Improving On-Call Communication Delays and Code Call Workflows with Web-Based Platforms

By Nicole Limpert

Swedish Health Services was founded as Swedish Hospital in 1910 by an immigrant from Sweden named Dr. Nils August Johanson. Over the years, the campus expanded and merged with other health systems to become Swedish Health Services. It is the largest nonprofit health provider in the Seattle metropolitan area, with five hospital campuses, two ambulatory care centers, and a network of more than one hundred primary-care and specialty clinics.

Swedish Health Services merged with Providence Health & Service, one of the largest health systems in the country, in 2022 after working together for ten years to provide comprehensive care across Western Washington state. The Sisters of Providence founded Providence Health & Services in 1859 as a nonprofit Catholic healthcare system. The health system expanded to include more than fifty hospitals, eight hundred-plus non-acute care facilities, and many assisted living facilities.

Their newly branded organization, Providence Swedish, provides an array of care throughout the Puget Sound region. Their system of eight hospitals and 244 clinics employs more than 2,200 providers and 22,000 caregivers. Providence Swedish delivers the most comprehensive healthcare service in Western Washington, providing care for 1.2 million unique patients annually.

Identifying Healthcare Communication Inefficiencies

Providence Swedish is committed to protecting its patients and has a rigorous quality and patient safety program. Staff submits a “Quality Variance” to their supervisors if an unexpected incident or event occurs that is inconsistent with the organization’s standards. This process results in service reports internally known as eQVR.

This dedication resulted in the First Hill and Cherry Hill campuses earning the highest hospital safety grade of A in 2022 from the Leapfrog Group in their biannual Leapfrog Patient Safety Survey. These campuses were recognized for success in protecting patients from harm and error.

Research indicates that poor communication among healthcare professionals is a leading cause of patient harm. In one study that examined healthcare communication flows, Improving Patient Safety Through Provider Communication Strategy Enhancements, researchers cited that time spent searching for and contacting appropriate providers (a.k.a. “problematic time”) was a crucial communication issue. “As data collection progressed, it became apparent that ‘communication events’ were complex and included time spent ‘hunting and gathering’ for the correct information related to whom to call, how to best contact them, and what to do when the primary person was not available. On average, ‘problematic time’ consisted of 10 to 40 percent of total communication time . . .”

The study’s results found that taking action to enhance teamwork and communication is crucial in preventing unfavorable patient outcomes. Taking action is exactly how leaders from Providence Swedish responded when they identified a communication weakness in their on-call system.

Supervisors at Providence Swedish noticed an uptick in eQVRs related to nighttime on-call providers failing to return calls or pages about patients. The eQVRs were escalated up the chain of command. It was discovered that communication breakdowns and delays were happening due to how updated on-call schedules were handled by the on-call system.

“We had situations where a provider may have a last-minute schedule change, an after-hours availability update, or needed to change their preferred method of being contacted,” said Brenda Frieboes, on-call manager for Providence Swedish. “The previous process for communicating those changes was for the providers to contact the call center and inform an operator. However, the only thing a hospital operator could do at the time was to take a message and put it in their ‘notes of the day’ system. There wasn’t a way for a general announcement to go out. That meant a nurse on the floor wouldn’t know about a schedule change unless they happen to contact the call center looking for help because they couldn’t reach a provider.”

Improving On-Call Communication and Response

Elizabeth Wako, MD, chief executive for Swedish Seattle, initiated the process of searching for a new on-call scheduling platform. She tapped the call center manager at Providence Swedish to find an advanced on-call scheduling system that could handle the roughly two hundred schedules that needed to be managed.

Brenda explained, “We had our on-call schedules in several different scheduling platforms from three vendors. The web program we used hosted every link for every schedule, both for the landing page and for the schedules themselves.”

The team needed an accurate on-call scheduling solution that made it easy to create, view, and update schedule coverage with the ability to easily dispatch messages to on-call contacts using their preferred method of communication. Brenda said, “We literally called around to different hospitals to see what system they used, and we became aware of the vendor we chose.”

The new on-call scheduling solution offered many benefits, including several that addressed the needs of the team, such as:

• Advanced notifications about unfilled schedules
• The ability for departments and clinics to enter and update their own schedules and add them to personal and mobile calendars
• Automated real-time updates

Staff who needed remote access to their schedule could do so via the internet using the vendor’s mobile-friendly care team collaboration application to:

• Access and view their on-call assignments and assign or request their own on-call assignments
• Swap shifts with one another
• Display information about on-call assignments for selected roles

Enhancing Patient Safety with a Frictionless Code Call System

When the call center team at Providence Swedish began the process of finding a new on-call scheduling system, they also decided to update their hospital phone operator console with a more robust platform that could better handle the roughly 2,500 calls they receive each day and to improve the code call process.

Brenda explained, “Providence Swedish has many different locations, and our hospital operators had to manually process code calls from each location using code sheets. For example, if someone from our Cherry Hill campus called a code stroke, operators had to write down the information, pull a Cherry Hill stroke form specific to their campus versus one from another site, and then call the code. There were about one hundred different code sheets for all our campuses. Depending on the code, this manual process could take up to two minutes each. We needed a system that could dispatch codes automatically.

“Providence Swedish wanted an operator console that could work enterprise-wide to guide agents through code calls and quickly dispatch to the correct location with a system that also tied into the on-call software. Our team also chose the vendor’s operator console,” said Brenda. “The vendor’s contact center software and widget-based care team collaboration app we use to manage on-call schedules can speak to each other. The codes are now dispatched through the system, which met all our needs.”

The scripting component of the operator console is fully customizable to efficiently guide operators through any type of call, including complex code calls. Scripts are preprogrammed into the call center software to ensure agents ask pertinent questions, provide the right answers, and direct calls to the appropriate person, department, or campus. Once the scripts have been programmed into the system, the call center agents simply read the prompts and follow the script.

Code calls can be incredibly stressful, and accuracy and speed are critical. Using the console system along with the app helps to:

• Reduce operator errors
• Improve efficiency for a better patient experience and outcome
• Contact the correct on-call personnel
• Provide detailed reporting analytics

“Now, when a code call comes in, it rings to an available operator, they select which campus, the code, and input any additional info needed into the fields to make the overhead announcement. It’s ‘click, click, click’ and they’re done,” Brenda said. “We dispatch between one thousand to twelve hundred codes a month from all eight of our hospitals, and most of our codes are dispatched in under a minute now. Dispatching our codes through this new system versus pulling the code sheet has significantly decreased the number of serious safety events.”

There are plans to introduce more automation and take advantage of the care team collaboration app’s interoperable capabilities. Currently, if a code STEMI comes through, the operator must navigate to the on-call schedule page to find and contact the on-call doctor. Soon, when the cardiology schedules are fully rolled over to the app and the operators dispatch a code STEMI, the system will automatically pull the STEMI doctor’s name, contact information, and notify that provider.

“We’re also working with the neuro-hospitalist team to complete an integration with the app and a notification application used in the ED,” said Brenda. “When a code stroke or code STEMI occurs, AMR (American Medical Response) calls from the field to notify the emergency department that they are bringing in a patient who is having a stroke. That sends a notification to the call center about a code stroke coming in. Currently, if our call center doesn’t hear from the ED within five minutes to initiate a code, an operator calls the ER to ask if a code stroke should be initiated. In this situation, time is obviously of the essence. We want to improve that process by using the information from the ED application to automatically notify the appropriate teams if there’s a code stroke that requires intervention.”

Implementing and Using the New Systems

Coordinating and implementing new software can be challenging for a system as large as Providence Swedish. While the hospitals will update their on-call scheduling platform to the care team collaboration app, hospitalist groups and other departments can decide to keep their current system. The entire organization is closely watching the project to see how it’s done and how successful it proves to be.

Brenda and her team began with a pilot group to train and roll over their schedules to the system. The providers, caregivers, nurses, and technicians who were involved all got twenty-four-hour access to their schedules via a QR code they scanned. When other departments saw the results and how easy it was to use, they were also interested in the care team collaboration application.

“Nuclear medicine and others wanted their schedule online too, so I’ve built quite a few new schedules for groups and departments who didn’t have online schedules before,” said Brenda.

Providence Swedish also has groups from a polyclinic with Kaiser Permanente Washington that admit patients to Providence Swedish hospitals. In the past, Providence Swedish providers would call Kaiser Permanente and speak with a polyclinic operator. The agent would connect the doctor from Providence Swedish and the doctor from Kaiser Permanente for a patient consult. These extra steps occurred because Providence Swedish operators could not access the polyclinic’s on-call schedules. Now the Kaiser polyclinic staff have their schedules online, making it much easier to find the information they need via the app.

Brenda continued, “More schedules than ever before are coming online and are easier to access. Plus, it’s direct access to the providers instead of going through an answering service or another switchboard. This is one of the huge benefits of the on-call schedules. I can build as many as I need with as many shifts listed per day as needed. The hospital schedules forty shifts a day. There’s really no end to what we can do or who we can accommodate as far as an on-call schedule. We’re already seeing the benefits of this program.”

Change can be intimidating to staff who are used to doing things in a certain way. However, once new users try it, they report it’s surprisingly easy to use. “The care team collaboration application is user-friendly,” said Brenda. “To be able to sit down and look at it, and then figure out how to do something with a program you’re not familiar with within a few minutes—if that isn’t user-friendly, I don’t know what is. When we were rolling out in the early stages, I had some difficulty getting the groups to enter their schedules for the next month into the app. I’d send a reminder and promise it would only take them a few minutes to complete. Then, I’d suddenly receive a message back a half hour later saying it was so easy that they got the next three months done!”

Brenda continued, “It’s better compliance to have schedules completed promptly. Before using this process, I would have to look at every schedule the week before they were due, and I’d have to email staff about it and offer to post it for them. That scenario has dropped considerably and made my job a lot easier. Now, staff gets their schedules completed on time.”

Customizable, Flexible Communication Software for an Evolving Industry

The United States doesn’t have a uniform health system. This means each organization or even department within the same organization operates in its own unique way and has particular needs regarding technology.

Operating systems used by healthcare have to be customizable and flexible to meet the needs of an industry that is embracing new tools to modernize internal systems. “We’ve had a lot of asks of our vendor, such as needing a customized single sign on process that our IT security wanted, the appearance of the on-call schedules, and tweaks to the software to make it work better for us,” said Brenda. “Their staff has always been very good at accommodating our requests or taking time to code something we need to work a certain way. I know that I can take any question, any ask to them, and it will be looked at and taken seriously.”

While health systems are trying to cut costs, they still must solve efficiency problems to address staff needs and better serve patients. Newly purchased technology should be an investment that can serve an organization with its present and future needs. “I personally wanted this vendor’s operator console and care team collaboration app. I was glad it met the hospital operator’s needs and was chosen,” said Brenda. “I fill in for the agents sometimes, and I liked it because it was a program that would grow with us. In five to ten years, we won’t be doing this process again. We’re not going to be looking for a new on-call scheduling platform or a new operator console system because our vendor will be able to meet our needs, as I see it, for the foreseeable future.”

Nicole Limpert is the marketing content writer for 1Call, a division of Amtelco.

By Ravi K. Raheja, MD

How accurate are the medical messages that your nonclinical operators send to your providers? According to Gilman and Bedigian, LLS, a law firm that specializes in medical malpractice, one of the biggest factors that leads to a lawsuit is when operators don’t send critical messages to doctors immediately. In fact, we have found that out of all emergency messages, about 30 percent do not accurately relay the situation for the provider to react. (Also see this white paper on the accuracy of medical messages.)

So how do you ensure that nurses and providers are receiving appropriate information? Below we discuss an easy-to-use tool that helps train operators so that all medical message intake verifies potential emergencies related to each patient complaint. Best of all, this solution only increases call time by an average of 30 seconds. 

Consider this example of a patient message: a patient calls and reports they are feeling dizzy, experiencing both a headache and what they think is a sinus infection. At first glance, this may not be serious. To an uncertified operator, this wouldn’t sound like an emergency. However, after using our augmented intelligence tool, MedMessage Assist, the message adds that the patient is feeling weakness in their arm, leg, or face. 

This information, coupled with the reported headache, automatically reprioritizes the patient’s request. The triage nurse calls the patient back within a minute and ends up advising them through triage protocols to go to the emergency department immediately.

The bottom line: the difference between a nonurgent and emergent call can be a single overlooked symptom.

When we refer to accuracy, we aren’t just talking about how well an operator records what a patient tells them, we’re talking about whether the operator knows to ask additional questions based on those symptoms. This is because patients and operators aren’t medically certified, so it’s easy for both of them to overlook potentially harmful health conditions that their initial symptoms represent. 

This also means that if a message doesn’t accurately reflect the urgency of the patient’s symptom, the patient might end up waiting too long to receive a callback. Unnecessarily long wait times for patient care then leads to poor health outcomes.

So how can augmented intelligence improve medical message intake?

Analyze Data Recorded by Your Operators

When you implement MedMessage Assist (MMA), its software will analyze the text that your operators are typing into their online forms while they’re listening to patient callers. Then, when it detects symptoms that might indicate more severe medical conditions, it prompts operators to ask qualifying follow-up questions. Those answers will improve the specificity of each message and allow providers to establish a proper sense of urgency for processing patients’ requests.

How big of a difference that could really mean?

By the Numbers

When reviewing 2,661 report tickets for patient complaints submitted to triage nurses, MedMessage Assist generated additional information for 726 of them, or roughly 27 percent.

We also learned that about a third of all emergency messages submitted were initially insufficient. MMA helped clarify the messages that were emergencies, and in about 2 percent of the cases, the symptoms were serious enough to require 911 intervention.

Using MMA adds little time to any patient call: roughly 24 seconds when the original complaint isn’t changed, and 40 seconds when it is. That means each call requires less than a minute to ensure the accuracy of patient symptoms so that they receive the appropriate care advice.

As operators gain more experience with MMA, we also expect to see them anticipate which questions to ask and use MMA to compare their work. Implementing MMA has led to accuracy scores of over 99 percent, in some cases vastly improving the message intake that some providers previously reported.

Additional Benefits

Message accuracy has a positive domino effect on several additional aspects of the patient experience.

Improving the patient intake process leads to faster dispositions and greater safety for those who may need assistance sooner than scheduled appointments. In turn, operators become more efficient, which shields providers from malpractice liability.

Beyond these benefits, MMA can work with existing software, so you don’t have to worry about implementing an entirely new system or synchronizing your data with it. There’s also a minimal learning curve for MMA, as the system is designed to be self-teaching. Finally, it meets all requirements necessary to be HIPAA compliant.

Improve Medical Message Intake with a Free Trial of MMA

We’re confident that MedMessage Assist and its augmented intelligence will transform the way that offices manage its patients’ calls. 

Ravi K. Raheja, MD is the CTO and Medical Director of the TriageLogic Group. Founded in 2007, TriageLogic is a URAC accredited, physician-lead provider of high-quality telehealth services, remote patient monitoring, nurse triage, triage education, and software for telephone medicine. Their comprehensive solutions include integrated mobile access and two-way video capability. The TriageLogic group serves over 9,000 physicians and covers over twenty-five million lives nationwide.

Are you ready to improve medical message intake and your patient health outcomes? Email us at info@triagelogic.com to schedule a 15-minute demo. You may also qualify for a free trial of MedMessage Assist.

Integrating with Epic’s Electronic Medical Records to Save Time and Enhance Patient Caller Experience

By Nicole Limpert

State University of New York (SUNY) Upstate Medical University, located in Syracuse, New York, has a campus that is comprised of hospital, clinical, academic, research, residential, and campus facilities. The Upstate University Health System includes Upstate University Hospital, Upstate University Hospital at Community Campus, Upstate Golisano Children’s Hospital, and multiple offices to serve 1.8 million people. The care they provide extends from Canada to Pennsylvania and includes a robust telemedicine program to assist rural communities.

The origins of SUNY Upstate Medical University stretch back to 1834 and today is the only academic medical center in Central New York. The University includes four colleges: College of Nursing, College of Medicine, College of Health Professions, and College of Graduate Studies, with a total enrollment of over 1,500 students. SUNY Upstate Medical University is the region’s largest employer with 9,460 employees. With a $600+ million payroll and numerous facilities, Upstate is a powerhouse for the economy of Central New York, generating $2.3 billion for the region.

Identifying Areas for Improvement

SUNY Upstate Medical University wanted to improve their healthcare call center performance and reduce caller wait times, shorten the time spent on each call, lower the call center’s abandonment rates, and provide a better caller and patient experience.

When looking at the call answering process, they discovered the time it took for operators to obtain information from callers could be improved. “We realized operators had to ask a series of questions to figure out which patient they were talking to,” says Jody Williams, call center systems administrator for Upstate. “Right now, they answer the calls with, ‘Thank you for calling, this is Jody, may I have the patient’s date of birth?’ and they search for everyone by birth date.”

The call center operators needed more information about each caller sooner, to reduce the overall time of the call, and to handle calls more efficiently. Staff from Upstate’s IT and call center departments realized that integrating with the Epic electronic medical record (EMR) software used by the hospitals and clinics would save valuable time.

Healthcare Communication Partners

Healthcare organizations and their patients rely on good IT partners to help with fast and accurate communications. However, most healthcare facilities use a mix of disconnected technology, and sharing information among healthcare IT systems has traditionally been a challenge.

Upstate has used their current vendor’s healthcare communication software since 2006 and works closely with them to meet their enterprise-wide communication needs. Jody comments, “We use several products from our vendor. One solution enables us to record custom greetings and automatically plays those greetings before operators answer calls. We use another for appointment reminders and just started using their integration engine to send SMS reminders, which people seem to really appreciate.”

Upstate contacted their contact center software vendor for guidance, and they confirmed it was possible to use the guided scripting solution to bridge the communication gap, while making sure calls would look the same to operators. For incoming calls, the automatic number identification (ANI) would be sent to Epic’s EMR database. Jody explains, “When the call comes in, the caller ID is pushed out to Epic, and then Epic returns the patient’s record on the operator’s screen. Operators can verify who they are speaking with using a shorter list of questions that are related to everyone who’s associated with that caller ID.”

Testing the Integration

Integration testing began between Upstate, their vendor, and Epic. The vendor worked on the scripting piece and Upstate’s in-house Epic staff worked with experts located at Epic’s Verona, Wisconsin campus.

“For this project we collaborated with vendor staff, several members of our IT group, and one of our Epic experts on site who worked with an expert from Epic’s home office,” says Jody. “Before the integration was a success, we had several calls between all parties to identify system requirements and build the scripts using suggestions from Epic. The staff from our vendor did virtually all the scripting, and they’ve been outstanding to work with.”

Evaluating Results Using Detailed Reporting

Upstate is using their call center software to keep track of the time spent on calls. Over time, the detailed reporting function will assess the results of the integration and determine how much time this project has saved. They look forward to seeing improved statistics.

“We implemented the Epic integration nine months ago, and as of now, it looks like we are saving an average of about 15 seconds on each call. We’re hoping we can cut 10-20% off the duration of each call. That will make a huge difference over the course of the whole day,” Jody explains. “The integration was first used with our ambulatory call center because they handle virtually all of the incoming calls for about fourteen of our ambulatory departments, which includes general medicine, dermatology, pulmonary, etc. They do some appointment scheduling, a lot of message taking, transferring calls to a nurse, and various requests that come from the patients. Any time a patient dials the main number for each of those departments, it goes to this call center and the wait time had been extremely high.”

Future Integration Plans for Efficient Workflows

There are plans to use this technology throughout more of Upstate’s call center departments. Some of the call center groups rely heavily on scripts which are used for appointments, physician referrals, prescription renewal, scheduling, crises and emergencies. These areas hope to also save time on calls and serve patients more efficiently by taking advantage of the Epic integration.

Scripts can be shortened because much of the information the operators need will already appear on their screen as they answer the phone call. According to Jody, “Our medical messaging group currently follows and completes a script with a caller’s name, patient name if different, provider information, and then they look up the doctor on call and add that to the script. After the integration, we will be able to pull most of that info from Epic.”

Nicole Limpert is the marketing content writer for 1Call, specializing in offering enterprise-wide communication solutions for healthcare organizations.

The Technical Side of Operators Working from Home

By Nicole Limpert

The University of Texas MD Anderson Cancer Center is named after Monroe Dunaway Anderson, a banker, and businessman born on June 29, 1873, in Jackson, Tennessee. His family began buying and selling cotton in 1904 and in 1907 MD Anderson moved to Houston, Texas to grow the family business. Monroe established the MD Anderson Foundation in 1936 before his death in 1939. When the Texas Legislature authorized The University of Texas to establish a hospital for cancer research and treatment, the MD Anderson Foundation matched the $500,000 that was appropriated for the hospital which was then named for its benefactor.

MD Anderson is the largest cancer treatment center in the United States and ranks number one in cancer care by U.S. News & World Report. MD Anderson is also a degree-granting academic institution and research center. MD Anderson employs more than 22,000 people, including 1,788 faculty members, has more than 680 inpatient beds, several research buildings and outpatient clinic buildings, two faculty office buildings, a patient- family hotel, and other off-site facilities for clinical and research use, making it one of the largest cancer centers in the world.

The Road to Remote Operators

The askMDAnderson service, formerly known as the Welcome Center, was established to provide answers, resources, and expertise to people with a cancer diagnosis. According to MDAnderson’s website, askMDAnderson (askMDA) can help people:

• Make an appointment
• Understand treatment options
• Learn about research studies
• Navigate the MDAnderson website
• Find out about patient amenities (such as travel and support resources)
• Access prevention and screening services
• Find accurate cancer information
• Locate community cancer resources

When a pandemic was declared in March 2020, MD Anderson required non-direct patient care personnel to work remotely. This included the operators for the askMDA line. “Before April 2020, our operators had never worked remotely,” says Ninette Thomas, askMDA Operator Manager. “We began to look at the resources we already had to develop a hybrid remote call center and realized we were not harnessing the full capability of the technology available to us. That lead to a collaboration with a lot of other departments at our organization to establish our hybrid remote call center.”

IT Mobilization

“The very first step was to determine the feasibility of allowing our operators to work from home. Luckily, we were already investigating the prospect of working from home, but the pandemic fast-tracked all our ideas and testing for how operators could work from home. We knew it was a possibility and we needed to figure out a way to make it happen,” says Jeffrey Cain, Applications System Analyst.

Once the IT team determined it was technically feasible for the operators to work from home, they began preliminary testing. That was followed by a new hardware roll out, new software installation, technical testing, and regression testing. Jeffrey says, “We had a mixture of technical and regression testing. We simulated a remote workflow in our testing environment and included our regression testings and scripts to determine if we needed to change anything in our ANI (automatic number identification) screening table.”

Custom call center agent scripting guides operators through each call no matter where they are located. Remote operators are provided with the exact information they need to provide the best patient experience and reduce call center error rates.

Michael Wolf, Principal Applications System Analyst and Technical and Support Lead for the IT team that supports the operators adds, “As IT support we had been working remotely one or two days a week for years. So, for our ongoing support, we were already working remotely using our call center software for regression testing, developing new call scripts, and modifying call scripts. We were able to go through the entire workflow for a couple of years which helped us transition after COVID-19 hit.”

IT Challenges and Departmental Collaboration

One of the biggest challenges the team faced was that all their operators worked on-site and used desktops. The IT team replaced all the desktops with laptops for each operator for a total of twenty-two new laptops. Each laptop required:

• A docking station
• The hardware operators needed to use the laptops in their homes
• Installation of all the relevant call center software used by operators and managers
• USB headset, wireless keyboard and mouse, and a mouse pad

New hardware and applications had to be used and integrated to ensure the system ran smoothly, “The introduction of the other applications meant we had to familiarize ourselves with these applications that interface with our call center platform because they had become an integral part of the operator’s workflow,” says Jeffrey.

Testing, planning, and coordinating how to work from home wasn’t just for the askMDA operators. All of IT had to go remote in April 2020. This meant deploying thousands of laptops to people across MD Anderson’s institution to give them the ability to work remotely.

Michael says, “It was a huge undertaking with a lot of coordination between IT groups. A command center was set up in our main administrative building for people to come in and get any equipment they would need to work remotely. This took some work and collaboration between our colleges on the Voice Engineering Team and us on the Applications Support Team. We had to work out all the kinks, but it did work thanks to a lot of cooperation and collaboration.”

Remote Operator Setup, Training, and Support

Working remotely meant new workflows and procedures would be introduced. Operators had to be trained on using VPN access, two-factor authentication or Velo-Cloud, and establishing audio just to log in. Ninette comments, “We wanted to make sure our operators had the exact same setup they had at home as they did on-site. They also got a pager so when we have a situation like a code blue, they know it went through successfully even though they are at home.”

“The operators were using physical desk phones and their extensions are tied to the ANI screening table and the call center software. We needed to be sure that they could now transition seamlessly back and forth from their desk phone when they’re on-site to working from home,” says Jeffery.

Additional procedures were also established such as:

• Following a specific login order to ensure nothing disrupted the system and it remained operable
• Steps to be done when returning to campus
• Using RDP (Remote Desktop Protocol) so IT can access the remote machines and make administrative changes

“Our training is 100 precent on-site because we want operators to be comfortable using all the applications before they go home. They are required to work 100 precent on-site for the first thirty days so they can ask questions,” says Ninette.

Remote Challenges

Web-based communication is fast, secure, improves communication times, adds efficiencies through remote access, and reduces the number of potential errors caused by miscommunication and absences. Yet, challenges still exist but they can be overcome with solid procedures and backup solutions.

Outages: Houston, Texas experienced a winter storm in February 2021 that essentially shut down the entire city. This demonstrated how important it was for MD Anderson to have remote procedures in place because some employees were unable to leave their homes. During and after the storm, many team members were without power which can be a downfall of working remotely. However, this organization has backup systems and procedures so communications could continue.

“We have backup procedures in case of a server or phone outage. There is a phone line that isn’t connected to our server so we can use that line for Code Blue and other emergency communications. If the phone system is down, we have landline phones that are hardwired into the building that are designed to work for codes,” says Ninette.

Staff management: Ninette comments, “We’ve been utilizing the reporting functionality of our call center software a lot more now that operators are remote. When we’re in the office and working together, I can hear my staff and know that they are working on calls. Now I’m using the reports a lot more than in the past to monitor productivity and availability. What was surprising to me was that I anticipated having a problem with performance when they went home, but what I found was that our productivity actually went up.”

Remote Benefits

MD Anderson had a separate “ride out” location in another building that was specifically designated as the location all the operators should go to in case of a disaster. The operators would relocate to this command center, which was outfitted with two desktop workstations and multiple open phone ports, where they could resume their normal workflows.

“We are now more prepared for hurricane season. We have less staff required for ride out because we have more people who are available to work remotely—provided they have power and internet. All we need is a power source to continue to work. We can literally work from anywhere,” states Ninette.

Michael adds, “Now that the operators have the ability to work remotely, the IT department has experienced benefits such as decreased overhead to maintain the equipment or perform quarterly tests and reduces our support time.”

Another benefit that came about with the operator’s ability to work remotely was schedule flexibility. After the thirty-day on-campus training, operators were able to go to a four-days-a-week/ten-hours-a-day schedule. The department originally offered only three shifts to cover their 24-hours-a-day, 7-days-a-week operation, but that has increased to seven shifts for more flexibility.

The team rotates the schedule so each operator is located on-site for only two days per week. This results in more flexibility for the operators, easier commutes, and they can limit the number of people on staff in compliance with their institution’s response to keep their employees safer during the pandemic.

Patient and employee safety are paramount. Even though between 82 to 91 percent of the operator staff work remotely per shift, there are still at least two operators in the building at all times in case there is a communication outage. Having a redundancy of operators on-site ensures normal operations without any interruptions.

“As a team, we have the difficult task of balancing patient safety, employee safety, and employee satisfaction. We have made every effort to make sure we are not putting anyone in harm’s way by taking unnecessary risks. Implementing a hybrid remote call center in the middle of a pandemic was challenging. However, the collaboration between the different IT groups and the askMDA operator team have made this a successful transition,” says Ninette.

Nicole Limpert is the marketing content writer for 1Call, specializing in offering enterprise-wide communication solutions for healthcare organizations.

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TriageLogic Helps Unity Health Network Enhance Patient Care and Reduce Costs

In this issue of AnswerStat we’re spotlighting the largest independent physician group in Northeast Ohio: Unity Health Network. With more than one hundred providers in thirty-two locations, Unity cares for hundreds of thousands of patient lives. Unity Health Network is also a leader in the Ohio Independent Collaborative, a statewide organization that unites other large independent physician groups to improve care and lower costs in the modern world of on-demand medicine.

Like most independent practices, Unity Health Network frequently uses telephones to connect patients and providers. Recently Unity recognized these communication channels were due for modernization. As part of its initiative to provide patients with high-quality, improved access to care, the group created a centralized call center, called the Care Coordination Center, with the help of TriageLogic.

“TriageLogic’s call center platform allows us to help guide our patients 24/7, giving them improved access to the correct facility for the care they need,” said Lisa Kilway, manager of care coordination at Unity Health Network. “By using TriageLogic, we can take care of our patients at the best location for the lowest cost, which means we’re not only providing improved care, but we’re also doing it more efficiently.”

By implementing the TriageLogic platform at the Care Coordination Center, Unity Health Network is able to build the foundation for its patient communication strategy. Only one year into the new call center, Kilway said Unity has consistently exceeded its goals month over month. “Previously, patient calls suffered an abandonment rate well over 50 percent, but since we created our Care Coordination Center, that rate has dropped to less than 10 percent.”

In addition to the call center platform, Unity Health Network also implemented TriageLogic’s secure texting feature, which allows for secure texting to a physician – eliminating the need for archaic pager systems. Each text is accessible by the physician for ninety-six hours, so they can review the text and pass it along if necessary. On the back end, the nurse can view when the doctor has received and read the text. “With a page, many times we just sent it and hoped for the best. As a nurse, I really don’t like those loose ends. Secure texting ties them up,” says Kilway.

Unity Health Network developed some key initiatives for 2016. As a starting point, the physician group began providing access and appointments without waiting for a physician’s staff to check voicemails and return calls. “We’ll be moving to do the same with all of our specialties,” says Kilway. “Our goal is to get patients from their primary care physician’s office to the specialists they need to see – sometimes even the same day. We’re able to handle their care much more efficiently and seamlessly.”

According to Kilway, Unity Health Network has even more ambitious plans for the future with technology-driven healthcare. “We’re also piloting a high-risk patient management program, which will include patient advisors who will monitor the patient through telemedicine devices and direct patient care.”

The need for greater, more immediate patient access will continue to grow in the future, and Unity Health Network is committed to being on the forefront. By using the latest technology and efficient communication, Unity will continue to provide modernized, on-demand access to the best healthcare in Ohio.

TriageLogic is a URAC accredited, physician-led provider of high quality telephone nurse triage services, triage education, and software for telephone medicine. Their triage solution includes integrated mobile access and two-way video capability. For more information visit www.triagelogic.com.

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By Charu Raheja, PhD, and Carla Price, RN, BSN

Numerous studies and countless articles have been written about the improper use of emergency rooms and the resulting high financial burden on the U.S. healthcare system. One study by the RAND Corporation indicates that unnecessary trips to hospital emergency rooms cost approximately $4.4 billion a year.

With the U.S. healthcare system in serious need of cost cutting, there is increasing pressure to minimize unnecessary use of the emergency room. In doing so, it is critical to ensure people who truly need care receive it in a timely manner, thereby reducing the potential for life-threatening conditions.

Over the years, telemedicine has been gaining acceptance as a means of lowering healthcare costs, and telephone nurse triage has become part of the telemedicine solution. By using standardized protocols to advise patients to get to the right place at the right time, telephone nurse triage can decrease unnecessary emergency room visits, resulting in significant healthcare savings annually.

However, one of the important aspects of nurse triage that is often overlooked is the profoundly human aspect of the service. Most callers are truly concerned, and having access to a triage nurse provides reassurance and guidance. It is difficult to put a price on peace of mind. In addition, several patients may not realize the severity of their situation.

This real life case highlights the importance of nurse triage in improving health outcomes.

Telephone Nurse Triage Case: It was a weekday morning when telephone triage nurse, Linda G. RN, received a call from the mother of an eight-week-old infant. The baby had been fussy for several days, was not eating well, and had a fever of 100.7. Nurse Linda used the Schmitt Thompson pediatric protocols, which prompted her to ask the mother if the baby had any recent immunizations.

“No,” she replied.

“When is the last time he saw the doctor?” Nurse Linda asked. The mother indicated that the baby had been to the pediatrician the week prior for vomiting, diarrhea, and fussiness, but no fever.

“Have you given him any medicines?”

The mother replied, “No.”

At that point, with the baby having been sick for over a week and now presenting with a fever, the guidelines recommended that Nurse Linda call the child’s pediatrician to inform him of the baby’s decreasing health status.

Concerned about sepsis and other potentially life-threatening problems, the doctor instructed the nurse to call the mother back and advise her to take the baby to the emergency room. The mother was genuinely surprised when Nurse Linda called back and relayed the pediatrician’s instructions, as she was completely unaware of the potential seriousness of her baby’s condition.

Without the guidance provided by telephone triage, protocols, and the nurse, the infant may have experienced delayed treatment, leading to potential increased morbidity, and even death, if the baby had been septic.

Life Saving Calls: As telemedicine continues to expand into new services, providing innovative and cost-effective care, it is important to remember the benefits reach beyond budgetary significance. Cases, such as the one described above, are a lot more prevalent than what one would expect.

For example, in a recent study, we found that as many as 7% of the patients who did not consider their case an emergency (and responded that they would have stayed home if they did not have access to a nurse) were actually told by nurse triage to seek emergency care. Even more alarming, about 1% of the patients who did not think they required emergency care were told to call 911.

This means that a large number of patients are at risk of serious health issues because of not receiving timely medical attention. Every call answered by Linda G., and other telephone triage nurses, may be the difference between life and death. Fortunately, for one eight-week-old baby who wasn’t feeling well, a telephone triage process was in place, and he received the care he needed.

Conclusion: While this is one case of many, a significant portion of the population does not have access to telephone nurse triage. Implementing telephone medicine to a greater population can save lives and improve health outcomes.

Charu G. Raheja, PhD, is the chair and CEO of Triage Logic. Carla Price, RN, BSN, is the nurse trainer for Triage Logic. For more information and related articles, email Charu.

[From the October/November 2013 issue of AnswerStat magazine]

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By Patty Maynard

Healthcare contact centers have been given an increasing amount of responsibility to help their organization meet critical goals related to health reform and patient engagement. With this added responsibility also comes an opportunity to shine – and play an even more valuable role in both your organization’s success and your community’s health. RelayHealth’s RelayCare™ provides the tools and technology to help contact centers achieve excellence in this expanded role.

The New and Expanding Role of the Contact Center: Last year, the Centers for Medicare and Medicaid Services (CMS) implemented its first round of reimbursement penalties for excessive readmissions, which led to more than 2,000 hospitals forfeiting about $280 million total in Medicare funds (Centers for Medicare and Medicaid Report, “Readmissions Reduction Program,” August 1, 2012).

As the penalties increase for excessive readmissions, contact centers can help solve this challenge. Leading healthcare organizations are taking positive steps to avoid CMS penalties and improve patient outcomes. Here’s one example.

Readmission Management Success Story: Wake Forest Baptist Health: Wake Forest Baptist Health, a nationally recognized academic medical center, had been making post-discharge calls to orthopedic patients for several years but saw the need for a more robust readmission management program. Beginning with general medicine and hospitalist patients, they later added cardiology and other patient groups.

The RelayCare Readmission Management protocol-driven workflows enable contact center staff to efficiently manage inbound and outbound readmission management calls, while giving patients a single access point for any questions or concerns. The surveys associated with each patient call are specific to his or her conditions, with an easy-to-follow interface that keeps users from having to scroll through questions that aren’t relevant. The workflow queues also include reminders for tasks, such as “Patient could not be reached; follow up again.”

Post-discharge patient outreach has added about 100,000 outbound calls to the contact center’s annual call volume. The thirty-nine full-time employees handle about 400,000 total calls. Overall, RelayCare facilitates easier, more consistent documentation across multiple touch points. Its reports track discharged patients through the readmission program and cross-references them against readmissions, enabling contact center staff and clinical leadership to view the program’s successes and identify areas for improvement.

The Emerging Importance of Care Management: While hospitals have a powerful incentive to reduce readmissions, a care management program is also important. Nearly 133 million Americans, or half the population, suffer from chronic diseases or conditions (Wu, Shen-Yi, et al, “Projection of Chronic Illness Prevalence and Cost Inflation,” RAND Corporation, 2000). Plus, their ongoing care management represents 85% of healthcare spending (Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2004). An outbound communication program managed by the contact center can yield many benefits:

• Promote self-care and a more proactive role among chronically ill patients
• Facilitate better care coordination
• Support a patient engagement strategy
• Reduce inpatient treatment when possible (to optimize utilization of hospital clinicians) by avoiding admission or readmission
• Provide care management resources for patients, caregivers, and the community at large

Top healthcare organizations use care management software to engage with patients and help them better manage their health. In addition to improving patient outcomes, they are realizing cost savings through reduced readmissions and ED visits.

To read more customer success stories, visit the case study section in the resource library at www.relayhealth.com or learn more by contacting a RelayHealth solutions advisor at 888-743-8735.

[From the June/July 2013 issue of AnswerStat magazine]

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By Samantha Walley

Comcepts is a Mississippi-based answering service assisting physicians and their practices nationwide since 2004. The software we were using could not keep up with our company’s growth. In some ways, it was actually holding us back, designed with a limited, one-size-fits-all set of features. However, we take a very hands-on approach with our clients. We provide an answering service experience that is more like an extension of their office than a generic call center. Plus, each of our clients would like their calls processed in a different way.

A few years ago, we began searching for new answering service software. From the moment we saw the client screen of one particular system, we knew we were close. It already had many of the features we were seeking, customization was possible, and ongoing development meant new features and updates would be available in the future.

Getting Up and Running: We implemented a training program well before the cutover so operators would be familiar and comfortable with the system early in the process. With our database switched over and the equipment tested, it was time to cut over. I won’t lie – I worried a lot before the switch, but it proceeded as smoothly as I could have hoped. We sequenced down the old system, and the new one took over.

Features and Benefits: The fun part started when we were able to use the system, experience the features, and customize each client’s screen for their practice’s needs. All the information our operators need is right in front of them, leaving no need to search for information on other screens or in multiple documents.

This gives operators the ability to complete calls faster. The information our clients deem important is gathered and delivered in the manner they wish without putting a strain on our operation. The same number of operators can now complete a greater number of calls in the same time, which translates into happier callers, pleased clients, and a more prosperous bottom line.

We now have the ability to add new services and features, which gives us an advantage in winning new customers, as well as retaining the loyalty of current clients. We have since added nurse triage services to our business offerings, and these services have been integrated into the system.

About Comcepts: Founded in 1999, Comcepts began as a medical transcription company based on the Mississippi Gulf Coast. In 2004, a client expressed his desire for an answering service that served “physicians only.” After much research and plenty of dead ends with existing answering services in the area, we decided to fill the niche ourselves. Comcepts has grown from a husband and wife team working around the clock to a dozen part-time, full-time, and reserve operators working in our offices. The addition of nurse triage services complemented and enhanced our answering service operation and is seen as an “added value” by our clients. For the next step, we are testing some operators working from home.

Samantha Walley is the president of Comcepts, LLC, which uses nCall answering service software developed and supplied by nSolve.

[From the December 2012/January 2013 issue of AnswerStat magazine]