 Existing research of telephone reminders and family based contracts have been shown to be effective at increasing adherence to treatment sessions such as hemodialysis and improving overall appointment attendance in the outpatient clinical system. Unfortunately, the compliance rates were also found to decrease within a three month period after the intervention was discontinued. The biggest obstacle to a clinic to implementing and maintaining such a system is the costs associated with running the program, primarily the cost of employing staff to make phone calls and continuous follow-up. Electronic systems to provide reminders to patients at their preferred time, in their preferred format, such as a text message or a phone call. In a study of primary care outpatient appointment attendance, the no show rate was reduced by both electronic reminders by 10. By cost-benefit analysis, it was determined to be financially beneficial to generate reminder messages for patients with a no-show probability of 5. 