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Mobile Apps and Telehealth: Another Channel for Reaching Your Audience


LVM Systems

By Sue Altman-Riffel

Healthcare contact centers have acted as the communication and wayfinding hub between their sponsoring organizations and the audiences they serve. In the 1980s, when I started my first hospital call center, there was really just one channel for quick communication: the telephone. It was a landline.

We didn’t give much thought to our audiences’ preferred communication methods back then. The only option of note was whether someone wished to be contacted on his or her home phone or work phone. Later came car phones and cellular phones, more possible options to be considered when collecting callers’ phone numbers.Healthcare contact centers have acted as the communication and wayfinding hub. Click To Tweet

The typical contact center users: patients, parents, plan members, and prospective community members have not changed much through the years, but their communication options have expanded.

Internet availability brought about health organization websites. The primary advantages of the website are 24/7 availability and no waiting on hold, allowing its audience to quickly find information, download forms, browse physicians and facilities. and register for programs and services, whether a call center was available or not. Contact centers (note the change from call center to contact center) continue to add support to a variety of website functions behind the scenes, but a growing list of transactions can be concluded without human support.

Websites continue to be an extremely important digital platform for healthcare today. Studies show that the user’s viewing device (for websites) can change throughout the day: a smartphone in the morning and while the user is commuting or at lunch, desktop use picks up during the workday and tablet use increases in the evening. But for the last ten years, the communication medium that has outpaced all others is the smartphone.

We Love Our Smartphones: Since the smartphone was launched, we humans have fallen in love with its convenience and offerings. We each have our favorite apps. They entertain, keep us connected, act as a platform for sharing our views, provide us with answers, and support telephone and video communication.

In the US, the average adult spends eighty-seven hours per month on their mobile devices, mainly smartphones. We keep them nearby, often in a pocket or purse. Studies show that 75 percent of smartphone users take their phones to bed with them. (I want to smirk at this, but I remember using my white noise app to fall asleep last time I traveled.) Clearly, we’ve incorporated smartphones into nearly all aspects of our lives, including managing our (and our family members’) health.

Each year, more functionality is integrated into smartphones (effectively hand-held mini-computers). The list of functions will look familiar. At present, hospital apps support many do-it-yourself (DIY) services, such as:

  • Locate facilities, with mapping and directions
  • Find physicians: search based upon specialty, insurance, location, language
  • Check symptom acuity, with self-care advice and connection to care locations
  • Connect to a triage nurse or telemedicine provider
  • Browse health information libraries
  • Look-up dosages; track medications
  • Login to patient portals
  • Engage in social media
  • Pay bills
  • Sign up for a class or event
  • Get reminders, encouragement, and education via push notifications

One of the many advantages offered by mobile is one-tap connections to the next services needed. A symptom check is one tap away from calling one’s doctor, finding an open urgent care (with map), scheduling (online or agentassisted), or connecting to a triage nurse or telemedicine provider.

Have Mobile Apps Replaced Talking to a Real Person? No. Although mobile is becoming the organization’s digital front door, it is not the sole communication vehicle. The choice between mobile versus livevoice is influenced by your audience, the service required, and its complexity.

Audience and Age: First, audience adoption of apps differs by age group. Pew Research regularly studies the adoption of technology by population. In 2015, they found that 77 percent of the eighteen to twenty-nine age group has used their smartphone to seek information about a health condition, compared to slightly fewer (68 percent) of 30-49 year olds.

They also explored the shrinking segment of non-users (13 percent for websites; 20+ percent for smartphones). The shared characteristics are highlighted as age 65+, income below the poverty level, low education (high school or less), and rural. If this describes a portion of your audience, then telephone services will continue to be the main medium for supporting them.

General Movement Away From the Telephone: Recent Forrester research “Your Customers Don’t Want To Call You For Support” tells us adults in the US prefer using web or mobile self-service more than speaking with an agent over the phone. This use increased from 67 percent in 2012 to 81 percent in 2015 among US online adults.

Although calling customer service has steadily decreased over the past six years, it is still used for escalation. Customers prefer to resolve straightforward interactions using selfservice (web and mobile), but still reserve complex issues for a telephone call.

For 10 plus years, contact centers have seen the volume of inbound calls decline—especially in the age group of 18-35 years. Creating a mobile app to engage this audience is a way of keeping their loyalty by respecting their self-service preference. They will connect by telephone when their health needs escalate or exceed self-service.

Applying this to healthcare contact centers, communication preferences are situational. One example is symptom checking (described as self-triage). Young parents may use an app or website to check their child’s symptoms. It will help them understand what action is appropriate: ER, office visit ,or manage at home for now, and offer step-by-step advice for managing symptoms.

But what if the parent has additional questions? A great solution is offering the symptom-checker user an option (within the app) to connect to a triage nurse or request a call back. In many instances, self-service may satisfy users’ needs. But self-service can escalate to a nurse if the situation turns out to be more complex.

Scheduling: Not all desired services can be completed quickly via mobile. Appointment requests are still largely facilitated through voicetovoice communication. In many cases,

  1. the office (or hospital department) needs more information about the patient than can easily be completed using a web or mobile form, or
  2. the back and forth of choosing an appointment time that suits both schedules can be done faster via telephone.

There are exceptions. Many health systems are piloting self-scheduling for certain types of appointments through their patient portal or through apps such as ZocDoc. It appeals to the self-service enthusiasts and rates highly for fulfillment of instant-gettification.

Mobile apps can be a conduit for connecting the user to your organization for appointments. Placing a “request appointment” button (within the symptom checker or the physician finder) in logical areas can funnel new patients to your scheduling center.

Mobile is Another Channel: At its simplest, mobile represents another change. Since the first healthcare call centers, there have been cycles of invention and change:

  • pilot a service based upon a health system objective or unmet audience need
  • fine-tune the process to reduce variation
  • make it more efficient using software or automation
  • reinvest any time saved into growth or starting another service

Communication and wayfinding services will continue to be multi-channel: telephone, video, website, patient portal, and mobile applications. As the mobile experience is demanded by a growing audience, more services will be supported by it. It will interface with additional software and applications, putting more self-service at your audience’s fingertips.

Mobile may connect your organization with a new set of customers: the 18-29 age group who only use their smartphone to place a call as a last resort.

There is an opportunity to leverage mobile to off-load low challenge or low acuity calls. This creates the chance to take on additional business, improve service levels, or shift staff to support new opportunities. Mobile is just another cycle of (re)invention and change.

Sue Altman-Riffel worked as a manager and consultant in the telehealth industry for 28 years. She currently serves as the CEO for two digital companies: Self Care Decisions and AppCatalyst, which support more than 200 healthcare organizations with self-triage and mobile application design and development.

Vendor Spotlight: TriageLogic Expands Telehealth’s Reach to Help Your Employees


TriageLogic


TriageLogic® believes no one should delay care because physicians are unavailable or the ER is too expensive. That is why earlier this year, TriageLogic launched a new product, Continuwell®, to provide telehealth services to a wider market. With Continuwell, TriageLogic tackled the big question that many organizations face: How do they keep healthcare costs down and employees healthy?

This new telehealth product was created to help businesses and organizations decrease employee healthcare expenses and reduce employee absenteeism by providing free, 24/7 access to a qualified, objective registered nurse. It also allows companies to engage employees by placing all services in one platform and send push notifications and messages.

A recent Pew Research study found that 77 percent of Americans own a smartphone. TriageLogic realizes the connection people have with their phones and their desire to be better connected with more aspects of their life.Continuwell nurses provide the necessary care without the need of a doctor in 3 out of 4 cases. Click To Tweet

The American Hospital Association found that:

  • 74 percent of U.S. consumers would use telehealth services.
  • 76 percent of patients prioritize access to care over the need for human interactions with their healthcare providers.
  • 70 percent of patients are comfortable communicating with their healthcare providers via text, email, or video, in lieu of seeing them in person.
  • 30 percent of patients already use computers or mobile devices to check for medical or diagnostic information.

Continuwell is a telephone healthcare service with a network of experienced registered nurses. Continuwell provides nurses on demand to evaluate employees and their family members to determine the appropriate care for their symptoms. Continuwell differentiates itself with its nurse-first model, where nurses use doctorwritten protocols to evaluate callers and determine the care to resolve their symptoms.

Continuwell nurses provide the necessary care without the need of a doctor in three out of four cases, saving the cost of a telehealth doctor visit and making the system affordable for employers and employees.

The Service

Step 1: A member enters their symptoms using a mobile application (app) or website portal.

Step 2: A registered nurse calls back within minutes.

Step 3: The nurse evaluates their symptoms and helps them with the next steps.

The team at TriageLogic has spent years developing a mobile app that would be user friendly, to increase utilization, as well as customizable, to allow employers or brokers to modify content to fit their specific needs. They recognized the challenge of getting employees to download, register, and then remember the benefits available to them through their employer.

The Continuwell platform allows organizations to select the services they want to include and creates a custom mobile app for their employees, where they get access to all of their services in one place. The app even has single sign-on capability to make it even more convenient. The platform is flexible enough that services can be added or removed on demand.

You take care of your patients, but who takes care of your staff? Why not extend a confidential and independent triage service for your staff by making Continuwell part of your employee benefits package? Continuwell is always available to help your staff get back on their feet, no matter the symptom.

Benefits

  • Easy to use, easy to access.
  • Customized with your logo and your own buttons.
  • Single sign-on ability means your employees can seamlessly navigate through all of your services.
  • Announcements and events calendar make it easy to keep information coordinated with all your employees, through push notifications.

Continuwell can place all wellness and health options in one, easy-to-access spot. With so many options available to employees, it is easy for a company’s benefits and programs to get lost. The customizable mobile application places the company’s benefits in employees’ hands, making it easy for them to find the resources they need, when they need them.

The Continuwell mobile app extends the reach of telehealth service to more people and puts them in control of their health. As telemedicine becomes more prevalent, TriageLogic is committed to providing hospitals and practices with the technological tools to meet the needs of their patients and staff. TriageLogic is also committed to helping its clients ensure high-quality care, while decreasing costs and improving patient satisfaction.

TriageLogicFounded in 2006, TriageLogic is a URAC accredited, physician-led provider of high-quality services and software for telehealth. TriageLogic is a leading provider of top-quality triage technology, mobile applications, and call center solutions. The TriageLogic group serves over 9,000 physicians and covers over 18 million lives nationwide. Visit www.triagelogic.com for more information

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Do Mobile Apps Belong in Telephone Triage?


LVM Systems


By Mark Dwyer

Being a “digital immigrant,” whose knowledge and comfort with mobile apps is admittedly deficient, over the past thirty years I have championed the value of a traditional, phone-based nurse triage call center. If I need clinical help (or vendor assistance, for that matter), I still prefer a phone call to interact with a person.

To me, texting, emailing, tweeting, or communicating by any other non-voice-to-voice method, not only can be cold, impersonal, and incomplete, it is often intimidating. Despite claims to the contrary, the developers of many mobile apps have compromised ease-of-use for faster programming and meeting product release deadlines.

That said, I do see a number of scenarios where having access to a mobile app or other software-based solution offers a real benefit to the consumer and a natural tie-in to today’s nurse triage call center. Let’s begin by looking at a few functions commonly used today in telephone triage call centers to which mobile apps are being interfaced.Callbacks should be made within thirty to forty minutes of receipt of the initial request. Click To Tweet

The Triage Nurse Callback Queue: The follow-up call queue is of weighty value especially when new patients call and all of the call center nurses are busy speaking with other patients. Here, assuming the call is of a non-critical, low-acuity nature, a non-clinical staff member could advise the patient that no nurse is currently available and he or she would gladly add the patient to the nurses’ callback queue once some initial information is gathered.

Web or Mobile App Requests for a Nurse Follow-up Call: For some, enabling the patient to send a summary of their conditions via a smartphone app would be the logical starting place for a phone app interface. Many hospital call centers have begun accepting this kind of communication.

Using the triage nurse callback queue for outbound calls to the patient enables the nurse to review the text sent via the mobile app. Once reviewed, the nurse calls the patient back to engage in a more in-depth conversation regarding the details of the patient’s symptoms.

As always, if the patient is experiencing critical symptoms, they should always be instructed to hang-up and dial 9-1-1 or proceed to the nearest emergency department.

Prioritizing Calls in the Callback Queue by Acuity: The best way to verify that each call added into the nurse callback queue has been assigned an appropriate acuity level would be to have all calls reviewed, assessed and, if needed, adjusted by acuity. To facilitate this, many sites have a charge nurse responsible for managing the queue throughout the day, making sure the highest acuity requests remain listed at the top of the “requests received for nurse call-back” queue.

But this is an article on mobile apps. Isn’t there a way to review and assign an appropriate acuity level with a technological solution instead of needing to manually review each request using a process that requires the addition of more staff?

Natural Language Processing: A more technologically advanced option would be to utilize one of the industry’s natural language processing (NLP) mobile apps. An NLP system can read, at the time of the initial call, the notes captured by the non-clinical, front-end intake person or directly by a call center nurse. The NLP can then interpret the notes into their clinical equivalents, assess the acuity of the call, and send the call to the follow-up queue or make it available to the nurse, in both cases with the appropriate acuity level.

There are systems that can automatically assign an acuity ranking to each call before adding it to the nurse callback queue. If the call is being handled directly by the call center nurse, this same information can be provided directly to the triage call center nurse to help direct her guideline selection. Doing so substantially reduces the time needed to manage the queue. Instead, the charge nurse could be used to provide greater value to patients by handling additional live triage calls.

Again, if needed, these calls could be assigned a higher or lower acuity level by the charge nurse monitoring the queue. When functioning correctly, the auto-feed, queue-sorting algorithm should take into consideration newly added calls every two to three minutes. Generally, callbacks should be made within thirty to forty minutes of receipt of the initial request.

Live Chat Technology: Another option traditional nurse triage call centers are beginning to embrace is utilizing live chat technology to enable the patient to directly interact with a triage nurse within just a couple of minutes of the initial inquiry. Here, via the chat function on most computers and smartphones, the patient can simply enter a brief description of his or her symptoms and send it to the call center. A triage nurse opens the chat, reads the patient’s notes, and then enters an educational or directive note back to the patient again in the chat window.

The nurse’s reply, along with the patient’s initial message, is returned to the patient for further review. If the patient is satisfied with the nurse’s response, he or she simply closes the open chat link. Otherwise, the chat can continue. Once the final message is sent, click to close the chat window. Be sure to follow organizational HIPAA privacy rules.

Using the chat function can be a great productivity benefit because a single nurse can manage multiple chats simultaneously. Just be sure, if chat is implemented in the call center, clearly segment each caller’s or patient’s data from all others to avoid inappropriately sharing personnel health information (PHI) with the wrong individual.

Self-Assessment via Guided Questions: Another mobile app gaining popularity in the telephone triage world is often referred to as a symptom checker. This app provides patients with the ability to self-assess their symptoms using a web or phone-based app. These programs typically begin by providing instructions for using the app and the site’s privacy rules.

When the patient is ready to begin, two diagrams appear, one male and one female, with several body regions defined (such as upper right leg, lower left leg, neck, etc.). The patient can rotate the body to indicate the concern has something to do with an area on the back. Once the body region is identified, the patient clicks on it to display a list of symptoms from which to choose (for example, muscle ache, sunburn, laceration, etc.).

Typically, these programs present a user-friendly interface with self-triage guidelines or some other healthcare information pertaining to the issue the patient is having. If the patient prefers to speak with a nurse, some of the more advanced symptom checker apps will enable the patient to request a follow-up call from a call center nurse.

The patient’s request is added to the nurses’ follow-up call queue. The process continues from there, processing the request much like the steps for chat follow-up interactions, except that the subsequent contacts take the form of phone calls instead of chat texts.

Photo of Wound: This is a surprisingly simple, yet significant feature of many remote apps tied to triage call centers. One of the greatest challenges of performing remote patient triage is the inability to see the patient’s symptoms or problem visually. By adding the ability to share a photo with the call center nurse, the patient can greatly enhance the nurse’s ability to successfully triage the issue.

It is true. A picture is worth a thousand words. These photos are typically shared as jpg files and are stored as part of the patient’s overall triage encounter record.

Video of Patient Behavior: Another visual tool available from some vendors is the ability to send and store a video of the patient’s behavior. Describing lethargic or manic behavior or the uncontrollable crying or hysterics of a toddler is often difficult for a highly stressed parent. Enabling the nurse to watch a brief video of the patient’s current activities can greatly improve the nurses’ ability to correctly assess the patient’s health issues.

Video-Based Doctor Visits: The last application is a rapidly growing phenomenon that spawned an entire new industry to address what many believe to be one of the greatest challenges of Obamacare: providing insurance coverage to twenty million Americans, while struggling with a major shortage of primary care physicians throughout much of the country.

Through governmental action such as the ACA, millions more Americans were provided government subsidized healthcare. Unfortunately, the vast majority of individuals who initially enrolled in the new programs were those of greatest ill health and costliest conditions. These individuals were also largely without a primary care provider. Consequently, the over-crowded, already backed up emergency departments across the country became even more congested with individuals who had nowhere else to go to receive the healthcare they needed to stay alive. Video-based doctor visits provided a partial solution.

The sharpest players in the healthcare triage call center niche will be those who devise a strategy to integrate with these video-based physician practices, performing both pre and post-visit calls and doing follow-up case management calls to these individuals.

The future is here. Either embrace it or miss this current wave—or might it be a tsunami?

LVM Systems logoMark Dwyer is a 30-year veteran of the healthcare call center industry. Mark is in his sixteenth year at LVM Systems where he serves as COO. LVM Systems provides healthcare call center software. For more information or a demonstration of LVM’s call center solutions contact Carol Zeek, regional VP, sales, at 480-633-8200 x279 or Leann Delaney, regional VP, sales at 480-633-8200 x286

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Medical Apps and their “Application” in the Clinical Contact or Monitoring Center


LVM Systems


By Traci Haynes, MSN, RN, BA, CEN

Mobile technology is growing exponentially. Hardly a day goes by when there isn’t information on a new medical app for mobile devices. Clinicians use them in their practice to increase efficiency in providing patient care and to effectively explain information to their patients. And individuals use them to learn more about their conditions, and then often to monitor their health status. They are also used as a way in which healthcare providers and patients communicate or interact.Hardly a day goes by when there isn’t information on a new medical app for mobile devices. Click To Tweet

The 2016 HIMSS Connected Health Survey reported that more than 50 percent of respondents indicated their hospitals currently use three or more connected health technologies, which positively affect their ability to communicate with patients and to deliver a higher standard of care. The Technology Marketing Corporation (TMC) reports that the global wearable medical devices market valued at $3.7 billion in 2015 is expected to reach $13.5 billion in 2022.

The advancement in technology in electronics and sensors has permitted devices to capture and present data from the number of steps walked to an EKG. Then it transmits that data to the user or healthcare provider by means of remote or wireless communication. TMC reports wearable medical devices are segmented into diagnostic (such as vital signs, sleep, activity, and fetal and obstetric monitors) and therapeutic (which includes pain management, insulin monitoring, respiratory therapy, and rehabilitation devices). Wearables have different sites of application including head strap, wrist, handheld, and shoe sensors.

Remote monitoring programs primarily focus on serious, chronic conditions that can result in repeated hospitalizations. Several studies have been done on pilot programs with discharged patients and their efforts to reduce avoidable readmissions and maintain medical stability. These individuals, based on their diagnosis, were outfitted at home with devices such as a digital scale, blood pressure monitor, EKG recorder, or pulse oximeter, along with a telestation that wirelessly sends measurements taken in the patient’s home to a monitoring center where the information is viewed.

If the patient data is outside the predefined parameters, appropriate interventions can be pplied, such as a medication change, dietary modification, home visit, or physician appointment. Another example is a sensor on an asthma controller inhaler and an emergency inhaler that sends a signal to a cellphone, which then transmits the information to a monitoring center to let them know whether the inhaler is being used as prescribed.

The innovations in technology and remote monitoring continue to expand. BAM Labs developed an FDA-approved sensor mat, to function as a smart bed, that is placed under a mattress to monitor presence, sleep pattern, and heart and breathing rates. The collected data is transmitted to an app viewable on an internetconnected device.

Other examples include eNeighbor developed by Healthsense, which uses sensors placed on the patient and throughout the home to detect falls, wandering, and medication adherence. Independa created a system for monitoring that can include gathering clinical measurements as well as sensors that monitor motion, toilet flushing, and door opening. The data is then reported via an online app.

Some experts say patient monitoring is necessary for hospitals and physicians to evaluate their business. And monitoring programs are tools to help achieve the triple aim: improve access, raise outcomes, and make the healthcare systems more cost effective.

Challenges have included funding, reimbursement, and patient engagement. Some individuals may have to be reminded or persuaded to use the apps, as unfamiliarity with technology can add an additional encumbrance. Other challenges include staffing needs, filtering the important biometric data and integrating it into the EHR, and questions of medical and legal liability.

Is there a return for the health systems that have implemented a remote monitoring program? The answer is “Yes.” An article in Medical Economics written by John Morrissey, published in 2014, indicated improvements in the bottom line over time. Gains were realized from decreased hospital admissions and reduced use of emergency services. Beyond costs savings, the patients benefitted from the assurance they were being monitored, which improved self-management skills, enhanced quality of life, and enjoyed increased satisfaction.

LVM Systems logoTraci Haynes, MSN, RN, BA, CEN is the director of clinical services at LVM Systems, Inc

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Registration Open for 1Call Leadership and Training Seminar

1Call, a division of Amtelco1Call announced the opening of registration for the Eleventh Annual 1Call Leadership and Training Seminar. The conference will be held September 12-14, 2017, at The Madison Concourse Hotel, in downtown Madison, Wisconsin. Topics currently scheduled include:

  • Updates for all 1Call Intelligent Series Solutions: Infinity, Genesis, and Soft Agent
  • Tips for transitioning to Soft Agent
  • New ideas for improving workflows using MergeComm automation
  • The latest on secure texting with miSecureMessages
  • Hands-on scripting
  • More topics to come.

This event provides attendees with a unique opportunity to learn how to use 1Call solutions to streamline communications throughout healthcare organizations, as well as an opportunity to network with other healthcare communication professionals. Attendees are also able to talk directly with Amtelco trainers, software developers, project managers, and field engineers.

According to Mike Friedel, senior vice president of sales, “After last year’s record-breaking conference, we are looking forward to another fantastic conference. Each year, we welcome many new attendees, as well as many returning attendees. The open atmosphere of sharing between attendees and Amtelco personnel makes it an extremely positive experience for everyone.”

For information contact 1Call at 800-225-6035, seminars@1call.com, or 1call.com.