Every October, Breast Cancer Awareness Month reminds patients and health systems of the same reality: screening saves lives, but awareness only matters when eligible women can book, confirm and attend their mammogram.
NL Health Services’ Breast Screening Program made that its focus with Carrick, replacing an overloaded phone line with one patient communication channel for text, calls and voicemail.
About NL Health Services
NL Health Services, the provincial health authority for Newfoundland and Labrador, first piloted Carrick’s automated text reminders at 9 sites to cut missed appointments. The results led to a province-wide agreement covering family care teams, surgery, screening and other programs.
“This small pilot quickly evolved into a multi-site initiative that has enhanced the patient experience, reduced no-show rates, and improved workflow for frontline teams.”
The Breast Screening Program adopted Carrick under that agreement for mammography booking, reminders and patient questions.
The challenge: a phone system that could not keep up
Patients struggled to get through, and staff spent their days on calls and voicemail.
Four pressures sat underneath:
- 1
Missed mammogram appointments
A no-show is more than an empty slot: it can delay detection and waste capacity another woman could have used.
- 2
A phone system that couldn’t keep up
A single, outdated phone line carried nearly everything. High call volumes overwhelmed clerical staff, a broken queue left patients waiting, voicemail became another backlog, and mailed reminders were slow and one-way.
- 3
Manual reminders and follow-up
Outreach depended on staff calls and manual follow-up. With no automated path from appointment booked to patient confirmed, outreach was capped.
- 4
Turning awareness into attended appointments
Awareness alone does not fill a schedule. Patients needed to book, confirm, cancel, reschedule or ask a question in the moment, without waiting on hold.
Why text?
Phone lines that handle scheduling and clinical questions cannot also carry outreach to tens of thousands of women, and letters bring low response and no confirmation data.
Text reaches patients on the device they already carry. No app download. No portal login. No new account. Patients reply in the same thread, and staff see it in real time.
Across a dispersed, largely rural province, that mattered.
How it was implemented
The program built its channel in stages, each live before the next, so staff adopted one tool at a time.
Pilot
Multi-site text reminder pilot
Scale
Province-wide procurement across NLHS
Stage 1
Automated reminders and two-way text
Stage 2
Smart voicemail
Stage 3
VoIP soft phone, all-in-one
- 1
Automated reminders and two-way conversations
Patients confirm, cancel, reschedule or ask questions by text, and staff manage every reply from one inbox instead of playing phone tag.
- 2
Smart voicemail
Voicemails are transcribed and summarized for quick triage, and callers can be moved from phone to text.
- 3
VoIP soft phone
Calls now sit alongside texts, voicemail and conversation history, so staff manage the whole patient journey in one channel.
Built for public health: privacy, compliance and integration
Carrick meets PIPEDA and PHIPA (Canada) and HIPAA (US) requirements, with a signed Business Associate Agreement on every plan.
In this first phase, Carrick worked alongside the existing scheduling system: staff kept booking as before, while patient conversations moved into Carrick. Salesforce integration is next.
The outcome
No-shows fell by two-thirds, and the same team now screens 10% more women with no additional staff. For a screening program, that means more chances at early detection and fewer wasted slots.
“The phone system was transformative. Bringing texting, phones and voicemail together gave the program a multi-modal communication channel that changed how patients reach us and how staff manage conversations. That all-in-one approach was key to the success of the Breast Screening Program.”
What staff and patients say
“It has significantly reduced the time staff spend calling patients and responding to voicemail… As well, patients are finding it much easier to contact the clinic, ask questions, and book or adjust their screening appointments.”
- 92%
- Staff found Carrick easy to use
- 96%
- Staff say it improved their workflow
- 83%
- Patients found texting the clinic easy
- 81%
- Patients feel confident communicating by text
Staff and patient survey across NL Health Services’ Carrick deployment (2,000+ positive patient reviews).
Running a screening program? See how Carrick could cut no‑shows and free up your team. A 20-minute walkthrough, no obligation.
What’s next: moving pre-screening upstream
Today a clerk asks each woman eligibility questions (age, cancer history, past mammograms) before she can be booked. The next phase moves that step upstream.
Now
Request by phone or text; clerk pre-screens
Next
AI pre-screening agent
Then
Salesforce integration
Result
Request → pre-screen → book, with staff oversight
Carrick is set to deploy an AI pre-screening tool that will:
- Ask eligibility questions directly and collect the answers
- Present answers to staff in a structured format for faster booking
- Answer everyday questions like “Will it hurt?” without adding call volume
After that comes full integration with the patient database and Salesforce scheduling, so patients can request, pre-screen and book with minimal manual handling while staff keep oversight.
Why it matters
Breast cancer is one of the most common cancers in Canadian women, and stage at diagnosis changes everything:
- Five-year survival, stage I
- 99.8%
- Five-year survival, stage IV
- 23%
- Treatment cost per woman per year, stage I (Ontario)
- $15.6K
- Treatment cost per woman per year, stage IV (Ontario)
- $137K
Every missed mammogram is a lost chance to catch cancer early. That is why these results matter.
Key takeaways
- 1
Fix the channel before you scale outreach
One channel absorbed the volume that had overwhelmed the phone line.
- 2
Move beyond one-way reminders
A reminder that cannot receive a reply does not close the loop. Two-way text is what drives no-shows down.
- 3
Meet patients on the device they already use
No download, no portal, no account. Confirming a mammogram should feel like any other text.
- 4
Measure staff capacity alongside patient outcomes
The capacity gain came from the same team. That belongs in the business case.
Frequently asked questions
What is Breast Cancer Awareness Month in Canada, and when does it take place?
Breast Cancer Awareness Month in Canada takes place every October. It is a national campaign period that raises awareness of breast cancer risk, promotes early detection, and encourages eligible individuals to book screening mammograms.
Who is eligible for breast cancer screening in Newfoundland and Labrador?
Breast cancer screening mammography is available to individuals aged 40 to 74 in Newfoundland and Labrador.
Self-referral is available through the MyHealthNL app or by calling the screening navigator line at 1-800-414-3443.
Screening is offered at five provincial locations:
- St. John's
- Gander & Grand Falls-Windsor
- Corner Brook
- Happy Valley-Goose Bay
- Labrador West
How did NL Health Services reduce breast screening no-shows by 67%?
The NLHS Breast Screening Program deployed Carrick, a patient communication platform, to replace a broken phone-based workflow with two-way text messaging.
Patients receive appointment reminders through native SMS with no download or login required and can confirm, cancel, reschedule, or ask follow-up questions in the same thread.
Smart voicemail transcribes and summarizes messages for faster triage, while an integrated VoIP soft phone brings calls, texts, and voicemail into one channel.
Staff manage all interactions from a unified inbox without toggling between systems.
Can Other Healthcare Organizations Use Carrick for Breast Screening Outreach?
Yes.
Carrick can support screening programs that need high-volume reminders, two-way booking conversations, cancellations, rescheduling, voicemail triage, and integrated phone workflows.
The NLHS Breast Screening Program shows how a screening team can reduce no-shows, increase capacity, and improve patient and staff communication without adding human resources.
Building on the success of the Breast Screening Program, Carrick is also expanding to serve the NLHS Colon Screening Program.
Sources: Five-year cancer survival by stage at diagnosis in Canada, Statistics Canada (2023); Updated breast cancer costs for women by disease stage and phase of care, Statistics Canada (2024); Canadian Cancer Society survival statistics. Program results reported by NL Health Services.