Consistent Triage and Advice:

Automated and Integrated at Each Contact Point

By Sue Altman

October/November 2005

Patients and callers have three sources for decision support information: their physician's office, a medical call center, or the Internet, but is the information they receive consistent between all three?  Well, until recently, it probably was not.

Physician-authors Barton Schmitt, MD and David Thompson, MD recognized the need to have consistent clinical content sets for each scenario several years ago.  They have authored triage protocol sets for use by physician offices, after hours and managed-care call centers, and consumers (parents, grandparents, teens, and adults).  Although the clinical information sets are written for distinctly different audiences (physicians, office staff, registered nurses, and members of the public), the triage questions and care advice are consistent and drive the same actions based upon the symptoms at hand.

The clinical content has been eagerly received.  More than 10,000 offices use the book by Barton Schmitt, Pediatric Telephone Protocols.  Thompson's book, Adult Telephone Protocols, was released in 2004 after years of demand for a companion to Schmitt's work.  Schmitt's and Thompson's After Hours Triage and Advice protocols are used by more than 300 medical call centers internationally - leading other content sources by a ratio of more than ten to one.

HouseCalls Online, the self care guides written specifically for use by consumers on the Internet, is the newest Schmitt/Thompson collaboration.  It is now in use or being installed by more than 30 hospitals and health plans.  HouseCalls Online has been well received by consumers of all ages.  It also extends decision support to a generation that is more comfortable online than on the telephone.

For the call center aspect, LVM Systems served as the integrators.  LVM has had the Schmitt/Thompson after-hours triage protocols in its medical call center software since 2000.  When LVM launched WebLink, its self-service Internet product, they embedded the HouseCalls Online self-care guides.  WebLink and the call center software, E-Centaurus, are fully integrated.  For the call center (and sponsoring organization), this means web "hits" or visits to HouseCalls Online can be tracked and reported directly using the call center's software.  Protocol usage can be compared and contrasted between calls received via the call center and consumers accessing the organization's website.

In 2004, LVM launched the first physician practice triage product, D.O.C., or Doctor's Office Calls.  From a content perspective, it provides an electronic version of Schmitt's and Thompson's office protocol books.  In relation to risk management, this product standardizes the process of providing telephone advice to patients and automates documentation of each encounter.  According to medical groups, it is also a conduit to getting physicians to use the same "decision system" for handling inbound patient calls. The D.O.C. product's success has been its ability to support a fast (five minute), yet thorough triage call and automate a variety of other practice functions.

But the piece de resistance is the integration of the office product with the after hours call center. This connection after the appropriate HIPAA Business Associated agreements are in place, allows:

• The physician office to view any after hours calls processed for their specific patient base and

• The medical call center to view the daytime triage calls processed by the practices for which they provide after hours service.

Some healthcare organizations are choosing to host the D.O.C. product and making it available to their affiliated physician practices.

So the opportunity is here.  The Schmitt/Thompson content can guide and support consistent decision-making - whether consumers access their physician office, the Internet or their healthcare organization's medical call center.  Also, the technology supports centralized management and reporting across the continuum.

Sue Altman of Call Center Consulting Network (3CN) can be reached at 480-706-2226 or  sue.altman@3cn.org.