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Medical Answering Services and Telephone Triage

By Nicole Limpert

Doctors in the United States first began using answering services in the 1920s so they would be made aware of patient emergencies. At that time, operators were basic message-takers and would pass along patient concerns and contact information to the doctor.

Today’s medical answering services provide a much wider range of services to lighten the administrative workloads of medical offices, and not only assist doctors, but also surgeons, hospice, home health, dentists, orthodontists, and even large healthcare systems. Medical organizations that use an answering service can experience increased appointment setting rates, better patient-doctor communication, improved patient satisfaction, and provide their patients with reliable access to care 24 hours a day, 7 days a week.

Some medical answering services can even provide telephone triage if they employ licensed professional staff members trained to give an accurate assessment of a patient caller’s concerns.

Telephone Triage

The use of triage originated during World War I to avoid focusing resources on victims with fatal injuries. Sometime in the early 1970s, health maintenance organizations (HMOs) instituted telephone advice services which led to hospital emergency departments establishing 24-hour telephone advice programs. Telephone triage is now a sophisticated practice usually performed by nurses and other highly trained medical personnel.

Telehealth, telemedicine, and telephone triage may all sound similar, but each are quite different. Telehealth focuses on the actual delivery of care (both preventative and curative). Telemedicine involves the diagnosis of a patient’s health compliant and recommended treatment by a physician via any form of telecommunication. Telephone triage is the assessment of a patient’s symptoms and the urgency needed to quickly get that patient connected with the correct doctor or department. 

Telephone Triage Communication Model

Effective communication is critical in telephone triage. Typical models of communication include three parts:

1. Data Collection: The answering service agent gathers data from the patient caller about the problem and asks open-ended questions to encourage more information about the symptoms.

2. Confirmation: The agent repeats the information using some medical terminology but in a way that the patient can understand. The patient confirms and redefines the symptoms if necessary.

3. Disposition: The agent may give advice about treating symptoms, but the main outcome is to quickly connect the patient caller with an appropriate doctor, clinic, or hospital department. 

To assist operators with remembering which questions to ask during the assessment, it is common for them to use a mnemonic device called OLD CART:

O (onset of symptoms): When did the symptom(s) first occur? Has it happened before?

L (location): Where on the body is the symptom occurring?

D (duration): How long has the symptom(s) been present and is it constant or does it come and go?

C (characteristics): Describe what the symptom(s) feels like.

A (associated factors): Are there any other signs and symptoms that occur?

R (relieving factors): Does anything make it feel better or reduce the severity?

T (treatments tried): What has been tried to relieve the symptom? Has anything worked?

Advantages and Disadvantages of Telephone Triage

There have been many studies published about telephone triage and how they help reduce a healthcare organization’s costs while helping patients experience better health and greater satisfaction. BMC Health Services Research conducted a review of existing body of research about telephone triage and advice services (TTAS) and found that, “TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care.”

The primary disadvantage of telephone triage is liability. Lawsuits can be filed if a patient call was mishandled. For example, a negative health outcome can be attributed to a miscommunication, because a patient was on hold for a long time, or due to a lack of information about the patient.

If the situation is serious enough and becomes a legal issue, the courts may even hold a doctor responsible if they find the person assisting the patient via telephone triage lacked skill or training. In the unfortunate event of a serious medical problem or death because of mistakes made by a triage service, anyone connected with the case (such as nurses, physicians, other medical personnel, the healthcare organization, and the patient’s health plan) could be sued.

Importance of Call Center Software for Effective Telephone Triage

Medical answering services who also offer telephone triage systems can safeguard against liabilities for themselves and their medical clients by using a robust call center software. All-inclusive, highly interoperable healthcare software can integrate with electronic medical record (EMR) systems and use artificial intelligence (AI) to help ensure operators are talking to the correct patient; customized scripting ensures operators are asking and giving correct information; and they also offer critical call priority and improved call routing.

Effective contact center software also provides a customizable reporting function to keep track of metrics that enhance accountability with call logging and video screen capture, connect remote agents, and manage on-call scheduling. Because calls, messages, screen capture images, and more can be recorded, tracked, time-stamped, and stored, data from call centers can also help protect themselves, hospitals, and patients in litigious situations.

Medical answering services can also take advantage of running their call center software in a virtual server environment or in the cloud. This enables their staff to work from home by turning any personal computer into a professional agent workstation. All the tools used by an agent in a medical answering service call center are accessible to the virtual agent.

Secure Messaging and Telephone Triage

A secure mobile messaging app can help keep both medical answering service providers and their healthcare clients HIPAA-compliant in the event an agent needs to contact on-call medical personnel about a patient caller.

If an agent determines a patient’s doctor needs to be notified immediately about a critical situation, a secure messaging app that’s integrated with the agent’s call center software and on-call software can quickly contact the correct physician. End-to-end encryption ensures all communications are secure and protected.

Persistent alert settings can be set so important messages won’t be missed, and full reporting functions available via the app tracks messaging histories including if a message was received, opened, and replied to.

With today’s technological advances and secure HIPAA-compliant communication options, medical answering services can provide outstanding telephone triage services that result in better patient care while protecting against liability issues.

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.

Amtelco Solution Helps Customers Transform Agent Experience

Amtelco announced that their Genesis Intelligent Series application version 5.4 is compliant with Avaya OneCloud Unified Communications as a Service (UCaaS) solutions, helping customers enhance call processing to prioritize critical calls and improve call routing and management. Avaya is a global leader in solutions that enhance and simplify communications and collaboration.

Amtelco’s solution is an all-inclusive healthcare call center software suite featuring multi-channel integrations with built-in speech recognition, text to speech, and voice services. The software helps customers track metrics with customizable reporting, enhance accountability with call logging and video screen capture, connect remote agents, and manage on-call scheduling. Customers can also run it in a virtual server environment or in the cloud. The application is now compliance-tested by Avaya for compatibility with Avaya Aura® Session Manager 8.1 and Avaya Aura Communication Manager 8.1 via SIP trunk.

“We are excited that our latest application release has successfully completed Avaya DevConnect compliance testing,” said Tom Curtin, Amtelco president. “Our mutual customers can confidently deploy it with the Avaya Aura 8.1 platform, helping them get more out of their communications infrastructure.”  

Amtelco is a Technology Partner in the Avaya DevConnect program—an initiative to develop, market, and sell innovative third-party products that interoperate with Avaya technology. As a Technology Partner, Amtelco can submit products to Avaya for compliance testing, where a team of DevConnect engineers develops a comprehensive test plan for each application to verify its Avaya compatibility. This enables customers to confidently add best-in-class capabilities to their network without having to replace their existing infrastructure, helping speed deployment of new applications and reduce both network complexity and implementation costs.

Learn more about how Amtelco is part of Avaya’s DevConnect program and Avaya’s other partner programs. The 1Call Division of Amtelco is a leader in developing software solutions and applications designed for the specific needs of the healthcare call center marketplace. 

TriageLogic Ebook Details Changes in Patient Behavior During COVID-19 Pandemic

TriageLogic® released a study they conducted of their telephone nurse triage system during the COVID-19 pandemic that analyzes caller data, protocols used, and general changes in patient behavior to shed light on the efficacy of remote care in the modern medical age.

COVID-19 altered many patients’ perceptions of healthcare. So much of the population was afraid of contracting the virus, and this fear was exacerbated by the potential risk of exposure in a hospital setting. As a result, telephone nurse triage took on a critical role, not only helping patients determine the circumstances under which they should seek emergency treatment, but also slowing the spread of the infection. 

TriageLogic already had experience providing homecare advice to patients, scheduling telehealth appointments, and directing emergency cases to the appropriate providers, and these only became more important during the pandemic. To evaluate how those patients’ needs changed, the company reviewed patient demographics, medical conditions, and outcomes reported through their nurse triage call center from January to October of 2020. The resulting data is published in their ebook 2020 Telehealth in Review: Symptoms, Outcomes and COVID.

It supports the assertion that nurse triage and remote care are essential advisors when it comes to directing patients to emergency services or safe and accessible alternatives. Key findings from the study include:

  • Women called two to three times more frequently than men, possibly due to OB/GYN patients. 
  • Gender ratios were roughly the same for pediatric patients.
  • More than one-in-four adults who called the nurse triage service required urgent medical attention, yet 86 percent of patients indicated they were not originally planning to go to the ER.
  • Women ages 18–45 tended to have more serious symptoms than other adult patients and were 1.5 times as likely to need urgent care than men their age. 
  • Women were also more likely to underestimate the severity of their symptoms compared to all other patient groups. 
  • Triage protocols determined that 30 percent of patients who were planning to go to the ER did not actually need urgent care, prompting nurses to advise them on alternative nonemergency options. 
  • Patients tended to underestimate symptoms that were signs of a serious medical condition, including abdominal pain, difficulty breathing, chest pain, high blood pressure, and COVID diagnosis or exposure.
  • Patients were more likely to delay seeking care during the pandemic when compared with data collected prior to COVID.
  • Telephone nurse triage has provided a safe and effective way to advise patients on the appropriate levels of care, saving lives and reducing burdens on healthcare systems during the COVID pandemic.

This data has been made available to the medical community at large to provide a transparent understanding of patient conduct and needs as the healthcare industry continues to evolve. 

TriageLogic is a URAC-accredited, physician-led provider of top-quality nurse telehealth technology, remote patient monitoring, and medical call center solutions, all for the purpose of encouraging positive patient behavior and improving access to healthcare. Founded in 2007, the TriageLogic Group now serves more than 9,000 physicians and covers over 20 million lives nationwide. They continue to partner with private practices, hospitals, and corporations throughout the United States. Email them at info@triagelogic.com.

Customer Service Book Released

Peter Lyle DeHaan Publishes New Book: Sticky Customer Service

Peter Lyle DeHaan released his latest book, Sticky Customer Service: Stop Churning Customers and Start Growing Your Business, on June 17. Sticky Customer Service addresses all aspects of customer service, with the telephone taking center stage.

“Customer service is part of every business, including healthcare,” DeHaan says. “Practitioners and leaders in the medical field can take these general business principles and readily apply them to patient interactions, informing day-to-day actions to lead to better outcomes and higher patient retention.”

In Sticky Customer Service, you’ll discover:

  • The three key areas where customer service occurs and why they must work together.
  • How to avoid common errors that too many businesses make.
  • Why delighting customers is not the best approach and sets up future failure.

“Customer service isn’t a once-and-done effort,” DeHaan states. “It takes ongoing work to truly meet your customers’ expectations.” In Sticky Customer Service, unearth practical, action-oriented insights to help turn customer service from an embarrassing weakness into a business strength.

Sticky Customer Service is book one in the Sticky series. Future titles include Sticky Leadership, Sticky Sales and Marketing, and Sticky Living.

Sticky Customer Service is available now in e-book, paperback, and hardcover.

June 2021 Issue of AnswerStat

Read the June issue of AnswerStat, the information hub for healthcare contact centers.



Feature Content:

Mental Health and Nurse Triage Calls During COVID-19, by Dr. Charu Raheja
Mental health became an important health concern during the COVID-19 pandemic and patients called medical professionals for help . . . . read more >>

Vital Signs: Article Library at PeterDeHaanPublishing.com, by Peter Lyle DeHaan, PhD
Five hundred call center articles consolidated in one place for easy access and convenient searching in this new article library. . . . read more >>

Guest Column: Remote Patient Monitoring and The Future of Remote Nurse Triage, by Ravi K. Raheja, MD 
Able to closely monitor chronic patients in a safe, cost-effective manner, RPM is one of the fastest-growing medical technologies.. . . read more >>

How Telehealth Employers Can Ensure Effective Communication with Remote Staff, by 1Call 
Discover how to have effective communication with remote workers and develop the right management mindset and technology to drive success. . . . read more >>

Ten Years Ago: Delivering Healthy Customer Interactions Through a Home-Based Call Center Solution, by Chad W. Lyne
With the adoption of virtual contact centers, healthcare organizations have an alternate way of doing business and interfacing with patients. . . . read more >>

Industry News

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About AnswerStat
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Article Library at PeterDeHaanPublishing.com

Access Two Hundred Healthcare Call Center Articles Now in One Place 

By Peter Lyle DeHaan, Ph.D.

For the past twenty years I’ve covered various aspects of the call center industry, publishing relevant trade periodicals. This includes AnswerStat, as well as our sister publication, Medical Call Center News. During these two decades, I’ve written over five hundred pieces about various aspects of operating and optimizing call centers. 

That’s a lot of material, averaging over two new articles a month for the entire twenty-year journey. This content spans four websites. Besides AnswerStat and Medical Call Center News, there are also Connections Magazine and TAS Trader.

Though you can go to each individual periodical website to read these articles, you can now access all this content in one place. (In addition, there are also posts about writing and publishing, as well as business content, accounting for 800 more pieces.) 

Conservatively, I estimate this article library totals over half a million words. That’s a lot of writing, enough for several books. I just need to find the time to edit and publish them. So, stay tuned for updates when these books release.

For readers who want to focus specifically on the medical field, you can read all two hundred healthcare call center articles from this one site.

This article library of content merges most of my industry information on one website. Plus, the handy search feature allows you to quickly access a specific topic. If you want to refresh your memory or reread something I’ve written in the past, this site is the ideal place to find it.

I begin this publishing adventure in September 2001, and I look forward to continuing it as we move into the future. And as this unfolds, watch for this article library to grow at the projected pace of two articles a month.

Something that’s become clear after the turmoil of 2020 is that the call center industry is an essential business communications vehicle that can weather any storm. More importantly, healthcare call centers have emerged as the future of the industry. 

It’s going to be exciting to watch this unfold, and I’ll be here every step of the way.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.

Mental Health and Nurse Triage Calls During COVID-19

By Dr. Charu Raheja

According to the Kaiser Family Foundation, 53 percent of American adults estimated that the COVID pandemic had a negative effect on their mental health. We looked at data from our nurse triage service to understand how mental health may be related to COVID cases in the United States. 

Triage nurses don’t receive many mental health related calls. While there are protocols in place for such cases, nurses are not trained mental health professionals. Calls about mental health are extremely low as patients only call if they feel they have no one else to talk to. However, during the COVID pandemic, we saw spikes in the number of patients who called about mental health. 

(Figure 1)

Figure 1 presents the number of calls about mental health that we received from January–October 2020. We include calls about both anxiety and depression. These patients who called the triage nurse line were not experiencing medical symptoms; they were calling only about mental health. Those who experienced anxiety or depression along with medical symptoms would have been categorized in the appropriate triage protocol. Figure 2 presents the total number of COVID cases in the US by month. 

(Figure 2)

We find that in the beginning of the pandemic, there was a large spike in the number of mental health related calls we received. The triage nurses received about ten times as many calls about anxiety in April compared to January 2020. After this initial surge, the number of mental health-related calls decreased, but remained elevated. We also found that anxiety increased with surges in the number of COVID cases in the US. 

Our results show that mental health became an important health concern during the COVID-19 pandemic and that patients began to reach out to medical professionals for advice. One reason may be that the pandemic disrupted mental health services even as people began to experience more mental health concerns. Nurse triage also serves as a way for patients to reach out to providers. Patients may have also called the nurse triage service because they were anxious about COVID and sought information or reassurance, even if they were not experiencing symptoms. 

For more data about symptoms and outcomes of our nurse triage during COVID-19, check out our white paper, which contains information that can help you better understand patient behavior during a major health crisis. 

Dr. Charu Raheja is the co-founder and CEO of the Triage Logic Group. The TriageLogic Group provides telehealth software, mobile communication solutions, and services to large medical centers and businesses around the country. It is part of the Women’s Business Enterprise National Council (WBENC), and it covers over 25 million lives nationwide. 

Contact Amy Smith at 888-TEAMTLC for more information.

How Telehealth Employers Can Ensure Effective Communication with Remote Staff

Presented by 1Call

Traditionally, remote work for healthcare positions was limited to medical billing, coding, and transcription. But in 2020, workers in all industries, including healthcare, were challenged to find ways to work remotely and still maintain the same level of productivity, security, and commitment to quality customer and patient care. 

Although the sudden shift to working remotely and working from home was initially disruptive, recent studies now show that remote workers can actually be more efficient than before. Many remote workers even boast higher morale and job satisfaction. Yet if remote workers are managed poorly or made to use inefficient technology, then communication breaks down and productivity and morale take giant hits. 

To ensure effective communication with remote workers now and in the future, healthcare organizations of all sizes must have the right management mindset and the right technology in place.

Remote Work Boosts Capacity

The COVID-19 pandemic highlighted how remote work and communication technology can reduce disease transmission among patients and medical teams without reducing capacity. Telemedicine enables more physicians to care for patients from a safe distance, allowing quarantined workers with mild symptoms to keep working. Doctors can provide immediate consults from afar. Shifting call center operators to remote settings even increases a healthcare organization’s physical capacity by creating additional space for triage or other forms of patient care.

Remote Work Isn’t Just for Desk Jobs

Remote work has many advantages for healthcare organizations, and not just for roles involving billing and administration. Pharmacists can review and enter online prescriptions. Nurses can provide afterhours triage. Clinical case educators can train nurses on new care procedures without having to gather in the same place. Care teams, doctors, nurses, and non-clinical staff can check in with each other remotely, as long as their technology is HIPAA compliant and secure. 

Communication Presents the Biggest Challenge to Remote Work

When teams aren’t in the same physical space, communication breakdowns are more likely to happen, especially if it isn’t clear whether a message has been received or how urgent it is. Important emails or messages can get lost among general updates. Tone of voice can be mistaken, especially when an urgent message is being conveyed. Personal devices used to access secure information can be compromised. Data is siloed as employees switch from one app to the next. When extra work must be done to keep records up to date between apps, errors are made. Productivity plummets along with morale.

Given the importance and difficulty of accurate, timely communication, how do you ensure your teams communicate effectively while they’re remote? Here are some tips:

Streamline communication devices and platforms: Communication technology must equip healthcare workers, not hinder them. Maximize every minute that physicians spend with their patients or communicating with the rest of the care team. Take the complication out of staying in touch by using a HIPAA-compliant secure messaging app that can be used on mobile phones, laptops, tablets, and desktops. Allowing staff to use their own devices also simplifies the learning curve, resulting in faster adoption of the communication technology.

Make quick communication updates easy and intuitive: Sometimes, long replies aren’t feasible, especially in the fast-paced world of medicine. Make it easy for your team to give each other the immediate replies they need to be efficient and accurate. Look for platforms that offer customizable, quick replies that can be sent with just a few taps or clicks. 

Set clear on-call times: Automatically sync your communication platform with your staff’s schedule. This will make it easier for your staff to know and respect each other’s on-call times. It will promote a healthy work-life balance and avoid the frustration of wondering who is available.

Build trust: Create a culture that trusts each other to answer messages when they’re received. You can do this by selecting a platform that displays when messages have been delivered, if they have been read, and what their urgency level is. Don’t contribute to alarm fatigue by inundating your employees with irrelevant or non-urgent messages.

Integrate with EHR to decrease data entry: Reducing the number of places data needs to be entered improves efficiency and accuracy. Your communication platform should sync with your organization’s EHR (electronic health record). This way, physicians can check lab results from another location, pharmacists can order prescriptions remotely, and surgeons can verify schedules ahead of time.

Insist on security and HIPAA compliance: While some HIPAA rules related to telehealth were relaxed in 2020, they may tighten up in 2021 and beyond. Instead of requiring your staff to take home additional secure devices, choose a platform that runs securely on their personal devices. Be sure to select a solution that offers end-to-end encryption of all messages and can be locked remotely in case it is lost or compromised. 

Move to the cloud: An on-premises-only solution limits your ability to shift workers to remote settings. Your staff should be able to securely access the data they need wherever they are. Storing information on the cloud will also reduce the need for on-site server maintenance. Your care teams can have synchronous, secure access to their patients’ data, wherever they are.

Summary

The ideal remote workers are self-starters who can focus on work despite the distractions inherent in working off-site. And the best remote managers are those who understand how to intentionally foster connection and communication without micromanaging. Last, invest in technology that is flexible enough to work with your staff and support your team’s unique capabilities and needs.