Tag Archives: future trend articles

ACA Opportunities Abound for Healthcare Call Centers

By Mark Dwyer

On June 28, millions of Americans anxiously awaited the long-anticipated Supreme Court ruling on the Affordable Care Act (ACA), otherwise known as “Obamacare.” I imagine everyone in the healthcare profession shared my apprehension that day. Leading up to the decision, there was much talk about what upholding or dismantling the ACA would mean to the healthcare profession and to the communities it serves.

Today, we now know much of the ACA was upheld. So, it’s full-steam ahead into an uncertain future. Whether you were for or against the ACA, the fact is it is here, and we must adapt appropriately. My personal opinion of the law aside, I believe, regardless of the Supreme Court ruling, healthcare call centers are positioned to play a more significant role.

The net effect will be millions of newly-covered people in the healthcare system. People who would otherwise forgo care or seek it at the emergency room will now be in search of a primary care provider and other preventive services. People who let their chronic diseases become major issues can now access disease management resources.

It does not take a social scientist to see that a large number of these newly-covered people will be looking for guidance on how to best manage their health. That’s where the healthcare call center becomes indispensable.

Healthcare call centers are an important key to improved efficiency in the healthcare field. As the ACA enters the implementation phase, here are some of the ways LVM sees healthcare call centers contributing or leading.

Hospital Readmission Reduction: One of the provisions of the ACA is a financial penalty for healthcare organizations that fall into the top quartile in terms of 30-day readmissions for selected disease states. For example, if a hospital has a large number of in-patients with a DRG (disease related group) of heart failure (HF) who are readmitted within 30-days of discharge, that hospital is at risk for losing a percentage of its overall Medicare reimbursement for the year.

Healthcare call centers are a logical and efficient means for monitoring the post-discharge progress of patients who were admitted with HF, acute myocardial infraction, or pneumonia.

Physician and Facility Referral: In some metropolitan areas, the number of newly-covered people in the healthcare system may number in the tens of thousands. Many of these people will be looking for primary care providers, as well as specialists. Is your call center prepared to deal with increased traffic?

Disease Management and Prevention: Under the ACA, there are several preventive treatments covered at no cost to the patient. Many of these preventive services are geared toward women. For example, women entering into the healthcare market can now schedule services like mammography, well-woman visits, and cervical cancer screenings via the hospital’s call center.

Moreover, the ACA provides a variety of grants for disease management functions like surveillance, research, and tracking. Here, healthcare call centers can take the lead, collecting pertinent data over the life of the individual patient. Call centers can collect and analyze patient data, interfacing with an electronic health records database or an ADT file, enabling data to be shared and available in real-time.

Even More: This is just the tip of the healthcare call center iceberg. There will be plenty of opportunities to offer improved services like telephone triage, class registrations, physician-to-physician referrals, and so on.

In addition, the healthcare call center is now being used as a guidance center for those people seeking a health insurance plan for themselves or their family. As new insurance companies enter the marketplace, consumers will most likely seek guidance on what type of plan or carrier is best for their needs. Healthcare call centers can play a crucial role as this approach evolves.

Former British Prime Minister Benjamin Disraeli once said, “The secret of success is to be ready when your opportunity comes.” Whether you were for or against the ACA, the opportunities it presents position the healthcare call center industry for current and future significance.

Are you ready?

Mark Dwyer is chief operations officer at LVM Systems, providers of the healthcare call center software suite, Centaurus.

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

Ten Mobile Communications Predictions for 2012

By Chris Heim

The year 2012 will be a transformational one for smartphones in healthcare. It seems that everyone – from teenagers to senior citizens – has a smartphone. Of course, millions of healthcare professionals now carry them as well. In fact, the growth of mobile technologies is really not even much of a news story anymore. What is exciting is that people are becoming clever at finding new ways to use mobile communications to make meaningful improvements in healthcare. Indeed, the still-emerging capabilities of today’s technologies go far beyond phone calls, email, and medical apps. Smartphones and other mobile devices have kicked off a communications and productivity revolution.

Given this changing environment and the new possibilities in mobile communications, Amcom assembled a roundtable of industry and technology experts to compile a list of what 2012 will bring for mobile communications in healthcare.

1) Hospitals will start doing even smarter things with smartphones: When smartphones began making inroads into healthcare, the industry was abuzz with the idea that they would soon elbow out pagers for critical communications. In 2012, more healthcare providers will recognize that smartphones have evolved into a core element of healthcare communications, enabling mobile access to EMR systems, a host of amazing medical apps, on-call scheduling, directory lookup and messaging, “contact me” preferences, and even medical device connectivity.

2) An incident involving compromised protected health information on a smartphone will cause headlines: A recent Ponemon Institute study found a shocking 32 percent increase in the frequency of data breaches in hospitals. Surprisingly, only half of those surveyed took measures to secure protected health information on mobile devices. The study reports an estimated average cost of $2.2 million per data breach related to this negligence.

Access to protected health information is an important topic when it comes to using smartphones. This is really a two-fold problem. The transmission of messages must be secure, and the information must remain safe once on the device in the event it is lost or stolen. Features like encrypted messaging, password-protected inboxes, and the ability to remotely wipe a device of sensitive data are key protections.

3) An increased proliferation of mobile communication devices: Some organizations have tried to support a narrow set of smartphones. However, the explosive growth of technologies and devices in this “consumer” oriented market means that the newest devices will always need to be incorporated. Smartphones aside, there are many other types of devices in hospitals today, and they all need to be part of the network. Tablets, in-building Wi-Fi phones, voice badges, pagers, and desk phones – every role seems to have a different type of device for receiving messages. Hospitals need a single system that deploys a message to the right individual or group on their preferred devices — no matter what those devices happen to be.

4) Traceability will become a requirement, not a luxury: When pagers were the de facto standard in mobile communications, there was always a problem with message traceability and knowing if and when an important notification was received. If someone launched a code call and one or more doctors or other responders said they didn’t receive it or were not on call, serious consequences could ensue. A 2010 study determined that $91 million in malpractice awards was due to communications errors in three areas: failure of physicians and patients to receive results, delays in report findings, and lengthy turnaround time.

Messaging traceability is now possible whether a communication goes to a smartphone, pager, Wi-Fi phone, or something else. In 2012, the difference between a hospital using the latest technology to do things the right way and one doing it the wrong way will bring this problem to light. Legal cases or the Joint Commission may establish traceable communications as a standard of care.

5) Predictions of the death of pagers will again be proven wrong: Many experts have predicted the death of pagers and paging for many years, but they are wrong. Those who have moved from pagers to smartphones for day-to-day messaging and information exchange probably won’t be going back, but pagers may be the right device for a portion of a hospital’s staff for years to come.

When disasters occur, voice cellular and even Wi-Fi networks can become clogged with traffic and shut down. In these times, wide-area paging has repeatedly proven itself as the “go-to” technology of communications flow. This is yet another year when hospitals realize there’s still a need for this trusty pal in disaster situations.

6) Specialized communication hardware devices will fail to gain traction: There are a wide variety of communication devices available. Pagers are cheap, reliable, and durable; a portion of the market will stay with them. Others will move to the part of the spectrum dominated by smartphones and tablets. In the middle, there will be very little room for specialized devices beyond long-trusted technologies, such as Wi-Fi phones.

The recent emergence of specialized hardware solutions that offer what a pager can do, and more, will ultimately prove to be a temporary success. Our research suggests that hospitals will continue to gravitate toward messaging on smartphones, which offer them even more of what a pager can do.

7) Web out, apps in: The first generation of smartphone users saw a barrage of “solutions” on their phones that just needed a browser to run. This was easy to deploy but difficult to use, so adoption lagged. Good apps make communication and data entry easier, not just mobile. This speaks to having the right form factor and touch screen capability. In 2012, power users will demand that mobile healthcare solutions be truly mobile apps – not just browser-based versions of Web solutions.

8) Hospitals raise the “Now what?” question with tablets: Tablets are amazing and have been purchased by many physicians. Hospitals are working on integrating them into their communications and work processes – with varying results. In 2012, more tablets will be sold than used effectively for communications in healthcare. Mobile healthcare initiatives will continue to struggle with best practices for using tablets for critical communications. People will still be wowed, but the highly compelling uses may be evasive.

9) IT and BioMed will join forces for improved workflow: There are many clinical solutions in hospitals that run well and serve a valuable purpose, but most don’t have a lot of IT involvement. Examples include medical devices such as patient monitoring systems, pulse oximeters, ventilators, and infusion pumps. These systems are essential for patient care, but they typically are handled by the BioMed team, not the IT team. This year will be pivotal for these two groups as they work together to develop an enterprise-wide communications platform, delivering clinical data via smartphones and other mobile devices.

10) Hospitals will deliver comprehensive mobile strategies: The concept of creating a documented mobile strategy has been on the rainy day list for hospitals. As already covered, some of the problems associated with not having a good strategy include failure to provide effective security and message traceability, as well as failure to consider issues raised by “bring-your-own-device” trends.

This year the CIO, CMIO, and others will outline an organizational strategy for mobile devices and enforce it. These strategies will include plans for supporting the many different devices in use. Other considerations to address will be whether devices are to run mostly on Wi-Fi or cellular networks – or both. These strategies will help determine which types of devices are needed for which functions.

Conclusion: The year 2012 will be an exciting time, as hospitals continue finding ways to use mobile devices and their capabilities to their full potential. Smartphones are wonderful on their own, but when integrated into a hospital’s broader communications infrastructure – spanning clinical systems, critical messaging, centralized directories and schedules, and lab results – they provide better, more informed patient care.

Chris Heim is president of Amcom Software.

[From the February/March 2012 issue of AnswerStat magazine]

Your Call Center Can Enable Timely Solutions

By Richard D. Stier

The industry shift from fee for service to value-driven payment has begun. Your healthcare call center can be an essential resource for your organization as it pilots that transition.

Amid familiar acronyms such as HMOs, PPOs, PHOs, IPAs, and MSOs is ACO, “accountable care organizations.” ACOs have two critical roles: manage patients’ healthcare and measure and report patient outcomes. The ACO represents an intentional shift from being paid based on volume to being paid based on outcomes; the better you do for patients, the more you are paid.

“The shift from volume-driven to value-driven payment is inevitable,” says Paul B. Ginsburg, Ph.D., in an article published in the New England Journal of Medicine. “Getting limited shared savings while embarking on the needed investments to build the infrastructure and relationships for improving delivery is better than getting no rewards under the fee-for-service system.”

The ACO is a seemingly simple structure. First, it manages utilization. Second, when the utilization of services is to take place, it finds where it can be done most efficiently. Michael Sachs, chairman and CEO of Sg2, observes, “Whatever the unit of service is, you want to reduce it. Whether I buy the procedure at $4,000 or $5,000 isn’t terribly significant. It’s whether the procedure is done at all.”

Excess readmissions = less reimbursement: Reducing preventable or “excess” readmissions represents a significant financial opportunity. Beginning in 2013, CMS (centers for medicare and medicaid services) will compile national data on readmission rates for eight conditions. The three initially targeted conditions for penalties are congestive heart failure (CHF), heart attack, and pneumonia.

According to David Ollier Weber in the September 27, 2010, issue of H&HN Weekly, “Medicare payment reductions for excess readmissions are calculated by the observed rate divided by the expected rate, minus a standard quality value of 1.” Therefore, in one example, a one percent excess in CHF readmissions would result in a reimbursement decrease of $421,000 instead of $80,000. What could be the financial cost of a one percent excess readmission rate in two or three clinical service areas?

ACO or not, your call center empowers important opportunities: Regulations favor primary care physicians. ACOs view PCPs as the leaders of patients’ healthcare and relegate other parties to being cost centers. Whether or not your organization deploys an official ACO, the success of primary care leverages the ripple effect of multiple clinical services across the enterprise.

Opportunity: Make your call center an intentional referral engine for primary care physicians.

In order to improve patient satisfaction, ACOs must have a patient survey tool in place. Beginning in 2013, the CMS will reduce payment for 3,500 acute care hospitals by approximately $850 million. The potential loss for one two-hospital, 950-bed system is about $2 million. Hospitals can earn that money back – and more – if their patient satisfaction scores exceed those of their competition. ACO or not, improving your patients’ experience of care is especially important for the call center, which is frequently the organization’s first point of contact.

Opportunity: Conduct outbound patient surveys; document and trend results.

Opportunity: Raise patient satisfaction scores with distinctively positive call experiences. Outline themes for consistent agent opening and closing, provide agent supportive messages of the day, and flag caller specific opportunities with “silent selling points.”

ACOs must have systems to identify high-risk beneficiaries, develop individual care plans, and a process to promote evidence-based medicine, patient engagement, and coordination of care. Whether or not you have an ACO, aligning patients with referrals to the most cost-effective, clinically appropriate site of care based on their clinical requirements is key.

Opportunity: Deploy clinical triage with evidence-based protocols, such as Cleveland Clinic guideline protocols.

Preventable readmissions will trigger reimbursement reductions beginning in 2013. ACO or not, avoiding costly reimbursement decreases is an emerging non-optional priority.

Opportunity: Make post-discharge outbound calls to clarify instructions, reduce medication errors, answer questions, and schedule follow-up appointments.

These call center opportunities can increase your stream of referrals to primary care physicians, improve your patient’s experience of care, triage callers to the least expensive clinically appropriate site of care, and reduce excess readmissions. These opportunities are relevant and timely, whether or not your organization deploys an official ACO. The industry shift from fee for service to value-driven payment is underway. Your call center can be a vital resource for your organization as it navigates that transition.

Richard D. Stier, M.B.A., is vice-president of marketing at HealthLine Systems, Inc.

[From the February/March 2012 issue of AnswerStat magazine]

It’s a Wireless World

By Kevin Beale

Someday, in the not so distant future, schoolchildren will read about the history of telecommunications and computing. They will read about how homes once were connected to the phone company, the cable TV company, and even the power company, by separate dedicated wires. They will read about how our offices used to be connected to the corporate PBX and to the local area network by other sets of wires. They will read about how we had to plug in our laptops, tablets, and cell phones overnight to charge their batteries. They will be amazed at how we could function while being tied down like this.

The world of wires is rapidly disappearing. We are breaking free from the wire tethers that keep us in our offices and limit our productivity as we move throughout our days. We are using smartphones, laptops, and tablets to access our applications, emails, files, and network resources no matter where we are. We can work from home while sitting in our most comfortable easy chairs. We can take notes in meetings without writing them on pads of paper and then typing them into our computers when we get back to our offices. Our stacks and file cabinets full of paper are disappearing.

With the advent of solutions (such as Amtelco’s miSecureMessages interactive smartphone paging solution) we are accessing on-call schedules, updating our statuses, and sending and receiving pages on our smartphones and tablets. When we receive pages, we are able to reply to the person sending the page, letting them know if we are able to respond or if they need to find another resource. What a concept, responding to a page and letting the person know we have received it! No more sitting by a phone and waiting for a return call. Who would have thought it would someday be this easy?

The final step in breaking free from our wires will be the deployment of wireless power. Wireless charging pads already are available for many of our smartphones and tablets. Imagine walking into your office or a hotel room and setting your phone on a charging pad. No more carrying chargers with us and replacing them when they get lost or burn out from overuse. Someday we won’t need to plug our computers, our lighting, and our appliances into wall outlets. Our AC power will be provided wirelessly, just as our voice and network communications are now.

We are in the midst of a major shift in how we live and work. We will have less stress and will be more productive. We will be more responsive and will provide better service to our customers. We need only to embrace the change, break free from all those wires, and enjoy the ride.

Kevin Beale is director of software research and development for Amtelco.

[From the December 2011/January 2012 issue of AnswerStat magazine]

Opportunities Abound for Healthcare Call Centers

By Mark Dwyer, LVM Systems

Since our founding in 1988, LVM Systems has seen a great amount of growth in the healthcare call center industry. It would be easy to say that the changes in the industry have been exclusively technological. In the past 20 years, we have gone from huge, clunky, and painfully slow shared workstations to the ability to work from home on a laptop computer.

Yes, technology has come a long way. But if you really want to look at the biggest advancements in the healthcare call center industry, it’s the people. The level of skill and professionalism in the healthcare call center industry has never been higher. Healthcare call center managers are evolving into highly valued strategic partners within their respective organizations.

The future holds a great amount of opportunity for managers and their centers. We see a few trends emerging that we believe will further increase the stature and responsibility of healthcare call centers:

Healthcare Reform – Accountable Care Organizations: As various components of the Affordable Care Act are implemented, there are opportunities for healthcare call centers to play a critical role. One such area is within the concept of Accountable Care Organizations (ACOs).

According to an article by National Public Radio’s Jenny Gold, an Accountable Care Organization “is a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years.”

Call centers that already provide services like physician referral, physician-to-physician referral, and hospital transfer know how to navigate disparate healthcare facilities. As ACOs begin to take shape, healthcare call centers are in a unique position to ensure the success of a burgeoning ACO. First, healthcare call center managers must understand their organization’s approach to ACOs. Once that is clear, you should make a case for participating in any strategic planning meetings. At those meetings, you can promote your expertise and put yourself in a position to be the hub of your facility’s ACO.

Medical Home: Medical home is similar in nature to ACOs. However, finding a single, universally accepted definition of medical home is difficult. The one characteristic most organizations have defined is the physician’s role. In a medical home care delivery system, there is a single primary care physician guiding the patient’s care.

The challenge for healthcare call centers in this scenario is that if physician offices take the lead role in coordinating patient care, they typically do not have a call center of any significance. In this scenario, a facility with a robust or growing call center can still provide this service but have data flow toward the patients’ primary physician.

Healthcare Reform – Readmission Reduction: Another element of the Affordable Care Act is the concept of readmission reduction. This is a punitive aspect of the Affordable Care Act that decreases Medicare payments to hospitals whose patients return to the hospital. This provision takes effect in 2013. This is another opportunity for healthcare call centers to take a lead. Call centers that are experienced with disease/case management should have an easier time transitioning into a readmission reduction environment.

In Conclusion: The future holds many exciting developments for healthcare call centers. Astute call centers managers will pursue these service opportunities, better addressing the healthcare needs of their community in the process.

Mark Dwyer is LVM Systems’ chief operations officer. He has more than a quarter century of experience in the healthcare call center industry.

[From the August/September 2011 issue of AnswerStat magazine]

Patient Heal Thyself

By Scott Zimmerman

As the healthcare reform bill leaves Washington and makes its way into the American health system, the rhetoric is over and the task of implementation begins. To say that the bill is far-reaching is like saying the 1985 Bears played a decent game of football.

From the greater regulation of private healthcare insurance, to the coordination of chronic disease management and care compliance, and removal of barriers to preventative services in Medicare – the next five years or so will see the healthcare industry struggle with now ‘mandated’ expectations to do more with less.  As a result, there is the potential addition of 16 million people to the Medicaid roll, making the need for preventive medicine and flawlessly managed care a critical tool in the management of cost. Patient communication will not be sufficient; it will be patient engagement that is key. Increasing patients’ proactive engagement in their own healthcare will play an essential role in cost management. The healthcare industry needs to take greater measures to create scenarios that help a patient “heal thyself.”

Politics Aside: Regardless of the politics, one thing is certain; managed and preventive care will play an ever more critical role in the long-term health of healthcare – and Americans. The role of technology will be thrust to the foreground in this regard. Its role in managed care “compliance” in terms of provider/patient service and HEDIS scores is nothing new, and outbound notifications and communications to patients reminding of health visits and check-ups are pretty much standard across all healthcare providers now. But it is technology’s potential to truly enable and positively affect preventive care and advance the outcomes of managed care, rather than simply being deployed as an administrative tick box, that the healthcare industry should be paying attention to.

New Ways to Communicate: A new category of patient engagement communications technologies – one that combines the advances in communications with a human touch – will benefit Medicaid, Medicare, and commercial healthcare both in service delivery and cost of service. These technologies are poised to play an important role in the shifts of ownership and accountability for preventive and managed care compliance, such as increasing patient accountability in proactive healthcare management. Why? Because at the bottom of all this is people. Funny, fickle, flawed people. People who forget to take medication, who don’t show up for appointments, who prefer to ignore a call for a mammogram rather than deal with the procedure. People who avoid pain in everything they do – even if it has catastrophic long-term implications.

The need here is to change behavior and to influence knowledge. It requires campaigns. Multimedia, multi-touchpoint, multi-month campaigns. Connecting, engaging, and educating – and then connecting some more. Repeating a message again and again. Yes, it does take people ten, twenty, and more messages and discussions before they finally accept and understand that a plan to address obesity is a priority, that engaging in a smoking cessation program is a necessity, or that taking medication on time in the right dosage will improve their overall quality of life.

Engagement communications that automate and create a two-way dialogue between patient and provider through online, mobile, digital, and good old snail mail methods offer transformational benefits in managed and preventive care, in service delivery improvements, and in better outcomes and cost management.

For Example: Imagine a scenario where an alert notifies both the primary care physician and a caregiver when an early stage Alzheimer’s sufferer doesn’t text or call in from a remote location to confirm they have taken their medication. Imagine a scenario where a pharma company that requires patients to complete a series of three vaccines to prevent future disease and is presently only at 80% compliance rate can send out multiple reminders through email, text message, and voicemail to increase compliance to near 100%. Imagine a scenario where preventive screening for osteoporosis, which is about .05% of the cost of managing the disease over five years, results in a 10% improvement in the compliance rate.

Imagine being able to find out at a moment’s notice the level of proactive and preventive steps patients are making in their own healthcare – and having the ability to share tailored one-to-one marketing messages and campaigns in an instant to increase their involvement, campaigns which enable patients to respond and engage in the dialogue. And imagine all these scenarios where outbound and inbound communications are not only personalized to the individual patient but can be massively scaled to millions of outbound connections and engagements a day.

Investment Considerations: An unpleasant truth is that “for profit” enterprises have to look very closely at the actuaries in investing in proactive medicine and preventive care. The more likely a condition is to materialize until after a patient is handed off to Medicare, the lower the interest in making the investment.

However, with greater government regulation in private health plans and the provision of services, the issue of investment becomes one of “how and where” rather than “if.”  The increase in investment will, of course, contribute to the rising cost of healthcare plans – both company and individual. While health providers will undoubtedly step up education and outreach efforts to ensure patients take proactive steps in the healthcare, employers too, who will be bearing much of the impact of increased costs, will expect and put measurements in place for employees to show proactive ownership and accountability in taking preventive steps to ensure their quality of health.

Advances in technology and communications, including voicemail, Facebook, SMS, and email, mean that people are reachable most anywhere.  Connecting and engaging them with timely, relevant, and impactful touch points, and leveraging these advanced communication tools will provide the healthcare industry with a compelling, high impact, and cost-effective channel to engage and empower people to take a greater and more proactive role in their own healthcare. Everyone wins.

Scott Zimmerman is president of TeleVox Software, Inc.

[From the December 2010/January 2011 issue of AnswerStat magazine]

Experts Predict Major Telcos Will Be Strong Force In Cloud Computing

The major global telecommunications companies will become strong players in the cloud computing market as interest from previously cautious end users increases rapidly over the next two to three years, Ovum has predicted. The report, by the independent telecoms analyst states, that AT&T, BT, Orange Business Services, and Verizon Business have made considerable progress in the arena in just over a year, and in terms of services, can now compete with established players from the IT industry.

According to the report, these companies have led a ‘competitive march’ from telecoms into cloud computing and now have widely acknowledged credibility in the field. Peter Hall, report author and Ovum principal analyst, said “The major telcos have a long heritage in providing managed data center services and hosting and have combined this with their networking and security expertise to meet the needs of customers for cloud computing services.

“Orange has coined the term ‘IT operator’ to reflect its new role in IT services by analogy with its traditional role as a network operator. We believe that the global and major regional telcos will become strong players across the full spectrum of cloud computing services including Infrastructure-as-a-Service (IaaS) and Software-as-a-Service (SaaS).

“We expect to see interest pick up quite rapidly over the next two to three years, so the time is right for many telcos to be developing a strategy and roadmap for their entry to the market.”

[Posted by Peter Lyle DeHaan, PhD for AnswerStat magazine, a medical healthcare publication from Peter DeHaan Publishing Inc.]

The Importance of the Contact Center in Mission-Critical Hospital Communications

By Gerard Shallo

Hospitals today exist in a challenging time. Not only must costs be managed more tightly than ever, but also the availability of healthcare alternatives requires levels of service previously unseen in the healthcare industry. This applies not only to patients but to caregivers as well, who today have more flexibility to choose the facility at which they work. To add to these demands, hospitals must always keep patient safety in the forefront. This is central to the mission of all hospitals, and ensuring fast, effective communications plays a key role in protecting patients around the clock.

On the front lines of this daily battle is the hospital’s operator group. They not only act as the first level of contact to the outside population and potential customer base, but they also play a key role in carrying out lifesaving communications every day. The importance of the communications going in and out of the contact center demands attention. Leaders in the healthcare community have long known the impact of the contact center on the overall operations of the hospital. This has led to a focus on communications technology to support improvements in patient care and safety, as well as cost reduction. Much of this begins with the contact center, where efficient communications can often mean the difference between life and death.

Given the serious nature of their role, hospitals need to approach communications differently from other industries. Because of this, a different type of communications infrastructure is required. Consider the following:

  • Communications can mean life and death: First, communications are mission-critical in a hospital. We are not talking about a message going to voicemail or someone missing a meeting. Lives are on the line.
  • Highly mobile workforce: Doctors, nurses, and other healthcare workers are always on the go. They spend the majority of their time delivering care and are not bound to a desk phone or computer.
  • Dynamic and complex directory: Patient information is transitory, and doctors may or may not be employed by the hospital, so creating an accurate directory that is continuously updated is a challenge.
  • Emphasis on paging and messaging to a variety of endpoints: In healthcare, there is certainly a large emphasis on paging and other types of mobile messaging. This is actually becoming more complex with an ever-widening variety of endpoints that people use to communicate.
  • More data from machines: Hospitals have more data coming from machines than most organizations. Examples include nurse call and patient monitoring devices. There is significant potential to redefine workflows within the facility by delivering this data to mobile staff.
  • Frequent group communications: Group communications in healthcare are also prevalent. Examples include crash teams and others who need to be notified for quick response to various codes. Notifications may have to go to roles rather than a named individual. An example of this would be the on-call cardiologist.
  • Traceable audit trails are essential: Traceability of everything that happened during a particular event is of utmost importance, so a full audit trail is required.

Choose Technology Designed with the Needs of Healthcare in Mind: The advent of computer telephony integration (CTI) has enabled new ways for contact center operators to go about their daily tasks more efficiently, trading in their phones and binders for computers, software, and headsets. There are many operator console products founded on this capability today, offering solid technology at a low price.

While this type of application may work just fine for a standard contact center, the modern healthcare environment dictates intense requirements and far more capabilities due to the life safety nature of everyday tasks. Hospital operators do more than simply answer and transfer calls. They manage code calls for critical patient situations such as heart attacks, infant abductions, and bomb scares. They help patients get in touch with the right doctors by facilitating physician consults. They get important messages to the right person quickly. With every communication, they promote established standards of care, both internally and externally. So what’s the difference between a generic computer-based contact center application and an industry specific healthcare console? Plenty.

Evaluating Options for Operator Consoles: Most telephony-integrated consoles promise fast and efficient call handling, in addition to cost savings, due to the ability to centralize call handling. These systems deliver functionality such as call parking, directory look-ups, and call queue statistics. These powerful features and capabilities go a long way toward reducing costs and creating a more efficient contact center. However, they may lack the functionality needed to truly keep patient safety in the forefront.

As one of the hubs of critical communications for the hospital, the contact center is directly involved in issues of life safety every day. Having this central role requires tools and functionality that go beyond a single system, delivering unified communications capabilities specific to healthcare. This means the ability to connect multiple systems in a way that allows key people to communicate easily using their preferred mobile devices.

Healthcare Communications Requirements: Today’s healthcare contact centers require capabilities that go beyond call handling and into areas related to patient safety, cost reduction, and streamlined communications. Five key functions must be addressed:

1) Integration with ADT/HL7 patient data: Most console applications will integrate with existing telecommunications systems, such as the PBX (private branch exchange), to offer telephony data. But in the hospital setting, who’s calling is just as important as the person they’re trying to reach. When a family member calls for a patient in a hospital, operators should be ready with all relevant and non-sensitive information regarding that patient. This is possible when the console is integrated with a hospital’s ADT (admit, discharge, transfer) data system. When a caller asks for “John Smith,” with a few quick keystrokes the operator should be able to know that John Smith is a patient who was admitted three days ago and doesn’t need to ask the caller to clarify their request.

2) Page-style messaging capabilities to ensure speedy enterprise communications: Paging is an integral channel of communications throughout the hospital. While many of the calls handled by the operator group are page requests, it makes sense for that operator to be able to receive the call, look up the requested physician or staff member, and initiate this message all from the same application. By integrating the console with key messaging systems, the process is simplified and expedited. This is vital when dealing with life safety communications, such as code calls.

Many physicians, nurses, and administrators today must now carry several devices at all times and are looking to trade in their “tool belt” of devices for a single smartphone for everything from code calls and consult requests to personal communications. Smartphones can replace pagers and allow staff to carry a single device for all communications, making both clinicians and IT teams happy. Capabilities, such as text messaging and full two-way communication, improve workflow, while rock-solid reliability ensures critical communications, such as code calls, reach the right person immediately.

3) On-call scheduling tools for operators and individual departments: The goal is to contact the right individual the first time. Therefore, the administration of on-call schedules is a critical responsibility in any hospital and one that can be directly linked to patient safety. Often, this functionality falls on the operator group. Having a correct and widely used on-call calendar is critical to patient safety because it means the right people can be reached on the right device when required. An on-call scheduling platform can be presented to console operators and be browser-based for staff members outside the contact center. It offloads this task from the operator group by giving individual departments a simple system for editing and viewing on-call schedules.

By making on-call scheduling available via Web browser, any user with appropriate access rights has the ability to review his or her personal on-call schedule. For staff members tasked with maintaining the on-call for an entire department, access to all appropriate schedules is readily available for editing as necessary. Many hospitals see the true value of an on-call scheduling tool as expanding the responsibility for schedule maintenance out to individual departments rather than remaining with the operator group. Although this represents a cultural change for many hospitals, having an intuitive tool helps the adoption process. Presenting these schedules in an easily referenced format, such as a standard calendar, makes review and editing simple and quick. It also ensures operators can always reach the right person for urgent and standard communications.

4) Mobile event notification: Many hospitals have inefficient processes for handling critical alarms and events involving point-of-care, security, fire, building management, and other systems. Likewise, critical code communications, which require compliance to standard operating procedures, could often be improved to speed response.

Many hospitals use technology to link alerts and alarms generated by various systems to the operator group and consolidate the management of critical codes and other important notifications. In addition to critical codes, technology can be used to centralize response to alarms for point-of-care systems (such as nurse call, patient monitoring, or ventilators), as well as security, fire, and other operational systems.  These notifications can also be sent directly to the appropriate staff members on mobile phones, smartphones, pagers, or in-house communication systems.

5) Reduction of internal “dial zero” calls to operators: Most hospitals report that thirty to fifty percent of the calls handled by the operator group come from internal callers. A significant amount of contact center traffic can be reduced by introducing tools that enable self-service directory lookup, on-call schedule reference and maintenance, and page message initiation.

A Web-based interface to the console directory serves as a data centralization point, a portal through which information can be both input and accessed. Such a tool enables a credentialed user to log in anywhere, at any time, via Web browser to view both his or her own on-call schedule, as well as the schedules of others, perform directory searches, and send pages or messages. Integration with the operator console database expands these capabilities beyond the contact center, allowing operators to focus on offering better customer service and performing revenue-driving activities. These capabilities greatly reduce the number of internal “dial zero” calls that go to the operator group.

Additionally, adding a speech-based directory solution to handle all internal “dial zero” calls will empower the hospital to perform required messaging and call transfers from any phone within the institution. Speech recognition technology may also be deployed externally, allowing the system to front-end main number calls, directing callers to their department of choice.

Conclusion: Technology advances offer new capabilities to hospitals. It is essential to evaluate these opportunities with the mindset that not all options are equal and that what works for other types of environments doesn’t necessarily fit a healthcare environment. When it comes to selecting the solution that will provide the communications foundation for a hospital operator group, due diligence is definitely required. The care and safety of patients – as well as the organization’s reputation – will all benefit from finding the best possible system to fit each institution’s unique needs.

Gerard Shallo, a product manager at Amcom Software, is responsible for the strategy behind a number of unified communications solutions at the company. The key focus for Gerard is to understand the needs of customers and the market as a whole to ensure Amcom continues to deliver mission-critical solutions as quickly and effectively as possible.

[From the August/September 2010 issue of AnswerStat magazine]

An Argument for the Computerization of Certification Exams

By Michael Brannick

Computer-based testing (CBT) is taking hold in nearly every professional sector, and healthcare-related fields are no exception. CBT combines all the necessities of paper and pencil-based testing (PBT) into an electronic format, making test administration more flexible, convenient, and secure.

The Certification Board of Nuclear Cardiology (CBNC) recently transitioned its certification exam from paper and pencil to a computerized environment, allowing it to both lengthen the testing window and increase the number of locations it is available to candidates. The paper-based version of the CBNC exam, available once a year and in only one location, limited both the scale and scope of the test. The computer-based version substantially decreases the importance of a candidate’s physical location, granting them the convenience and flexibility to test almost anywhere. With regard to testing seat availability, CBT allows the testing window to be more easily extended. In the case of CBNC’s exams, once offered on a single day each year, is now offered in a fixed administration of one week per year, increasing both convenience and flexibility to candidates.

An additional, one-off benefit of transitioning to CBT and expanding test availability is that an increased number of candidates can be accommodated at any one time. Occasionally, with high-stakes tests, seats fill up early, and those candidates who wait until the last minute to register for an exam end up scrambling to find an opening. Candidate testing volume, an important measurement in any testing program, often increases as a side effect of the enhanced availability that comes with CBT.

Another obvious benefit and strength of CBT is the increased security it offers program owners. Paper-based tests must be printed, transported to the testing location, and stored in a secure location until the test date, and while PBT remains a secure way to test, CBT offers an enhanced level of protection. CBTs are encrypted and transferred electronically from the test administrator’s datacenter directly to the testing center over a secure and private network. Since the encrypted test never actually sees the “light of day” until a candidate brings it up on his or her PC, there is almost complete absence of transport risk.

An additional security risk of any administered test is item exposure and test content security. Various test navigation and presentation strategies, made possible only through CBT, can help mitigate item exposure concerns. Test items can be stored electronically, and either pre-selected by the test sponsor for a given exam or randomly pulled on test day. Additionally, advancements in item management software have made it easier for organizations to maintain an up-to-date item bank, and remove or replace test items easily and at will.

Perhaps the most dynamic aspect of CBT is its ability to more closely replicate the “real life” experiences of people in any profession. Candidate users of computer-based tests often experience colorful high-resolution images or relevant video clips as part of their testing experiences. In the computerized version of the CBNC exams, for example, images and figures similar to those seen as part of physician’s actual practice can be replicated to offer a more true-to-life testing experience.

As to how an application of CBT could aid tele-nurses, providing accurate information on a broad range of health concerns at a moment’s notice is imperative. By pulling questions randomly from an electronic database right before the exam and limiting resources available to candidates during the exam, daily tasks can be effectively simulated, thus enabling certification to more thoroughly assess candidate skills.

There is most certainly an argument for the computerization of certification exams, especially with those testing programs that require larger-scale, higher stakes or increased flexibility. Computerization and digitization of content is growing more prevalent in every aspect of society, with the medical profession often at the cutting edge. The computerization of tests is critical to ensuring that future doctors, cardiologists, and nurses are experiencing the most accurate, secure and “practical” experience possible – ensuring that the rest of us will be well cared for in the future.

Michael Brannick is president and chief executive officer of Thomson Prometric, the recognized global leader in technology-enabled assessment services, providing paper-and-pencil, Internet, and computer-based testing solutions.

[From the June/July 2007 issue of AnswerStat magazine]

Emerging Trends in the Teleservices Industry

By Richard Zielinski

The most significant industry development in the past ten years has been the dramatic rise in communications capabilities and the subsequent fall in communications pricing. These forces have opened the floodgates for the trade in employment services on a global scale. The effects of this revolution have been felt in almost every sector. The empowering capabilities of advanced communication technologies will certainly be the pivotal force shaping economies and societies over the next 50 years as well.

Spurred by toll-free, 1-800 calls, U.S. call centers expanded quietly in the 1980s. By 2001, they employed close to four million Americans. Call centers had grown rapidly during the 1990s in the U.S. Their growth began to level off after the year 2000. These leveling numbers can be explained, in large part, by the offshoring of these same teleservice jobs.

While the costs and benefits of outsourcing to developed countries are hotly debated here in North America, developing countries are eagerly recruiting these jobs. India, with its 25 million well-educated English speakers, has been a major beneficiary of offshoring practices. The typical call center agent in India is a young, recent university graduate working on a fulltime contract. An equal number of men and women are employed in this sector and when offered jobs, the overwhelming majority of applicants accept.

In the teleservices industry, jobs that can be standardized and are rule-based are the easiest to transfer and this is where most of the early growth has been. Organizations are effectively using offshore call centers to save up to 60 percent off original home-country costs. These phenomenal savings are driving companies worldwide to continue this trend, constantly pushing its limits. The limits of this type of trade are restricted only by the imagination and the creative abilities of entrepreneurs worldwide. As this process unfolds, the capabilities and opportunities for employment growth in teleservices for both LDCs (less developed countries) and developed countries will grow.

One fascinating industry that is coming of age is telemedicine, which uses advanced technology such as real-time video, conferencing, imaging, and much more to directly link specialists with patients regardless of geographical location. Telemedicine is already turning into big business for many specialists, including U.S. radiologists who have started companies offering 24-hour consulting services. Currently, telemedicine is being used within the U.S. to serve areas where there are shortages of specialists, especially in rural areas.

Early feedback shows that telemedicine is bringing higher-quality service to more patients and it is lowering health care costs by improving efficiency. More and more doctors are beginning to offer their expertise to the global market with new systems emerging for a wide range of medical services including, but not limited to pathology, oncology, back-to-work therapy, diabetes, stroke, cancer, and optometry. These examples demonstrate that even high-skill services can be performed as a teleservice. This is a significant development for LDCs as well because they are equipped to take on some of these higher skilled jobs and respond to global demands.

Ultimately, it is up to the citizens and entrepreneurs of developing countries to decide to what extent and to what level they can service the global market. It takes a deep understanding of innovative technologies and an imaginative mind to create new business ideas and to transform them into reality. Fortunately, many people around the world are doing just that and it is this entrepreneurial spirit that has emerged as the engine of global economic growth.

Richard Zielinski is a researcher at the Progress and Freedom Foundation, studying the digital revolution and its implications for public policy. The views expressed are his own. He can be reached at rzielinski@pff.org. His Master’s Thesis is The Offshoring of Teleservices, Opportunities and Macroeconomic Effects on Developing Countries.

[From the February/March 2005 issue of AnswerStat magazine]