Health Navigator Partners With ERatHome

Expands access to care and medical information for retail clinics and home-based urgent care services

Health Navigator announced it has partnered with ERatHome, a network of retail clinics and home-based urgent care services, to expand access to providers and control the flow of medical information between patients and clinicians. As part of the collaboration, Health Navigator will support ERatHome’s Hive application, which is designed to share medical records and treatment history among care teams, provide patients with 24/7 access to doctors, facilitate appointment scheduling, send automated reminders and alerts, and share patient education resources.

“ERatHome provides a valuable opportunity to expand access for patients and providers through its Hive application. This partnership will introduce consumers to a new level of care convenience that includes valuable aftercare instructions and resources,” said Patty Maynard, senior vice president of business development, Health Navigator. “Health Navigator aims to enhance the patient experience with easy-to-understand clinical information in plain language, which makes the Hive application an ideal match.”

Patients in the ERatHome network can use the Hive app to call or schedule a virtual visit with a doctor. Doctors use patient information to make a preliminary diagnosis based on symptoms and suggest the next steps to take. Health Navigator provides a diagnostic decision-support platform that features clinical codes, symptom checking intelligence, and process analysis for clinicians. By integrating Health Navigator’s comprehensive set of codes and analytics, ERatHome provides a more accurate, efficient diagnostic process, which can produce improved outcomes.

Moving From “Sick Care” to “Health Care”


LVM Systems


By Mark Dwyer

In 2012 our government enacted legislature that mandated U.S. hospitals reduce re-admissions by emergency departments (ED) admits for the first thirty days post discharge. To force this change in behavior, rather than waiting for hospitals to choose to proactively address the overall health of their communities, the government began penalizing hospitals who had higher than average readmission rates through a deduction in their reimbursed Medicare payments.

This was a radical change in American healthcare as it put the onus of keeping patients well on the hospitals and providers who treated them. No longer could hospitals simply wait for individuals to require hospital care, rather it became their responsibility to proactively manage ED admitted patients for at least the first thirty days post discharge. If they were unsuccessful in providing the patient with the tools and help needed to keep them from re-admitting, they bore the weight of a financial penalty.

Initially, the penalty amounted to 1 percent of the hospital’s total annual Medicare reimbursement. It was tied to three specific DRGs (diagnosis related groups): acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Each hospital was scored against its neighboring hospitals to determine which ones had readmission rates in the highest twenty-fifth percentile of their surrounding hospitals. If a patient who had been admitted via the ED due to one of these three DRGs required readmission within thirty days post discharge, and the hospital’s readmission rate was in the highest twenty-fifth percentile of hospitals in the area, the hospital’s overall annual Medicare reimbursement was reduced by 1 percent. Although 1 percent may not seem like a lot, when it was applied against the hospital’s entire Medicare reimbursement dollars it was significant—especially for hospitals operating with only 2-3 percent profit margins.

But the government didn’t stop there. In year two of the program, the percentage of Medicare reduction was increased to 2 percent of the hospital’s total annual Medicare reimbursement amount. Then in year three, not only was the percentage again increased to 3 percent of the hospital’s overall Medicare reimbursement, but three additional DRGs were added: elective knee replacement, elective hip replacement, and chronic obstructive pulmonary disease (COPD).

At this point many hospitals began paying attention, especially when over 2,200 U.S. hospitals were penalized for failing to reduce their readmission rates. To address this ever-increasing reimbursement reduction, hospitals had to implement programs to manage Medicare patients post discharge for at least the first thirty days. To do so, many home grown programs were introduced with varying success.

A number of healthcare software vendors also began developing and marketing programs to help educate and manage the patients post discharge. Some of these programs involved on-site care management visits, phone calls, reminder texts, and emails. Some also involved extensive motivational programs designed to not only assist the patient in remaining proactive in their care but also the patient’s caregiver. Too often the Medicare patient’s primary caregiver is their elderly spouse who is also battling a litany of health issues. Assisting them and other familial caregivers was determined to play a critical role in the process.

But what about the many patients who suffer from more than one chronic disease? Some vendors realized that many Medicare patients suffer from co-morbidities. It is not unlikely for an individual with diabetes to also be obese or someone with HF to have been admitted with an AMI DRG. Initially, since these various disease states were defined as separate care plans, patients suffering from co-morbidities experienced multiple interactions post discharge to manage all conditions that could possibly result in a costly readmission.

To motivate patients and their caregivers to follow post-discharge instructions regarding medications, to make and attend post-discharge provider appointments, and to integrate with the hospital’s care management or medical call centers, vendors have begun collaborating with leading content developers. By adding patient educational and motivational training content to their software programs, post-discharge programs can enable the nurse or care coordinator conducting follow-up calls to select the specific information needed to address each of the patient’s multiple issues. This co-morbidity program approach eliminates the need for redundant calls to address each of the patient’s healthcare issues. Instead it enables the nurse or care coordinator to select the content, surveys, motivational scripts, and other resources needed to meet all of the patient’s unique needs across a wide array of health conditions.

Future thinking hospitals and providers who see the need for follow-up beyond the initial thirty days post discharge are beginning to take a stand for long-term health management by using customizable co-morbidity programs. This is a real step in the direction of healthcare management. Imagine a future where healthcare generates greater revenues from having empty beds, keeping area residents healthy and at home.

LVM SystemsMark Dwyer is the COO of LVM Systems, Inc. For more information about LVM’s Co-morbidity Care Management Program (CCMP), contact LVM Systems sales at 480-633-8200 x223 or info@lvmsystems.com.

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The Contact Center’s Role in Reducing Readmissions

LVM Systems


By Traci Haynes MSN, RN, BA, CEN

reducing-readmissions-2

Reducing hospital readmissions has been a focus of the healthcare environment for many years. Steven Jencks MD, dubbed by many as the father of readmission research, along with Mark Williams MD and Eric Coleman MD, analyzed medical claims data from 2003-2004 to describe the patterns of rehospitalization and its relationship to demographic characteristics of hospitals.

They learned that almost one-fifth (19.6 percent) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within thirty days. They also found that 34.0 percent were rehospitalized within ninety days; and that 67.1 percent of patients who had been discharged with medical conditions and 51.5 percent of those discharged after a surgical procedure were rehospitalized or died within the first year after discharge.

Furthermore, of the 50.2 percent of patients rehospitalized within thirty days post medical discharge to the community, there was no bill for a visit to a physician’s office between the time of discharge and rehospitalization. Additionally the average length of stay (LOS) of rehospitalized patients was 0.6 days longer than that of patients in the same DRG (diagnosis-related group) whose most recent hospitalization had been at least six months prior. The cost to Medicare for rehospitalizations in 2004 was $17.4 billion (Jencks, S.F., Williams, M.V. & Coleman, E.A., 2011).

In 2007, the Medicare Payment Advisory Commission (MedPAC) reported to congress that 13 percent of patients rehospitalized within thirty days of discharge in 2005 were for reasons potentially preventable. These readmissions accounted for $12 billion in Medicare spending.

As a result, the Patient Protection and Affordable Care Act (PPACA) of 2010 mandated that the Centers for Medicare and Medicaid Services (CMS) implement a program in which hospitals with higher-than-expected readmission rates for certain designated conditions experience reductions (penalties) in their Medicare payments. Beginning in October, 2012, the hospital readmission reduction program (HRRP) began adjusting hospital payments based on excess readmissions within thirty days of Medicare patients following myocardial infarction (MI), heart failure (HF), and pneumonia hospitalizations.

The maximum penalty at that time was 1 percent of a hospital’s base Medicare reimbursement rate per discharged patient. Beginning October, 2013 the penalty increased to 2 percent and then to 3 percent the following year (2014). The first year more than 2,200 hospitals were penalized for failing to meet standards, with 8 percent incurring the maximum penalty. In addition to the MI, HF, and pneumonia penalties, readmission penalties now include elective knee and hip replacements and chronic obstructive pulmonary disease (COPD).

The healthcare reform mandate required addressing a long-time quality issue. According to Bisognano and Boutwell, the primary reasons for readmission were no physician follow-up visit, medication discrepancies, and communication failure during transitions of care (Bisognano, M. & Boutwell, A., 2009). Eric Coleman MD and others identified poor information transfer, poor patient and caregiver preparation, and limited empowerment to assert preferences as the primary reasons for readmission. Contributing factors include nurses not having time to thoroughly address the needs of both the patients and caregivers upon discharge, the hospital setting not being conducive to education that will drive behavior change before discharge, and the care continuum breakdown between hospital discharge and the hand-off to primary care (Coleman, E.A., Parry, C., Chalmers, S., & Sung-joon, M., 2006).

The uneven impact of the penalties has been a significant concern for hospitals that care for a larger number of low-income patients. They claim it is more difficult for their patients to adhere to post-hospital instructions including payment for medications, dietary modifications, and transportation to follow-up appointments.

To address these challenges some hospitals have implemented measures including discharging patients with medications, home-visits, and follow-up calls. Other interventions include hiring specialty care coordinators and transition coaches to provide follow-up care for patients with multiple comorbidities, providing patients with extensive teach-back for multiple days prior to discharge so they’ll better know what to do once they are discharged. In addition, many include comprehensive medication reviews with a clinical pharmacist.

The contact center can be an integral team player in reducing avoidable readmissions by enhancing the quality of care in the hospital-to-home transition through the combined capabilities of technology and human interaction. While discharge planning should begin upon admission to the hospital and include arranging for durable medical equipment (DME), transfer to step-down as appropriate, home health care, transportation needs, communications with primary care providers (PCPs), and discussions with caregivers, the extended care team which includes the PCP, caregivers, pharmacist, and other members of the interdisciplinary team can be greatly improved by the services of the contact center in helping to comprehensively coordinate the patient’s care.

The patient and their caregivers will also benefit from the reinforcement of information provided, teach-back, appointment reminders, and coordination of services including transportation, as well as medication reconciliation and symptom assessment resulting in earlier interventions and improved outcomes. Extending the contacts beyond the thirty-day penalty period will bring even greater benefits to patients and caregivers that may prolong readmissions indefinitely.

What readmission reduction activities are occurring within your organization? What is your contact center’s role in reducing readmissions? What level of service do you or can you offer?

Some contact centers make one post-discharge call to review the patient’s diagnosis, instructions, medications, education materials, and ensure the patient has scheduled their follow-up appointment with positive results. Others make several outbound calls to the discharged patient including a call within the first twenty-four to forty-eight hours post-discharge.

In addition the call center staff or care coordinator may reach out to the patient again after their first appointment, which ideally occurs within seven days post-discharge. This call typically is used to review the follow-up appointment instructions, any changes in medications, assist in referrals and scheduling with additional providers or resources, and communicate to the interdisciplinary team as appropriate. During this contact, biometric monitoring may also be tracked through technology or as self-reported by patients or caregivers.

Whatever level of service provided, it’s a win-win for the patients, their caregivers, and the organization. Utilizing the contact center to identify and implement communication strategies that effectively engage the patient and their caregivers adds value to the organization and the opportunity of better outcomes for their patients.

LVM SystemsTraci Haynes, MSN, RN, BA, CEN is director, clinical services at LVM Systems, Inc.

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Three Ways Telehealth Can Improve Access, Workflow, and Patient Satisfaction



By David Thompson

Dr. David ThompsonConsumers are increasingly choosing telehealth encounters over visits to the doctor’s office or the ER. In fact, it’s estimated that by 2020, 78.5 million consumers will be using e-Health applications. Why? It boils down to cost and convenience: telehealth encounters are convenient and easy to fit into busy schedules and lifestyles, and they often cost less than a clinic, urgent care, or ER visit.

Telehealth is also growing because it offers a number of benefits for healthcare professionals. These include improving patient access to care, delivering a more consistent workflow, and facilitating better communication between healthcare providers along the care continuum.

Are you not sure if investing in a telehealth strategy is right for your organization? Consider the following ways in which this technology can give your organization a boost:

1) Expand Access to Care: The shortage of healthcare professionals is no secret. About 20 percent of Americans live in rural areas without easy access to primary care or specialty medical services. Hospitals, health systems, nurse advice lines, and medical call centers can use telehealth solutions to:

  • Connect with patients outside clinics, urgent care, or emergency rooms using the patient’s preferred channel of communication, be it text message, web portal, or phone call
  • Provide nurse-led telephone triage of patient symptom calls and nurse-led education for health information calls
  • Deliver physician-led (or advanced practice provider) telemedicine care, such as audio and video encounters with patients in their own homes

Access to care can also affect patient satisfaction, and happy patients are more likely to return to your healthcare system and to you, as a provider of care.

2) Improve Consistency and Safety in Clinical Workflows: Recent e-Health technologies can also drive novel improvements in clinical workflow. For example, telehealth platforms can help your staff:

  • Capture the reason for the visit quickly and accurately: What is the patient’s chief complaint?
  • Prioritize care delivery: Who should the nurse or doctor speak to first?
  • Suggest the most relevant telephone triage guidelines for medical call center nurses: What is the best treatment guideline for the patient’s chief complaint?
  • Identify health information resources: What additional information or Internet resources could be shared with the patient?

Keep it simple. Did you know that e-Health technologies can use natural language processing that takes patient free-text input (“I have chest pain and trouble breathing”) and translate that into data? This natural language processing codes the patient text for chief complaint, acuity, and SNOMED and ICD10 codes.

This pre-process structured data can then be used by a telehealth platform to automatically place patient cases in rank order, based on the severity of the individual’s chief complaints. The telehealth platform can also automatically red flag higher acuity cases for more immediate attention or prioritized follow-up.

A nurse or a doctor can then speak with patients based on their order in the queue, using acuity level, arrival in queue, and time in queue.

3) Facilitate Communication Between Providers Along the Care Continuum: All too often, patient information exists in silos. There are virtual walls between the medical call center nurse, the telemedicine provider, the hospital, and the primary care provider. Successful healthcare organizations and providers are looking for and implementing ways to facilitate communication between providers along the care continuum.

Successful care will be measured by how well healthcare organizations and providers:

  • Capture patient information as data rather than as narrative
  • Store patient information in an organized manner
  • Use patient information to improve medical decision-making;
  • Transmit this data to subsequent providers along the patient’s continuum of care
  • Leverage such data to improve medical care, speed up care delivery and reduce costs: better, faster, cheaper

For Example: John Gomez, a 22 year old, has had worsening ear pain for two days.

  • Pre-process: John calls and speaks with a non-clinical service representative who works with his doctor. She obtains John’s demographic information, transcribes his chief complaint, and assists him in completing an online “rapid medical history” for ear pain. The telehealth platform lists recommended care options based on John’s symptoms, his availability, and his doctor’s preferences. The service representative then arranges a telemedicine encounter.
  • Process: The doctor reviews the rapid medical history, validates this information during the telemedicine encounter, and provides treatment recommendations.
  • Post-process: A nurse in a centralized medical call center contacts John in two days to make sure he is following treatment recommendations, getting better and has no further questions.

Real-world Healthcare: Telehealth technology isn’t a panacea for all healthcare issues, but it can be an effective tool that healthcare organizations should consider for their changing patient and business needs.

Consider the following:

Use of telehealth is growing:

  • Over two thirds (67 percent) of patients using telehealth last year said it somewhat or significantly increased their satisfaction with the care they received.
  • Telehealth is increasingly being promoted by employer-sponsored benefit plans and major health plans as a covered clinical service. In fact, 74 percent of employers said they plan to offer telehealth benefits within their benefit plans this year.
  • The cost of a virtual encounter is significantly less (close to half the cost) than an ER or primary care visit.

Telehealth can support business growth for healthcare companies by:

  • Establishing a more efficient workflow and allowing healthcare providers to do more with fewer clinical resources
  • Allowing health systems to incrementally increase their cash flow
  • Delivering a consistent and accurate diagnostic and care plan experience to patients

Telehealth can contribute to the greater good by:

  • Improving quality of care while reducing costs
  • Helping providers and health systems keep up with the ever-changing healthcare delivery landscape
  • Providing an answer to the existing and future care delivery bubble of physician shortages combined with the influx of baby boomers requiring medical care

As healthcare continues to evolve and as consumers become increasingly engaged in their day-to-day health and the care they receive, telehealth technology is sure to continue its rapid growth. Innovations in care delivery, healthcare consumerism, regulatory standards for providers, and technological capabilities will fuel this growth. Be sure to stay informed and continue to ask the question: how can we use telehealth technology to deliver a better experience for our customers and patients, while improving outcomes and financial performance?

David Thompson, MD, CHC, FACEP is CEO and chief medical officer at Health Navigator. A part-time faculty attending in the Northwestern Memorial Hospital Emergency Department, Dr. Thompson also serves as chief medical information officer for ECI Healthcare Partners and works as an author and partner with Self Care Decision, LLC and Schmitt-Thompson Clinical Content, LLC. Reach him at david.thompson@healthnavigator.com.

Can Telehealth Save Medicare?

By Charu Raheja, PhD

Currently Medicare is waning under the pressure of much of America’s population living longer than the system can support. With this in mind, the healthcare system is desperately in need of innovative ways to improve healthcare and reduce costs. One possible solution to the problem is the proposed Medicare Telehealth Parity Act of 2015, H.R.2948, sponsored by Rep. Mike Thompson and introduced July 7, 2015. The bill is the beginning of a revamp of Medicare’s approach to treatment and care that could improve American health and lower healthcare costs as a whole. Telehealth allows patients to contact a nurse or physician directly via their cell phone or computer to discuss symptoms and receive care without leaving the comfort of their homes.

Though telehealth as a whole includes many moving parts, one essential component for the success of telehealth is telephone nurse triage. Telephone nurse triage is a system by which registered nurses are available to take patient phone calls and determine the proper amount of care needed in the proper time frame. Nurses use standardized symptom-based protocol guidelines to ensure high quality of care with every phone call.

With convenient access to nurses 24/7, patients are empowered to make the right decisions about their health and what the next steps for their symptoms should be. Patients who better understand their conditions and have a method of self-management, such as access to a registered nurse, are more able to decipher the appropriate level of care, thus avoiding costly ER visits and improving overall patient satisfaction.

An important aspect for the successful use of nurses in telehealth is for the nurses to have direct contact with physicians. In many systems triage nurses communicate patient call information with providers, allowing for better patient relationships with their provider and continuity of care. Nurse triage facilitates the best use of the healthcare workforce by alleviating doctor workload pressure and allowing them to reach the most urgent cases first.

By utilizing telephone nurse triage as an affordable telehealth option, everyone benefits; providers can be assured that their patients are receiving the best care possible. Patients are satisfied with their care and confident in decisions made regarding symptoms they were once unsure of. And the cost of healthcare in America will be driven down by the efficiency and convenience of patient access to healthcare professionals at reduced costs.

Currently most Americans think of telehealth as an option for those living in remote areas where it may be difficult to visit a doctor’s office, but there is infinite value in the use of telemedicine in urban city centers where the emergency room census can be extremely high. Telehealth provides a positive alternative to unnecessary urgent care and emergency room visits, lowers hospital re-admissions—and with the healthcare costs saved—could in fact save Medicare.

Charu Raheja, PhD, is the CEO, chair, and co-founder of TriageLogic. Founded in 2005, TriageLogic is a URAC-accredited, physician-led provider of high-quality telephone nurse triage services, triage education, and software for telephone medicine. The TriageLogic Group serves over 7,000 physicians and covers over 10 million lives nationwide. Charu also serves on the board of Community Health Charities. For more information visit www.triagelogic.com.

(This piece was inspired by Michael Hodin’s post “Saving Medicare” in Huffington Post, October 26, 2015.)

[From AnswerStat December 2015/January 2016]

Flu Season: Reflection and Preparation

By Ravi Raheja, MD

During the summer months, it can be nice for the staff when the telephones calls to triage centers and practices slow down. Summer is a good time to sit back and relax, but it is also the best time to get ready for the busy winter season ahead.

While flu and cold season typically peaks between December and February, it can begin as early as October and continue as late as May. With this in mind, it is important for healthcare providers to take additional steps to make sure they have a plan in place before the patient load gets higher.

Proactive Steps for Individual Practices:

  • Use summer visits and annual physicals as an opportunity to educate your patients about their need for a flu shot in the winter.
  • Evaluate your providers’ schedule templates and plan to make changes to accommodate more sick appointments, walk-ins, and extended hours.
  • Evaluate your telephone triage system to ensure you can handle a higher volume of phone calls. Consider the following four items: First educate front staff about potentially dangerous symptoms that cannot wait for a callback. Next standardize the approach to taking messages and relaying them to the triage nurse, both urgent and routine. Then train staff on telephone triage using triage books, online resources, and in-house materials. Finally ensure you have triage protocols available either in book or electronic format, so they can be used to provide standardized, reliable telephone care that can be documented in your EMR.

Proactive Steps for Call Centers:

  • Review last season’s data to evaluate call volumes and patterns. Even though specific call patterns are not as predictable, seasonal call volumes can be anticipated. Callback times are also valuable to establish service levels and goals.
  • Plan to hire seasonal employees to assist with increased volume. Summer is a good time to prepare to recruit and train based on last year’s volume and your call center’s growth.
  • Use the slower summer months as an opportunity to refresh your nurses’ triage skills with additional training material and reminders.
  • Send out surveys to get feedback from clients to help you prepare for the upcoming season.

Continuous evaluation of the quality of your service keeps a call center strong and healthy. Since summer offers a perfect break in patient calls, why not use the extra time to prepare for the upcoming flu season? When the season hits, there will be little time to ask these questions and improve your service. Keep patient health and nurse morale your highest priority by using the summer months to get ahead.

Ravi K. Raheja, MD, is the COO and medical director of TriageLogic, a URAC accredited provider of quality triage solutions, serving over 3,000 physicians and covering over 6.5 million lives. TriageLogic provides both software and after-hours nurse triage services. For more information contact Amy Smith at 888-832-6852, or visit www.triagelogic.com.

[From AnswerStat August/September 2015]

Telehealth Checklists: Staying on Track Across the Miles

By Dr. Charu Raheja

There is no question that the world has become increasingly complex. There is more to remember, more tasks to complete, and more expected of everyone working in most every profession. We have become smarter, with more skills and technology that help us do amazing things. Unfortunately, even with all the knowledge available, the news is filled with accidents that occur as a result of memory or task failure. Ships run aground, doctors cut off the wrong leg, airplanes crash, and brakes fail to work because someone somewhere forgot to do something important. Whether the memory loss is due to having too many things to remember, or things being so mundane that they are overlooked, checklists offer a simple solution that provides a significant impact.

Checklists Come of Age: “In a nutshell, checklists ensure people are applying all the knowledge and expertise they have consistently well,” says Atul Gawande.

The aviation industry is credited with starting the checklist process in an effort to make sure pilots did everything needed to properly fly the “new and advanced” Boeing 299, which was more advanced than any airplane at the time. However, checklists are now used to carry out complex tasks required by firefighters, insurance companies, police departments, and hospitals.

Whether used in routine and repetitive situations or last-minute emergencies, checklists help people prioritize what is important, balancing judgment and procedures. Checklists can also be used when coordinating activities involving diverse teams that are working together, such as those involved in multi-tiered projects. By using checklists, every stage of the process can be standardized so that each group involved completes the appropriate steps as needed and on schedule.

Checklists in Medicine: In 2001, Johns Hopkins Hospital started using a simple checklist of steps to help decrease the incidence of central line infections in intensive care. The simple steps were:

  • Wash hands with soap before treating the patient.
  • Clean the patient’s skin with chlorohexidine antiseptic.
  • Put sterile drapes over the entire patient.
  • Wear a surgical mask, hat, sterile gown, and gloves while carrying out the line insertion.
  • Put a sterile dressing over the insertion site once the line is in.

After a year of monitoring the results, they found that the ten-day infection rate went from 11% to zero. This prevented forty-three infections, eight deaths, and saved $2 million in costs over a fifteen-month period.

Over the past few years, the benefits of checklists in medicine have reduced numerous medical complications, saved countless lives, and conserved billions of dollars. From local health departments to the World Health Organization, checklists are not only helpful but are critical to successful patient care programs.

Checklists Benefit Telehealth: While known for increasing efficiency, telemedicine can create substantial risk due to its nature of providing real-time patient information across computer networks. It is for that reason that every telehealth program can benefit by implementing a guiding checklist, or series of checklists, which ensures every step is accomplished as required. Here are some of the areas checklists can be useful in telehealth:

  • Relying heavily on technology, telemedicine programs must take extra care to safeguard the transmission of sensitive data. A checklist of each step from planning to implementation ensures each step is properly executed.
  • Run a thorough check on all equipment prior to use so substitutions can be made in a timely manner in the event anything is not working properly. Using a checklist to verify each piece of equipment and the proper procedures will ensure everything is working as required and can minimize technical issues.
  • Make sure all personnel are properly trained on the equipment and on the proper transmission of patient data in conjunction with HIPAA regulations. Training procedures, HIPAA forms, and procedural steps can all be simplified into efficient checklists for everyone to follow.
  • Utilize standardized protocols to improve the consistency of care. From the initial discussion or nurse triage, to the telehealth consultation and reporting, checklists provide an orderly process that covers each step and increases patient safety and satisfaction effectively.
  • Medicare reimbursement filing is organized into a checklist by various agencies so that telehealth providers can make sure they are eligible, and provide the correct information and CPT/HCPCS codes for payment.

Simplicity at Its Best: If organized properly, a checklist often looks like a list of items that are simple and easy, perhaps even absurdly common to people regularly engaged in the process. However, that is exactly why they are so important. A checklist is designed to keep employees from forgetting the simple steps and overlooking the obvious. They keep people and projects on track, and offer protocols that safeguard quality. The best time to incorporate the use of checklists is when you think what you are doing is too simple to forget or too complex to remember every step.

With numerous complexities and simplicities in telehealth, proper checklists and protocols can be the difference between a successful consultation and a waste of resources.

Charu G. Raheja, PhD, is the chair and CEO of TriageLogic Management. For more information and additional resources, email Charu.

[From the August/September 2013 issue of AnswerStat magazine]

Impact of Telehealth and Remote Patient Monitoring

By George Tilley

Telehealth is integrating into the mainstream of healthcare delivery at an accelerating rate, as many telehealth ideas that were once just concepts are now showing signs of promise for their clinical effectiveness and cost-efficiency. Patients, care providers, payers, and governments are exploring its use as a supplement or replacement for more traditional healthcare services.

Our healthcare systems are being stressed to the breaking point as costs and demand continue to grow, being driven by our rapidly aging population. Many are looking for solutions. The push from the Center for Medicare/Medicaid Service (CMS) under the Affordable Healthcare Act and payers is to explore alternative approaches, particularly for lower cost options, such as those offered by telehealth. Whether it is an illness prevention measure, such as maternal health and employee wellness programs, or complex continuum of care initiatives, such as those focusing on chronic diseases and hospital readmissions, telehealth offers a solution.

Capitalizing on this trend, virtually every technology company is rushing to the market with devices to monitor glucose levels, blood pressure, medication adherence, weight, and other common issues. The potential is great, but it is not without concerns. Pilot projects to deploy them proliferate; however, few have mastered the intricacies of delivering healthcare services remotely to large populations. A comprehensive approach is required.

For many, the challenges have included:

  • Lack of trained clinical personnel with the specialized skills set required to remotely monitor a patient’s biometrics and advise them accordingly
  • Failure to provide a 24/7 response to alerts from these devices
  • Lack of cost-effective systems capable of escalating responses to the patient from an automated message, to a health service representative, to a nurse, and to a physician
  • Inability to deal with co-morbidities or to respond to patient concerns outside of regular support hours or separate from the condition being monitored by these devices
  • Insufficient professional and management staff to oversee the operating systems and communications/information infrastructure and to be able to scale up the pilot projects into successful operations.

Some state-of-the-art medical call centers have long had the ingredients necessary to address some or all of these critical concerns. Partnerships between nurse advice line service providers and equipment suppliers are beginning to meet the need.

A key ingredient for a successful program is the clinical guidelines used for remote patient monitoring. Some use models seeking to extend care from institutions to home-based settings. Device manufacturers, likewise, use models that were adapted from those used for face-to-face encounters; however, they may not be well-suited. More appropriate are those specifically designed for telephone nurse triage, such as the Schmitt/Thompson protocols. If remote patient monitoring is to achieve its full potential, this clinical issue need to be addressed.

In another initiative, the Government of Canada, through its Atlantic Innovation Fund, is supporting a program to develop clinical protocols specifically for remote patient monitoring. InfoClin, with the assistance of experts from McMaster and Memorial Universities and other leading clinicians from the US and Canada, began developing clinical protocols for the remote management of congestive heart failure, diabetes, and chronic obstructive pulmonary disease last September.

In addition to these initial three diseases, work is underway with key stakeholders in the mental health field to identify service gaps and opportunities that can be remotely monitored and supported by health professionals. Also, a maternal health initiative provides new moms with regularly automated messages, nurse coaching, and monitoring during pregnancy and following delivery.

All of these clinical guidelines need to be embedded into decision support software in preparation for use by teams of health professionals throughout the world. With the rollout of these protocols targeted at remote patient monitoring, a new resource can be offered for clinicians. Such clinical protocols are the key components to a successful comprehensive telehealth system.

George Tilley is the business manager with Fonemed North America. He has thirty years of experience, primarily in an executive capacity in the Canadian healthcare system, which has given him a firsthand appreciation for the challenges of the healthcare system and the opportunities that telehealth offers.

[From the August/September 2012 issue of AnswerStat magazine]

The Intersection of Healthcare and IP Contact Center Technology

By Steve Kowarsky

The delivery of health-related services and information via telecommunications technologies is sometimes known as telehealth or telemedicine. Interest in this trend is fueled by the growing emphasis on improving healthcare systems globally. Telehealth encompasses much more than home monitoring systems and video conferences with doctors. In some telehealth patient monitoring studies where patients used only a telephone to report their health status, the results were better than those in studies that relied on remote devices.

Such findings underscore a growing trend in healthcare applications enabled or greatly enhanced by the use of an IP contact center platform. IP contact center technology can be a critical tool for providing patients with unprecedented and cost-effective access to superior healthcare services.

The following are just a few of examples of this rapidly evolving family of applications.

Health Coaching: Health coaching is one application that can be streamlined with an IP contact center platform. In health coaching applications, professional health coaches work with individuals to increase adherence to regimens associated with disease management, dietary plans, or exercise programs. According to the Wellness Council of America, one dollar invested in health coaching yields three dollars in savings. This statement is supported by the market experiences of many large providers who have already turned to health coaching to reduce costs and improve the health of their clients.

With an IP contact center-based health coaching application, the productivity of coaches is optimized in two ways. First, the platform can automatically dial participants in the program and only connect calls to coaches when a participant answers the phone. Predictive dialers eliminate the need for coaches to waste valuable time repeatedly dialing numbers that are busy, are not answered, or are picked up by an answering machine or voicemail.

Second, for both inbound and outbound calls, scripts guiding the conversations with clients can be automatically and instantly tailored to the individual participant based on data stored in other back-end applications, such as EHR (Electronic Health Record) or CRM (Customer Relationship Management) system. In this way, any coach can deliver the same high level of service.

An IP contact center platform can also benefit coaching applications by its ability to make staffing geographically transparent. Coaches can be located anywhere: in a centralized contact center, across multiple centers, at home, or even in different healthcare facilities. In sum, the right IP contact center platform can enable the health coaching provider to boost the productivity of coaches, improve their job satisfaction by eliminating routine tasks, improve their return on investment, and, most importantly, ensure the best possible service levels for clients in the program.

While these benefits are certainly significant, perhaps even more impressive are the potential impacts of an IP contact center on device-free remote patient monitoring.

Remote Patient Monitoring: Conventional remote patient monitoring (RPM) relies on a wide variety of devices that either automatically upload data telemetrically or that require a patient to call in and report on read-outs from a device. The benefits of RPM are significant. In a 2009 report, the New England Healthcare Institute projected savings of $6.4 billion annually in the United States if RPM were used for the management of congestive heart failure. Somewhat ironically, the report also indicated that RPM devices themselves are one barrier to achieving these savings.

Fortunately, a new approach called device-free RPM that does not rely on any patient devices, except for a telephone, is now being explored. Most notably, a study was sponsored by the Iowa Medicaid Enterprise, as well as a number of other healthcare entities in that state. The study involved 187 chronic heart failure patients who were asked to respond to an automated, telephone-based questionnaire each day. If a patient did not call by a certain hour, the system initiated a call to the patient. A care coordinator monitored responses via exception reporting and personally followed up, if necessary. Hospital admissions were then compared for this group in the 12-month study period to the 12 prior months. Results were nothing short of profound: heart failure admits were down 89.8 percent during the study and all cause admits were down 60 percent.

With results like these, device-free RPM may well become the key application to underscore the enormous opportunities possible with IP contact center-based healthcare. The contact center is the ideal infrastructure for supporting the interactive voice response (IVR) system required to administer the questionnaires, route the responses to the appropriate caregiver based on responses, and initiate outbound calls by care coordinators when specified conditions are met.

At the Intersection: Health coaching and device-free RPM only represent the tip of the iceberg for the endless possibilities at the intersection of IP contact center technology and the healthcare industry. With an IP contact center platform, many types of healthcare applications can be delivered over any electronic media channel by live healthcare representatives and/or automated contact systems. Employees and systems can be distributed across a region or across the globe, linked together virtually over the IP network.

IP contact center technology enables intelligent queuing and routing of inbound and outbound telephone calls, Web chats, and emails, while also supporting full interoperability of healthcare applications with EHR, CRM, scheduling, billing, and other business applications. With the right multi-tenant technology, healthcare providers can create and support any number of virtual contact centers of any size on a single platform with unified transaction recording, reporting, and administration.

Any kind of reactive or proactive patient-provider interaction can be supported over any type of communications channel. At the same time, such technology enables each healthcare application, location, or entity to maintain complete autonomy and to implement the full security required by health information privacy regulations.

Healthcare providers are increasingly discovering that IP contact center technology can be a critical tool for providing patients with cost-effective access to superior healthcare services and a better overall patient experience. This, the intersection of healthcare and IP contact center, is improving the cost, quality, and availability of care.

Steve Kowarsky, executive vice president of CosmoCom, is one of the architects of the company’s growing presence in the healthcare industry. CosmoCom’s unified, all-IP contact center suite enables businesses to quickly, easily, and economically fulfill the most complex customer interaction management requirements of today and tomorrow.

[From the October/November 2009 issue of AnswerStat magazine]

Using IVR to Improve Post-Discharge Patient Care

By Gary Hannah

Recent studies have shown that twenty percent of patients experienced adverse events following hospital discharge. Most commonly, these events are related to adverse drug effects, therapeutic errors, and nosocomial infections, those that are a result of treatment in hospital and secondary to the initial condition. One third of these events led to at least temporary disability, and three percent led to death. Other recent studies have estimated that between 44,000 to 98,000 deaths per year in the United States were related to hospital-related errors, many of which were preventable. In an era where regulations are holding healthcare facilities liable if these events are not adequately mitigated, hospitals are wondering how they can conduct effective post-discharge follow-up with patients when budgets and human resources are already stretched thin.

The good news is that one-third of these events can be prevented with proper post-discharge patient follow-up, and speech technology solutions can assist hospitals in providing consistent quality of care and patient assessment.

Best practices show that follow-up is important and if it is done often, it is the hospital nursing staff that is tasked with the responsibility of following up by telephone with patients who have been discharged. It can take as many as five calls to reach a patient, meaning nurses are spending inordinate amounts of unproductive time. This makes an already costly endeavor even more expensive and adds even more to a nurse’s already overloaded workday. Manual collection of data is not only time consuming, but it also often results in inaccurate data stored in disparate systems. This ineffective system relies on the independent analysis of data to recognize trends and determine the need for and specifics of any required medical intervention.

However, the fact remains that the proper follow-up process is imperative to ensuring top-quality patient care. What alternative is there to having RNs making these calls, and how can hospitals ensure that their nursing staff’s time is put to best use?

An interactive voice response (IVR) system, previously only associated with telemarketing or customer-service automated systems, can automate the post-discharge patient follow-up by using customized rules and call scripts to gather important data from the patient, ensuring that scarce nursing resources are used only where personal follow-up is required. Natural voice recognition speech technology has advanced to the point where the systems can determine with great accuracy the confidence levels of responses based on various terms and the positive or negative connotations of the particular words. Business rules can determine the course of action for the call, whether the patient is transferred to a live attendant at a medical call center, a notification is sent to a nursing station and pertinent callbacks can be conducted by a medical professional, or data is merely collected for statistical trends and patient satisfaction analysis.

A recent study showed that the incorporation of an IVR reduced nurse workload by eighty-eight percent and enabled nurses to focus their follow-up efforts on just those patients who truly required their attention. Surprisingly, the same study showed high patient acceptance rates for the new system, with two-thirds of patients expressing a preference for the automated system. With the automated system, patients felt that they could be more honest as there was no immediate judgment or bias associated with their responses.

An IVR can fit seamlessly into any health facility’s IT and phone systems, providing details on patient calls to help mitigate adverse events, as well as reduce liability. One-quarter of post-discharge emergency department visits, re-admissions, and deaths are due to adverse events. If these secondary care requirements are reduced, hospitals will enjoy tremendous cost savings and be able to allocate resources only to those in need.

In addition to post-discharge patient monitoring, the IVR can assist in a wide range of healthcare situations. Patients and nurses alike can respond to telephone surveys to indicate satisfaction levels, an important performance indicator for healthcare facility executives and an integral business variable in pay-for-performance situations. In pandemic scenarios, large groups can be monitored and statistics gathered to help predict outbreak models and treatment strategies. Ongoing monitoring of patients with chronic conditions like diabetes, reminder systems for elderly patients to take the proper amount of medication at the proper time, and outpatient monitoring for addiction management programs and rehabilitation can all be conducted using an IVR.

When choosing a solution, ensure that the IT footprint is minimal, that the vendor offers technical support, and that adherence to all privacy and compliance regulations relevant to the facility and healthcare jurisdiction are strictly enforced. Depending on the needs of the facility, the infrastructure setup, and IT resources, a hosted solution might be a better fit. A range of options exist with a range of prices and a healthy, due diligence process will help to find the right solution for every environment and telephone triage model.

As healthcare facilities move to an electronic health model, adopting technology solutions for everything from the identification of patients to point-of-care bedside diagnostic tools, the institution of an IVR to conduct patient follow-up makes good sense from both cost and patient-care perspectives. IVR does not replace the need for medical professionals and medical call centers; however, IVR improves processes and enables the most effective use of hospital and personnel resources.

Gary Hannah is the founder, CEO, and president of Vocantas Inc., a developer of advanced speech technology solutions that recently launched its CallAssure product line, an interactive voice response system optimized for the healthcare environment. The company also has products for the utilities, emergency preparedness, and customer service markets. For more information, visit www.vocantas.com.

[From the August/September 2008 issue of AnswerStat magazine]