Using Telehealth Data to Improve Patient Care

By David Thompson, MD

Understanding what drives patients to seek treatment can help you educate and prepare staff, which improves the patient experience. While you may have a gut instinct as to your patient’s chief complaints, have you ever crunched the numbers? Health Navigator has. We’ve explored approximately 20,000 medical call center patient interactions to identify the top reasons patients called, how urgent their symptoms were, and peak call times.

The analysis included information for patients from all age groups and found the top complaints included: fever, vomiting, stomach pain, cough, and head pain. Patients with the most urgent needs were babies or infants three to twenty-four months old (nearly 35 percent of calls), while the least urgent calls involved children (two to twelve years).

Understanding why and when people contact nurse advice centers allows telemedicine providers to manage staff expectations and prepare for common interactions. This can be accomplished by using a diagnostic telehealth platform that codes the chief complaints. This serves as a starting point to analyze the most common interactions at a hospital or health system.

If healthcare professionals and call center staff know what to expect in the average telehealth experience, they can:

  • Prepare a standardized call flow format and follow-up questions for their system’s top complaints.
  • Calmly and consistently handle patient calls and manage expectations.
  • Plan workflow and staffing needs, based on patient prioritization and time of day.

Diagnostic platforms can also provide data healthcare professionals can use to determine the suggested treatment protocol for common complaints and to enhance staff training, such as to:

  • Teach incoming staff the most common chief complaints.
  • Document follow-up protocol and questions to ask.
  • Prepare educational information about recommended treatments.

Consider the patient who contacts a medical call center about a persistent cough. The responding staff member recognizes this as a common chief complaint and asks follow-up questions suggested by the telehealth platform. This allows staff to consistently communicate the most common treatments for a cough and to provide care instructions for the patient. The telehealth platform can also provide easy access to printable aftercare instructions to share with patients.

This more efficient workflow can ultimately create a more effective environment for staff and contribute to patient satisfaction and retention efforts. The needs of a patient population may change over time, but data about common chief complaints can help understand these cycles and market services accordingly throughout the year.

David Thompson, MD, 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 works as an author and partner with Self Care Decisions, LLC and Schmitt-Thompson Clinical Content, LLC. In a collaboration with well-known pediatrician Dr. Barton Schmitt, Dr. Thompson has developed a comprehensive set of telephone triage protocols that are used in medical call centers and doctors’ offices in the United States and internationally. He can be reached at david.thompson@healthnavigator.com.

Using Mobile Apps to Engage Patients


TriageLogic


By Ravi Raheja, MD

Telehealth and mobile applications are changing the way healthcare is delivered. A recent Pew Research study found that about 77 percent of Americans own a smartphone. Smartphone users spend about 1.8 hours every day on their devices, and 89 percent of that mobile media time is on an app.

Anyone who owns a smartphone has come to rely on mobile applications to quickly access anything from their bank accounts to social media pages, even to that game they are addicted to. As the public relies more on technology, the telehealth field has grown and adapted to meet patients’ need to stay connected and in control of their health.

Mobile apps play a huge role in bridging access from the provider to the patient. However, as with all new technology, medical mobile apps face obstacles and the challenge of regulation. In recent years, there has been an explosion of patientcentered apps to aid in health and wellness.

Healthcare Mobile Apps Help Patients With:

  • Connecting to their physician’s office
  • Researching health insurance benefits or claims
  • Looking up reviews on providers
  • Finding nearby urgent care centers and ERs
  • Managing chronic disease
  • Lifestyle management
  • Smoking cessation
  • Diagnosis
  • On-demand doctors and telehealth

The Patient Behavior: A key issue for brickandmortar providers is to ensure their patients receive continuity of care with their health. However, with so many outside options available through mobile apps, doctors have to find ways to stay in touch with their patients and ensure patients come back to them for health issues. Solutions include providing patients with a service, such as a nurse triage on call, to ask questions about their symptoms when the office is closed. In addition, doctors can have their own mobile app to engage customers and improve access to the office for prescriptions and appointments.

Provider Driven Telehealth Apps: There are many times when a provider can use mobile technology on phones or tablets to assist in patient care. Mobile apps can send notifications or events directly to patients, such as reminders for appointments and tests or even reminders to help with antibiotic compliance.

Some mobile apps, such as My24/7HealthcareTM, allow patients to send messages to practices to request appointments and prescription refills. Additionally, some telehealth apps allow providers to virtually extend their hours, by allowing patients to conveniently access the practice and their nurse triage from their mobile app. A quality mobile app for a practice allows providers to increase engagement with patients, improve patient convenience accessing the office, and extend the hours when patients can get questions about their health symptoms answered.

In another use of mobile applications, patients can use telehealth mobile apps to replace in-office visits with their providers. This is most useful for rehabilitation or post-operative care patients and those with chronic conditions, who require regular follow-up care or monitoring. Many of these patients have transportation issues due to their health conditions. With the use of mobile applications, patients are able to chat or send images of their progress or setbacks, saving patients the time and money it would take to go to the physical office.

Finally, mobile health applications have proven especially beneficial to rural areas with limited access to physical medical facilities. Rural locations tend to have a shortage of specialists. Primary care providers can use mobile technology to access specialists from large institutions to virtually assist in the care of their patients. The primary care doctors themselves can save their patients time and effort to drive to their offices by conducting telehealth visits using the mobile application.

Regulation: As with any communication tool with patients, an important consideration is that all communication between patients and providers has to be HIPAA compliant. For example, text messages must be secure and coded to ensure that only the patient and the provider are able to access the information. In addition, when sharing a family account on a telehealth mobile app one must have a way for the patient to determine what is visible and to whom.

Though many states have passed telehealth coverage laws, there are still many issues with service reimbursement. Currently, there is some controversy over telehealth parity laws, which would require reimbursement by health plans for telehealth services at the same or equal rate as those services performed in person.

Since telehealth mobile apps are a relatively new tool, the medical community is still developing ways to regulate this industry in order to evaluate and prevent potential dangers. The US Food and Drug Administration (FDA) has weighed in on which apps require regulatory oversight and which do not.

Conclusion: Physicians need to acknowledge and embrace telehealth mobile apps or suffer losing patients to those who are able to integrate the needs of the patient. In this on-demand society, it is important for practices to adapt from the traditional model of healthcare.

Telehealth mobile apps have made it easier for the patient to take an active role in their healthcare, while making access to physicians and medical providers more convenient. While mobile technology has changed the way telehealth is practiced, there is still a lot of data that needs to be examined and adjustments made to the different models to figure out the best approach for the future of healthcare.

TriageLogicDr. Ravi Raheja is the medical director of TriageLogic, a URAC accredited, provider of quality triage solutions, serving over 9,000 physicians nationwide. TriageLogic provides software, mobile applications, and nurse triage services. Recently, TriageLogic expanded its offering to provide employee telehealth solutions through Continuwell. For more information contact Amy Smith at 888-TEAMTLC or visit www.triagelogic.com.

Healthcare Uncertainty and Optimism


LVM Systems

Whatever the future throws at us, the healthcare contact center industry will respond with excellence

By Peter L DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatThe healthcare industry in the United States exists in uncertain times. What does the future hold?

  • Will the status quo prevail, along with its current problems, trending issues, and looming concerns?
  • Will we experience a mere tweak in our present situation? And if so, will the adjustments make healthcare provision easier or harder?
  • Will we witness a 180-degree turn? And if so, will we have a white-knuckle, breath-taking adventure or a controlled U-turn?

I don’t pretend to know the answer, but what I do know is that healthcare contact centers are the solution.

  • If it’s the status quo, we’re ready to elevate our game.
  • If it’s tweaking the current path, we’re ready and will adjust.
  • If it’s a great reversal, we’re poised to embrace what happens.

In any of these scenarios, I’m optimistic that healthcare contact centers are in a prime position to be part of the healthcare industry’s solution. As a group, we’ll improve the overall level of patient care, expand affordable solutions to more people, and be a key resource to all stakeholders.

Whether healthcare contacts occur via the phone, text messaging, webchat, email, mobile app, or video, healthcare contact centers have the experience, the staff, and the infrastructure to take innovation to a higher level. In addition we have the vision needed to capitalize on whatever may come.

How do I know this? It’s easy.

Just read the articles in this issue of AnswerStat. They make me giddy. And beyond this, our editorial advisory board has laid out a great vision for the rest of the year and into 2018. Already I’m hearing ideas from our insightful industry writers and I’ve already seen a couple articles for our next issue.

I can hardly wait.

Though we, in the healthcare industry, live in uncertain times, I’m full of optimism for our future and the future of healthcare.

Peter L. DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat and a passionate wordsmith. Connect with him on his blogs, social media, and newsletter, all accessible at www.authorpeterdehaan.com.

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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.

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.

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.

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 SystemsMark 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 Apps Affect TelehealthMobile 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.

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

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A Day in the Life of an Offshore Medical Coder



By Dr. Liza Alcances, MD

The life of medical coders is completely different from the life of clinicians. Weekends are usually free, the shifts are fixed, and there are not a lot of different activities that fill their days. Coders may miss the exciting work of hospital duty, unique patient complaints, and endless rounds, but there is something to be said about an organized and sedate work life.

An Early Start: Most medical coders work days. A few companies require their coders to work nights, parallel to their US counterparts. Day shifts start as early as 7 a.m. This means that coders have to wake up early, allow for adequate travel time, and get to their offices on time. The dress code is usually business casual, so dressing for work depends on the coder’s fashion sense.

Life on the Production Floor: Each coder works on a computer, either a desktop or a laptop. Most will have the codes already in the software, removing the need for using hard copies of the manuals. Depending on the project, coders can be assigned cases directly from the system they’re using or assigned charts by their supervisor or team leaders. Quotas are set depending on the type of coding they do.

Generally, outpatient coders work on more patient charts, and inpatient coders work on a lesser number of charts. They are not allowed to pick the charts to work on, and so they gain experience working on a wide variety of cases. They must also finish the work assigned to them or meet the required quota, so the coders must stay focused and manage their time. Since they work on protected health information (PHI) and must meet US privacy standards, mobile phones are not allowed on the production floor.

Breaks and Lunch: Two short breaks are given, one in the morning and one in the afternoon. Coders may use the time to take snacks, smoke, have a power nap, or go to the break rooms or to the pantry. Many companies provide indoor entertainment devices, like game consoles, table tennis, foosball, and the like. Some have quiet rooms, meant for sleeping.

Lunch breaks are longer. Most would have their own canteen, and many companies are situated in areas near commercial establishments. Coders won’t go hungry, and usually have enough time to get some coffee or dessert after lunch.

Home Sweet Home: Since coders start their day early, they also end the workday early. Most are usually off by 4 p.m., leaving them ample time to spend with their family or indulge in other activities. Of course since they have to go back to work early the next day, they also go to sleep early.

Other Activities: Audits and team meetings are common occurrences. These are done with their superiors and sometimes with their US counterparts. The quality of their work must be top-notch, and companies require at least about 95 percent accuracy in their coding.

Companies usually hold town hall meetings quarterly. They also schedule team building sessions, family day, sports fests, and other activities that allow coders to release stress. Some companies sponsor seminars and appoint management trainees so that coders will have additional skills that they can use to better themselves and to help the company.

In Summary: The life of a medical coder isn’t something the entire healthcare community is aware of. Medical coding is a specialized occupation, requiring specific knowledge and high analytical skills. There are many challenges but also many opportunities. Some might think that the coder has a boring desk job, but as one of the occupations highly desired in the healthcare BPO, it can also get exciting.

Dr. Liza Alcances MD, RN, CPC, CPC-I, CIC, is the assistant manager, training—healthcare at TeleDevelopment Services.

Medical Call Centers Are Here to Stay


TeamHealth Medical Call Center


Patient Care is Non-Negotiable, and Contacts Centers Can Play a Key Role

By Gina Tabone, MSN, RNC-TNP

Changes to the American political scene are upon us and most certainly will have an impact on the provision of healthcare. Regardless of party affiliation, there are several healthcare reform objectives that need to remain in the forefront by future government leaders. Examples include enhancing quality of care, interdisciplinary coordination and collaboration, better utilization of available resources, gaining efficiencies, and reducing the per capita cost of healthcare.

Focusing on these concepts will contribute to the goal of improved outcomes for both individuals and overall patient populations we serve. The benefits achieved must continue regardless of who is leading the country. Nurse triage as a component of an integrated medical call center is a pivotal intervention and no longer optional.

The world of medical call centers (MCCs) has finally gained the recognition and credibility in the healthcare marketplace that many of us have been trying to expound for two decades. Centralized medical call centers are rapidly emerging as the backbone of health systems because they are integral in achieving better patient outcomes.

The new administration has wisely sought healthcare advice from the most innovative physician leaders in America. Toby Cosgrove of Cleveland Clinic and John Noteworthy of the Mayo Clinic were invited to meet with President Trump to share their thoughts on the Affordable Care Act (ACA) and suggest ideas to plot the best plans for the future.

Concerns were expressed that the current model needs to focus more on patient health and wellness and less on the avalanche of paperwork. This has negatively affected the day-to-day responsibilities of clinicians who are held accountable for reporting on hundreds of quality indicators. These points of contention are agreed upon by most caregivers. Cleveland Clinic and Mayo Clinic have improved patient access, outcomes, and satisfaction by integrating state of the art integrated call centers with clinical access across their multi-state enterprises.

Hopefully, their example will resonate and continue to motivate other organizations to rapidly integrate outsourced or optimized in-house MCCs as a proven solution for reaching the three goals of the triple aim: improving the patient experience of care, improving population health, and reducing the per capita cost of healthcare.

Improving patient experience of care requires open access channels to care. Access means that patients are able to receive the most appropriate level of care needed, in a time best determined by specially trained nurses guided by evidence-based tools. The patient learns to expect reliable advice, taking into account their current health state and is consistently available day or night. Gaps in care are eliminated and delays are avoided, leading to favorable patient outcomes and higher reimbursements in a fee-for-value model. When patients’ well-being is enhanced, everyone gains—most especially the patients. MCCs can stake a claim for making that happen.

The year 2017 will have many organizations taking a close look at their operations and making tough choices about what functions are best accomplished internally and which ones can be entrusted to an outside partner. IT is a department that is being outsourced by some of the largest hospital systems in the country. Patient financial services is another service with options for outsourcing where the benefits to an organization outweigh the costs incurred. Incentives for meeting targets are common. Last, there is a surge by strategic decision makers to explore nurse triage services being performed by an outside call center partner.

The common denominator in all three areas where outsourcing is increasing is the fact that there is a reliance on human capital and all of the contingency costs that goes along with being an employer. High labor costs often consume up to 70 percent of many call centers’ operating budgets. Outside partners can assume the responsibilities with greater efficiency and better outcomes for a lower cost. There is also the possibility that many vendors are willing to assume some of the risks associated with the successful attainment of goals.

The choice to retain, outsource, or develop a hybrid of both is a multifaceted decision that is reserved for leaders at a higher level than the call center. Organizations have to thoroughly evaluate the options to determine which one best aligns with their mission, vision for the future, and strategic plans.

MCCs are branching out and taking on a variety of responsibilities that are well suited to be conducted remotely and reliant of state of the art technology and a dedicated work force. Once the technological infrastructure is created, the MCC can be enhanced to take on additional functions. Appointment scheduling is the most common task of many MCCs and often happens in tandem with the strategy of centralization. Electronic medical records (EMR) products have customized templates embedded with providers’ schedules that are used for office visits, imaging, or procedural appointments. Outbound calling campaigns are often conducted in conjunction with scheduling for appointment reminders.

Centralizing all medication refill requests is emerging as a successful addition to many MCCs. Call center technology such as CRM (customer relationship management) allows for requests to be tracked, acted upon, and measured to ensure established targets are met in a timely manner. Without measurement there is no possibility for improvement. Patients can expect a standard process for medication needs and a defined time for responses or resolution. Medication management and compliance is critical for optimal outcomes, so implementing a process that fosters it is a good idea. Patients stratified as high risk garner the most advantages, which contribute to maximum reimbursements for medical treatments.

MCCs have taken on the significant task of not only caring for the acute needs of primary care patients, but the chronic needs of vulnerable high risk patients as well. Successful coordinating and transitioning of care is central to every health system’s strategy for sustainability today and growth tomorrow. Nurses are the clinicians assigned to figure out how to morph from case management to transitional care coordinators.

Regular communication between the patient and the caregiver is vital and is often by telephone, text, or email. Training the newly created care/transitional nurses in the fundamentals of remote patient care is imperative and is based on the standards of care for telephone triage nurses. The practice of triaging the acute symptoms has branched out and will serve as the starting point for nurses involved in coordinating care.

It is up to those of us established in the medical call center industry to continue to proclaim the unlimited value of a MCC to the healthcare industry. In many healthcare organizations more than 10 percent of employees spend the majority of their day doing their job on the telephone. The benefits of centralizing and consolidating the work they do are undeniable.

C-suite leaders must accept the fact that medical call centers are no longer considered an expense but an investment with impactful ROI (return on investment).

Initially there were call centers, then access centers, followed by contact centers, and in 2017 we are engagement centers. The task at hand is to capture the limited attention of decision makers and educate them on the role MCCs play in a fee-for-value system and the distinct results that are possible. The future may be uncertain, but there remains a need for products, services, and expertise that bring the call center to the forefront of patient care.

TeamHealth Medical Call CenterGina Tabone, MSN, RNC-TNP, is the vice president of strategic clinical solutions at TeamHealth medical call center. Prior to joining TeamHealth, she served as the administrator of Cleveland Clinic’s Nurse on Call 24/7 nurse triage program.

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Should You Use an On-Site System or Internet-Delivered Solution?

By Peter L DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatWe understand a computer room full of equipment. It’s tangible. We can see it, touch it, and kick it (but don’t do that). It’s how we’ve done things for decades, since the beginning of computers and telephony switches.

Contrast this to internet-delivered solutions, which go by a myriad of names, such as SaaS (software as a service), cloud-based solutions, hosted services, and a few more labels that have come and gone. The oldest I can remember is provided by ASPs (application service providers), but I haven’t heard that in years. For the sake of discussion, let’s call all variations of this offsite provisioning concept as internet-delivered solutions.

An on-site system allows for greater control. But with control comes responsibility: maintenance, database backups, software updates, spare parts inventory, disaster recovery, backup power, and technical staff. Financially, an on-site system (hardware and software) represents a tangible asset, which is a capitalized purchase and a depreciated line item on your balance sheet.

While there are usually some ongoing costs for an on-site system, these are minor in comparison to the onetime purchase price. An on-site system doesn’t require internet access to operate, but with the increased need to access information and remote systems through the internet, this advantage is rapidly diminishing.

Although vendor stability is a concern for both options, with on-site systems, there is at least the potential for the call center to continue operating if the vendor fails; this is not so with the alternative.

Internet delivered solutions represent a newer way of provisioning a call center. With it the responsibility to install, maintain, and update equipment is removed, but along with it goes the associated control. Financially, an internet-delivered solution is a service, which shows up on the income statement as an expense. It is not a capital expenditure and there is nothing to depreciate. The only costs are a predictable, ongoing monthly expense, which is generally proportionate to usage.

Internet delivered solutions also offer the flexibility to quickly ramp up and ramp down capacity as needed. Operations may be deployed anywhere in the world where there is reliable internet access, easily accommodating remote agents.

However, there are two chief concerns with cloud-based solutions. One is the requirement of a stable internet connection for the call center or remote agents. Without internet access, the call center is effectively down. The other concern is with the vendor. Do they provide always-on, fully redundant, carrier-grade stability, with 24/7 tech support? Are they financially viable to offer cloud-based service for the long-term? If they stumble or fail, the call center immediately suffers the same fate.

For much of the call center industry’s history, on-site systems was the only option. Some call centers continue to pursue this approach, not because they’ve examined the alternative, but because that’s how it’s always been; they see no point in changing. This is shortsighted. Equally unwise are call centers that race headlong into internet-delivered solutions, wanting merely to follow the current trend. They dismiss the alternative without consideration simply because it’s the old way of doing things. An unexamined strategy is really no strategy at all.

Neither approach is universally right. Both have advantages; both have disadvantages. Take a careful look at the pros and cons of each approach. Then make a strategic decision on which one is the best for you and your call center. Your organization’s future may be at stake.

Peter L. DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat and a passionate wordsmith. Connect with him on his blogs, social media, and newsletter, all accessible at www.authorpeterdehaan.com.

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