a named contact in their phone, they may view incoming messages and spam or unwanted solicitation.