Tag Archives: medical answering service articles

Combating Alarm Fatigue


1Call-call center

Presented by 1Call, a Division of Amtelco

How Alarm Fatigue Affects Staff and Patients

If you step into any in-patient hospital or critical care center, you’ll notice one thing in common: near-constant, loud, piercing alarms. Of course, the purpose of an alarm is to get someone’s attention immediately when something abnormal occurs. One study records an average of 1.2 alarms heard by a nurse every sixty seconds or as many as 359 alarms per medical procedure. Few alarms are of any clinical value, making them frustrating to hospital staff and, in the worst cases, harmful to patients. Overall, frequent false alarms and noise levels do little to foster a healing, comforting environment.

Alarm fatigue results in increased response time or decreased response rate due to experiencing excessive alarms. Click To Tweet

The ECRI Institute listed alarm fatigue, or missed alarms, as the #7th Health Technology Hazard of 2019. An average nurse in the ICU has to deal with three dozen kinds of alarm sounds, but several studies support the fact that most people cannot differentiate between more than six different alarm sounds.

Imagine you’re a nurse who has just sterilized your hands to administer care to one patient, and you hear an alarm sound from another room. Immediately, you’re distracted from your task at hand. You must quickly identify the alarm type from where you’re standing and decide if it’s more important than the care you were about to provide. Regardless, you’re distracted from the task at hand.

To complicate matters further, many alarms are non-critical issues or irrelevant to the specific patient. In fact, recent studies estimate as many as 90 percent of alarms in critical care settings are either false or clinically irrelevant. This leads healthcare providers to believe that many devices are crying wolf, delaying practitioner response time when a real emergency occurs. This is alarm fatigue at its core: a delayed response, or no response at all. Sometimes, habituation results in some alarms not even being heard.

It’s no surprise that alarm fatigue is a severe challenge for healthcare providers. Alarm fatigue results in increased response time or decreased response rate due to experiencing excessive alarms. When nurses do not respond quickly enough to the few alarms that need response, patient care is affected. The Joint Commission made alarm management a National Patient Safety Goal over five years ago and has prioritized it every year. There were more than 560 alarm-related deaths in the United States from 2005 to 2008, and by 2012, the number was reduced to 80 deaths over a three-year period.

Strategies to Reduce Alarm Fatigue

Any time spent responding to false alarms is time that could have been spent focusing on patient care. Here are two strategies to reduce alarm fatigue: 

1. Reducing false alarms by considering the clinical context: A standardized set of alarms for every patient is one of the primary contributors to excessive, unnecessary alarms. These can be tweaked for the needs of the patient during check-in. For example, a sharp increase in blood sugar of a diabetic patient may be extremely important and time-sensitive, while the same alert in a non-diabetic patient isn’t a cause for concern. By taking the vital signs of the individual patient into consideration when setting alerts, practitioners reduce the number of false alarms from the start. One solution to this challenge is a dedicated messaging platform that allows for electronic health record (EHR) integration.

By taking a few moments to set up the customized alarms relevant to the patient’s characteristics, the frequency of unnecessary or unimportant alarms decreases significantly. Additionally, when a care team knows that alerts are chosen precisely, individual practitioners respond more carefully when alarms sound.

2. Alarm Priority Systems and Customization: Clinical alerting that routes alarms directly to practitioners’ devices reduce sensory overload for both patients and care providers. Patient care is improved when important alarms get a response as quickly as possible, but patient care is also improved by a restful, quiet healing environment. By funneling the important alarms directly to the physician or nurse on-call, the number of distracting, audible alarms on the floor decreases to only the most critical. 

A messaging platform that integrates with the nursing call center helps triage low-priority alerts to unit coordinators. Only actionable alarms relevant to the nurse’s unit are sent directly to them. More importantly, directing all alarms to one specific device reduces the cognitive load and number of distractions a nurse experiences during a shift.

Additionally, funneling alerts to one device means that the care provider can identify the type and location of the alarm immediately: without having to memorize dozens of alert sounds, drop their current task, or rush to another end of the unit.

Secure Texting: Closing the Gap to Create Effective HIPAA Compliant Communication


TriageLogic

By Ravi K. Raheja, MD

Once a triage nurse has done an initial evaluation on a patient, there are times when the protocol or circumstances require a physician to get involved. In these instances, it is critical for the nurse to get in touch with the provider who is on call, securely and effectively, to communicate the needs of the patient. This requires relaying protected health information, or PHI, securely.

Traditionally, the nurse will page the doctor to call their phone number. The physician calls back, and the nurse verbally relays the relevant information. There are several drawbacks to this option:

It is critical for the nurse to get in touch with the provider who is on call, securely and effectively, to communicate the needs of the patient. Click To Tweet
  • It is time-consuming for the doctor. They must call back and verbally listen to each case.
  • There is no confirmation if the provider received the page, which can lead to a delay in care if the nurse does not follow up closely.
  • The doctor may be involved in a critical procedure or another call and does not know how urgent the request is from the nurse.

Secure texting was created to overcome these drawbacks and provide an efficient way to transfer information that does not hinder daily workflow.

With secure texting, the provider gets a notification from the nurse. The nurse can send protected health information securely. The provider can read the message, and the nurse gets a notification confirming that the message was received and read. This approach supplies the provider with detailed written information as well as allowing them to evaluate the urgency for the call so they can determine the proper callback time and plan before they contact the triage nurse.

While there are many secure messaging platforms available—almost every one of them requires the provider to install and set up an app on their phone. It also requires ongoing support for the app. When the doctor changes phones, the operating system or app needs to be updated.

Providers who are looking for secure texting methods should find platforms that allow for all the features of secure texting and chatting with the nurse, but without an app required on the doctor’s phone. With these types of platforms, nurses can auto-populate the patient information and send the provider’s cell phone a link (with no patient data). 

The provider follows the link and securely accesses the confidential message from the nurse. The provider can then call the nurse back, call the patient back, or securely chat with the nurse. The nurse receives a notification both when the message is delivered and when it is read; this provides continuity of care and prevents any lapse in communication. The messages and secure chat for the nurse are documented in the triage system for future reference.

Providers love this type of service because it does not require any setup on their part and takes less than five minutes to train on the system, which can quickly be done by the practice manager at the provider’s convenience. There is no impact to the service if they change phones or have updates to their device. Setup is quick and easy since there is no app to download and register.

TriageLogic

Ravi K. Raheja, MD is the COO and medical director of the TriageLogic Group. Founded in 2005, TriageLogic is a URAC accredited, physician-led provider of high-quality telehealth services, nurse triage, triage education, and software for telephone medicine. Their comprehensive triage solution includes integrated mobile access and two-way video capability. The TriageLogic group serves over 7,000 physicians and covers over 18 million lives nationwide. For more information visit www.triagelogic.com and www.continuwell.com.

Mitigating Medical Call Center Risk


LVM Systems

By Traci Haynes

Does the word risk evoke an emotional connotation? Regardless of the inference and based on life experience, the word can carry an emotive element. There are uncertainties in risk, which may be associated with hobbies, tasks, or employment. 

Calculated risk is one in which a chance is taken after careful consideration and estimation of the probable outcome. Healthcare organizations employ risk managers to identify and evaluate risks to reduce injury to patients, staff, and visitors within the organization. 

The five basic steps of risk management include: 

  1. establish the context
  2. identify risks
  3. analyze risk
  4. evaluate risks
  5. treat/manage risks
Minimizing risk is essential in the medical call center environment. Consider your potential for risk; then analyze, evaluate, and manage it. Click To Tweet

Risks do exist in a medical call center. There are employee risks and patient risks. These can include risks from the physical environment, clinical management, and technology. What can organizations do to help mitigate these risks? Be calculative, carefully considering and estimating probable outcomes. Even doing so will not eliminate total risk.

An excellent resource that covers information on risk is The Art and Science of Telephone Triage: How to Practice Nursing over the Phone. It is a book written by two industry leaders in the field of telehealth nursing practice, Carol Rutenberg, RN-BC, C-TNP, MNSc, and M. Elizabeth Greenberg, RN-BC, C-TNP, PhD. The book also documents the history of telephone triage and its subsequent evolution, real case scenarios, a chapter of FAQs, best practices, and other topics. 

Minimizing risk is essential in the medical call center environment. Consider your potential for risk; then analyze, evaluate, and manage it. Also essential is focusing on ways in which the medical call center can support the organization’s risk avoidance. Of utmost importance to every organization is supporting the Institute for Healthcare Improvement’s Triple Aim initiative and optimizing health system performance of better outcomes, lower costs, and improved patient experience. 

Hospitals throughout the country are aggressively tackling performance improvement within their own organizations, and evidence shows their efforts are working, helping to reduce risk. The recent addition of a fourth aim emphasizes the importance of improving the experiences of those in the workforce who provide healthcare. The Quadruple Aim focuses not only on better outcomes, lower costs, and improved patient experience, but also on improved clinician experience. 

A medical call center’s number one asset is its staff. Employees need to feel recognized for the work they do. Their working environment should encourage respect and foster a sense of belonging and purpose. They should have the ability to influence their work, as well as given opportunities for professional growth.

Let’s drill down a little further on potential risks in a medical call center. Please note this is not an all-inclusive list and not in order of importance. However, it is information to consider. 

Clinical Management

  • Clinical oversight (such as the medical director): approval of clinical content, decision support tools, educational material, medications, orders, etc.
  • Job descriptions: title, clear description of work duties, purpose, special skills, and qualifications for the position
  • Scope of service: what type and for whom 
  • State Board of Nursing Nurse Practice Act: Follow standards of practice
  • Licensure: state license, Nurse Licensure Compact 
  • Orientation/Training/Preceptor: defined program with monitoring, feedback, and evaluation
  • Policies and procedures: associated with call handling and call scenarios
  • Performance monitoring/evaluations: formal approach using call records and/or call recording
  • Continuous quality improvement: process to identify issues, implement/monitor corrective action, and evaluate the effectiveness

Technology 

  • Electronic Health Record (EHR): access and by whom
  • Computers: hardware/software, latest recommendations, updates, backup, and archiving
  • Database: decision support tools and functionality for a standard method of documentation of the encounter, optimizing the intake of information, and supporting a consistent approach to provision of information and directions for care; reporting of outcomes
  • Telephone system: supports call handling that may include auto-attendant, call routing, tracking average speed of answer, time in queue, abandonment; real-time monitoring, reports, and recording of calls
  • Chat/email/texts/photos: accept and save as part of EHR
  • HIPAA compliant: protecting health information

Physical Environment

  • Outdoor surveillance monitoring
  • Lighting: internal measurement, general, task, emergency, external
  • Security locks: after-hours or 24/7
  • Parking: onsite, offsite, monitored, lighting
  • Security personnel: onsite, offsite
  • Sound: acoustics, masking, privacy 
  • Workstation ergonomics: standing/sitting, monitor height/distance, keyboard/mouse position, adjustable chair with height/arm height/back support, headset, and so forth. 
  • Repetitive stress injuries: most commonly affects injuries to the upper extremities (wrists, elbows, and hands) due to repetitive keyboard activities

Patients and Families

  • Medical call center access: 24/7, after-hours, business hours, community service, or provider/payer service
  • Reason of call: emergent, urgent, semi-urgent, and non-urgent
  • Language and culture: linguistically and culturally appropriate and using an individual’s primary language
  • Age-specific or all age groups
  • Social determinants of health: influences an individual’s quality of health
  • Past medical history: health status prior to encounter and effect on the reason of call/disposition
  • Chronic conditions: type, number, affect the reason for call/disposition
  • Medications: routine, prn, affect the reason for call/disposition
  • Preventive health: affect overall health
  • Disabilities: type, affect the reason for call/disposition
  • Disposition: collaborative decision, access for care as needed
LVM Systems logo

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

Cyber Security and HIPAA in a Medical Contact Center



By Bobby Bennett

With cyberattacks on the rise, what steps should a contact center take to prevent falling victim? First is to recognize it could happen to anyone. Do not equate small with safe. According to a 2017 Trend Micro online survey, 45 percent of small business owners believe they will never be targeted. The cyber security firm 4iQ states in its 2019 Identity Breach Report that cybercriminals targeted small businesses with cyber-attacks at an inordinate rate in 2018—up 425 percent over the previous year. 

With cyberattacks on the rise, what steps should a contact center take to protect its patients health information? Click To Tweet

Ways to Prevent Cyber Attacks

  • Install, use, and regularly update antivirus and antispyware software on every computer used in your business.
  • Use a firewall for your Internet connection.
  • Download and install software updates for your operating systems and applications as they become available.
  • Make backup copies of important business data and information.
  • Control physical access to your computers and network components.
  • Secure your Wi-Fi network and make sure it is hidden.
  • Require individual user accounts for each employee.
  • Limit employee access to data and information. Also, limit authority to install the software.
  • Regularly change passwords.
  • Consider two-factor authentication such as password and PIN.

The Federal Communications Commission provides a Small Biz Cyber Security Planner on their website. 

Another factor to be mindful of as a call center that takes calls for healthcare providers and clinics is that you are a business associate of the covered entity. A HIPAA business associate is a contractor or vendor to a HIPAA-covered entity that creates, maintains, or transmits protected health information in performing a function or service to the covered entity:

If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules. (HHS.Gov)

A business associate contract serves to clarify and limit, as appropriate, the permissible uses and disclosures of protected health information (PHI) by the business associate. They may use or disclose PHI only as permitted or required by its business associate contract or as required by law. 

A business associate is also directly liable and subject to civil and criminal penalties for making uses and disclosures of PHI not authorized by its contract or required by law. It is important that employees are trained and understand the HIPAA rules required of a business associate. You can find sample Business Associate Agreement Provisions and training resources on the HHS.gov website.

Text messaging or SMS has become the preferred method of message delivery for both the contact center and healthcare providers today. With this growing trend comes risk associated with the transmission of PHI. 

Standard forms of SMS could mean that text messages may remain on a device for an extended time. If the device is recycled, lost, or left accessible to unauthorized persons, HIPAA violations may occur. You must provide safeguards to reduce your exposure to these risks. 

Secure Messaging is a secure, HIPAA-compliant way to safely exchange sensitive information via text. Most contact center system vendors have developed secure messaging applications for use with their systems. However, quite often it is difficult for a contact center to convince a large medical group to make changes and convert from their current secure messaging provider to one offered by the contact center. 

If you are not using a HIPAA-compliant application for text messaging, do yourself a favor and contact your vendor to see what they have available.

Bobby Bennett is the western regional sales manager for Startel, Professional Teledata, and Alston Tascom, leading providers of best-in-class contact center solutions for healthcare and medical telephone answering service call centers. Startel’s Alston Tascom Division has created a stand-alone, vendor-agnostic secure messaging gateway which has integrations with some of the most popular secure messaging providers. Contact Bobby at bobby.bennett@startel.com or 800-782-7835.

State University of New York (SUNY) Upstate Medical University


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Integrating Epic’s EMR System with SUNY Upstate Medical University’s Call Centers Saves Time and Enhances Patient Caller Experience

State University of New York (SUNY) Upstate Medical University, located in Syracuse, New York, has a campus 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-dollar payroll and numerous facilities, Upstate is a powerhouse for the economy of Central New York, generating 2.3 billion dollars 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.

SUNY Upstate Medical University wanted to improve their healthcare call center performance and provide a better caller and patient experience. Click To Tweet

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 1Call’s healthcare communication software since 2006 and works closely with 1Call staff to meet their enterprise-wide communication needs. Jody comments, “We use several products from 1Call. Perfect Answer enables us to record custom greetings and automatically plays those greetings before operators answer calls. We use appointment reminders and just started using MergeComm to send SMS reminders, which people seem to really appreciate.”

Upstate contacted 1Call for help, and 1Call confirmed it was possible for their guided scripting 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 shorter lists of questions that are related to everyone who’s associated with that caller ID.”

Testing the Integration 

Integration testing began between Upstate, 1Call, and Epic. 1Call 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 1Call 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. 1Call staff did virtually all of the scripting, and they’ve been outstanding to work with.”

Evaluating Results

Over time, Upstate will use 1Call’s detailed reporting function to assess the results of the integration and determine how much time this project has saved. 1Call keeps track of the time spent on calls and they are looking forward to seeing improved statistics.

“The integration will first be 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.,” Jody explains. “They do some appointment scheduling, a lot of message taking, and 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. 

“We implemented the Epic integration nine months ago, and as of now, it looks like we are saving an average of about fifteen seconds on each call. We’re hoping we can cut 10-20 percent off the duration of each call. That will make a huge difference over the course of the whole day.”

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.”

1Call, a division of Amtelco

Epic Systems Corporation, or Epic, is a privately held healthcare software company founded in 1979 by Judith R. Faulkner and located in Verona, Wisconsin.Since 1976, Amtelco has been providing innovative communication solutions to call centers around the world. In 1997, the 1Call Division was formed to offer enterprise-wide clinical communication solutions designed specifically for healthcare organizations. 1Call is dedicated to serving the unique call center and communication needs of healthcare organizations, helping improve communications between patients, physicians, and staff by connecting people and information.

Should We Worry about Physician Burnout?



How Telephone Triage Call Centers Can Help

By Shannon Bays-Crockett

When studying worrisome symptoms among physicians and mental health workers in the 1970s, Herbert Freudenberger, a German-American psychology, coined the term burnout. HHS described professional burnout in 2017 as an occupational hazard that could lead to high-quality healthcare professions leaving the practice of medicine. By 2017 physicians reporting frequent or constant feelings of burnout totaled 51 percent—up from 40 percent in 2013.

The Center for treatment of Anxiety and Mood Disorders reports that physician burnout is growing in the United States. One in three physicians experiences physician burnout at any point in time. Compared to other professions, physicians are fifteen times more likely to experience burnout. About 45 percent of physicians report that they would quit the profession if it weren’t for the money. Approximately 400 physicians commit suicide each year. Those numbers emphasize the need to quickly address the burnout issue.

Physician burnout symptoms seem to mirror indications of other stress disorders, but there are also distinct differences. Dr. Dike Drummond, author of the blog “The Happy MD,” talks about physician burnout in his article “Physician Burnout and the Four Phases of Compassion Fatigue” (blog post #297) when he says, “Losing the ability to feel empathy, sympathy, and compassion for your patients is a constant risk for all of us.” 

Nurse triage call centers help physicians achieve work/life balance by reducing or eliminating after-hours and on-call requirements. Click To Tweet

Physician burnout symptoms might include:

  • Physical and emotional exhaustion that leaves physicians worn out and unable to recover during downtime
  • The development of a cynical and negative attitude regarding work and patients
  • A reduced sense of purpose along with a feeling that what they’re doing has little to no meaning or value

Ashley Altus, a writer for The DO for the American Osteopathic Association (AOA), reported on Dr. Octavia Cannon’s talk to the January 25, 2018, AOA LEAD (Leadership, Education, Advocacy & Development) Conference in Austin, Texas. Dr. Cannon challenged physicians to teach students and residents about the importance of life outside of medicine. “Encourage them to take time for themselves,” Dr. Cannon said. 

Dr. Cannon continued to discuss how stress for young physicians is at its peak during training in medical school and residency, citing Medscape’s 2018 National Physician Burnout and Depression Report in which data suggested that 42 percent of physicians reported symptoms of burnout. Ms. Altus reported on five key takeaways.

1. The highest rates of burnout occurred in critical care medicine, neurology, family medicine, OB-GYN, and internal medicine. The lowest burnout rates appeared in the specialties of plastic surgery, dermatology, pathology, ophthalmology, and orthopedics.

2. More than 50 percent of physicians feeling burned out noted that a contributing factor was that they had too many bureaucratic tasks, such as charting and paperwork.

3. Patient care declines when physicians suffer from depression. Approximately one-third of physicians reported that they are easily exasperated, and 32 percent reported that they were less engaged with patients because of depression.

4. About 50 percent of physicians reported that they cope with burnout through exercise, while about 46 percent talked with family members and close friends, and about 42 percent coped by getting more sleep.

5. Physicians are split on possible solutions to burnout. About 35 percent favored reduced financial stress through increased compensation. About 31 percent favored a more manageable work schedule and on-call hours. And about 27 percent felt that decreased government regulation would be the most popular suggestion.

Senior news writer for the American Medical Association Sara Berg suggests that medical students might consider the inherent or potential stressors of a specialty as part of their decisions about the specialty they want to practice. In a recent survey about burnout and depression, more than 15,000 physicians from twenty-nine specialties provided responses that indicated 42 percent of respondents were burned out, which was down from 51 percent the prior year. 

The rates of burnout among medical specialties are:

  • Critical care: 48 percent
  • Neurology: 48 percent
  • Family medicine: 47 percent
  • Obstetrics and gynecology: 46 percent
  • Internal medicine: 46 percent
  • Emergency medicine: 45 percent

Addressing Physician Burnout 

Private practice physicians have similar issues. Imagine the pediatrician at a daughter’s dance recital or a son’s football game, and the phone rings. The caller is the worried parent of a child who is spiking a fever. The physician is torn away from the family activity to advise the child’s parent. The doctor becomes frustrated by missing his own child’s big moment in the spotlight and can’t get that back. Somebody loses out, and the choice between duty, frustration, and guilt is not an easy decision. 

Physicians list the top stressors to be bureaucratic tasks, heavy workloads, computerization, and working around the clock.

In their article, Adams and Loftus discuss steps that Emory University’s GME program, the seventh-largest GME program in the country, has taken to prepare future physicians. Highlights of the Emory program are.

Pay Attention: Stress often takes a silent toll. Physician wellness improvement programs can be implemented at worksites.

Fill the Tank: Stress is cumulative and must be managed early and continually. Ensure that staff takes time for meal breaks, makes priorities of time with family and vacations, exercise, eats properly, and sleeps enough hours to restore the body and mind. 

Boost Empathy: Ensure that psychological and/or spiritual support is available for physician and nursing staff when disasters, both big and small, happen. Adams and Loftus offered this from George Grant, a psychologist and theologian: “A major cause of physician stress and burnout is ‘empathic’ imbalance. Most clinicians, to devote the fullest attention to patient and program, are taught to suppress their own concerns and feelings.”

Champion Wellness: Just as physicians tell patients to eat better, exercise, quit smoking, and find healthy ways to relax, the message needs to be passed along to other physicians and medical colleagues.

Strengthen Compassion: Research has proven that compassion is not an inborn trait. It can be taught and strengthened through instruction.

Restore Joy: The Blue Ridge Academic Health Group report, an annual publication, stated in one of its recent issues: “We pay a staggering cost in lost productivity, risks to mental and physical health, eroding quality and safety, diminished patient satisfaction, staff turnover, and lost dollars. 

“At the extreme [is the] personal toll of depression and suicide…. When joy is lacking and burnout is present, the stakes are high.”

Healthcare Call Centers

One popular solution—after-hours telephone triage—works well to achieve all the above goals as well as serve the needs of anxious patients. Nurse triage call centers help physicians achieve work/life balance by reducing or eliminating after-hours and on-call requirements by offering patients telephone access to advice that is based on guidelines established according to preferences of each provider’s practice. All patient calls are triaged using evidence-based guidelines and are directed to the appropriate level of care. All call records are forwarded directly to the patient’s care provider so they are available the next business day.

By partnering with accredited health call centers for after-hours telephone triage, providers can enjoy their professional as well as their private lives. Other benefits of afterhours nurse triage are reflected in improved physician recruitment and retention, as well as a more satisfying patient/physician encounter when the physician is rested and refreshed. 

Shannon Bays-Crockett is a strategic communications specialist with AccessNurse.

Using an Outsourced Telephone Triage Service for Suicide Prevention


TriageLogic

By Ravi K. Raheja, MD

Telephone triage nurses play a critical role in suicide prevention and serve as the first point of contact for callers in need of immediate assistance. According to the CDC, 123 Americans die by suicide every day, and for every person who dies from suicide every year, another 278 people think seriously about it but don’t kill themselves.

As the demand for mental health services grows, practices are turning to outsourced telephone triage call centers to support their practices. Call center triage nurses trained in treating patients with mental illnesses are better prepared to intervene and often alleviate lengthy interruptions to the normal call flow of a practice.

Common Warning Signs Of Suicide

  • Talking about wanting to die or to kill oneself.
  • Looking for a way to kill oneself.
  • Talking about feeling hopeless or having no purpose.
  • Talking about feeling trapped or being in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious, agitated, or reckless.
  • Sleeping too little or too much.
  • Withdrawing or feeling isolated.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

What Can Triage Nurses Do to Help?

Triage nurses need to find a connection with the patient. They combine both clinical judgment and emotional connections. Click To Tweet

In moments of crisis, connecting with a trained triage nurse can deescalate the suicidal crisis and provide immediate help. It is never easy to talk about suicide, but it is crucial for triage nurses to be comfortable talking about suicide in the same way they talk about chest pain. How they handle each call can be life-changing for the caller.

Triage nurses need to find a connection with the patient, find the patients local emergency assistance numbers, and be ready to involve all resources available to help prevent this patient from harming him/herself.

It is essential for the triage nurse to be sympathetic, non-judgmental, and accepting. The caller has done the right thing by getting in touch with another person. No matter how negative the call seems, the fact that it exists is a positive sign, a cry for help.

Triage nurses always have the caller’s safety in mind. They combine both clinical judgment and emotional connections to assess the patient’s situation to identify possible mental health issues.

Even though remote triage nurses typically can’t see their patient, they must develop that all-important trust quickly and by means other than visualization for the caller to open up and be honest with the nurse. Not all patients can accurately describe their condition, history, medical conditions, or other pertinent information. The telephone triage nurse must decipher this uncertainty.

Sometimes the patient needs emergency treatment, while other times they are reaching out for someone to talk with and work thru difficult situations like substance abuse, economic worries, relationships, sexual identity, getting over abuse, depression, mental and physical illness, and loneliness.

Just talking about their problems for a length of time gives some suicidal caller’s relief from loneliness and pent up feelings, an awareness that another person cares, and a sense of someone understanding them. Also, as they talk, they get tired and their body chemistry changes. These things take the edge off their agitated state and help them get through a bad night. Suicide calls can be difficult, but with proper training, protocols, and disposition, telephone triage nurses save lives, one call at a time.

TriageLogic

Ravi K. Raheja, MD is the CTO and medical director fo the TriageLogic Group. Founded in 2005, the TriageLogic Group is a URAC accredited, physician-lead provider of high quality telehealth services, nurse triage, triage education, and software for telephone medicine. Their comprehensive triage solution includes integrated mobile access and two-way video capability. The TriageLogic group assists their clients with value based care and serves over 7,000 physicians and covers over 18 million lives nationwide. For more information visit www.triagelogic.com. and www.continuwell.com.

Is It Time to Start a Medical Answering Service?

How to Start a Telephone Answering Service, by Peter Lyle DeHaan, PhD

Get the latest info in the book How to Start a Telephone Answering Service.

Industry veteran Peter Lyle DeHaan released his insider’s guide to starting an answering service earlier this year. How to Start a Telephone Answering Service concisely shares the essential information needed to start an answering service. Based on decades of industry experience and years of consulting for hospital communication centers, healthcare call centers, and medical answering services, Peter Lyle DeHaan, PhD, released this book as a service to the industry.

“I open the book trying to talk people out of starting an answering service. If they decide to proceed, I want them to do it right and not damage the industry by making naïve mistakes,” said DeHaan. It’s an essential resource for anyone thinking about starting a medical answering service.

“When I consulted for the industry, people kept asking for information on how to start an answering service. I repeated the same advice so often, that I eventually to putting it online.” Since day one that website received steady traffic. Now, for the first time, that updated information is available in a book. Available in paperback and e-book. Learn more at www.StartAnAnsweringService.com.

Healthcare Call Centers Help Bring Care to the Medically Underserved



By Nicole Limpert

A person medically underserved, is someone who does not have health insurance. Estimates from the Centers for Disease Control and the National Health Interview Survey cite that in 2017, 29.3 million, or 9.1 percent of the population were uninsured.

Vulnerable Populations: Multiple studies have found that vulnerable populations in the United States, including the elderly, low-income, ethnic minorities, migrants, and people who received limited education, are also medically underserved.

People with various life experiences may interpret symptoms differently, such as thinking a seizure is a spiritual issue rather than a medical complaint, or expressing concerns about depression as anger rather than sadness.

Poor Access to Healthcare: Living in a rural location and having inadequate transportation present challenges when trying to access healthcare. Rural areas are sparsely populated, resulting in a lack of available services. Rural communities comprise roughly 20 percent of the United States, yet less than 10 percent of doctors practice in these communities.

People in rural areas rely on their own transportation to and from health services. A report released in December 2018 from Pew Research Center, found the average travel time by car, to the nearest hospital for rural Americans, is about 17 minutes compared to 10 minutes in urban areas.

However, even people in urban areas have difficulty visiting their doctor’s office. Transportation can be a challenge for people with disabilities, those with chronic illnesses, the elderly, and people who are low-income. Approximately 3.6 million Americans, from both rural and urban areas, experience missed or delayed medical appointments due to transportation issues.

Medical call centers play a critical role in helping to serve the medically underserved. Click To Tweet

Support from Healthcare Call Centers

Technology enables medical call centers to effectively become an extension of a hospital or clinic’s operations. The communication software used by medical call centers can securely access a patient’s electronic medical record (EMR), update EMRs with notes, and record calls needed for insurance claims and workmen’s compensation. Because everything is documented, detailed reports can be generated for reporting purposes.

Medical call centers can provide or facilitate healthcare-related services 24 hours a day, 7 days a week. They play a critical role in helping to serve the medically underserved, by addressing two of the biggest barriers to healthcare: language and transportation.

Language: Healthcare staff work with an enormously diverse patient population. Understanding a person’s language leads to better healthcare. Multi-lingual call centers hire operators to assist non-English speaking patients or use confidential over-the-phone interpreting (OPI) services for access to hundreds of different languages.

Transportation: Patients with mobility challenges or who live in rural areas don’t have to leave home for some services. Operators can coordinate care, make follow-up calls, schedule visits, contact on-call medical staff, and manage referrals.

Some call centers staff nurses or multidisciplinary teams (such as a resident, pharmacist, and social worker) who are qualified to make health assessments, give medical advice, and escalate critical concerns. These call centers can offer nurse call helplines, emergency mental health counseling, and other critical support.

Helping Hospitals that Help the Underserved

Reduce Penalties: A recent study done by Harvard suggests that hospitals located in low-income areas are more likely to receive penalties due to Medicare and Medicaid’s survey-based reimbursement programs. Patients are asked to provide information about their healthcare experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Unacceptable survey outcomes can result in hospitals losing some reimbursements.

The American Medical Association Journal of Ethics reports that the Centers for Medicare and Medicaid Services (CMS) can currently withhold one percent of Medicare payments—30 percent of which are tied to HCAHPS scores. When Medicare and Medicaid account for more than 60 percent of all care provided by hospitals, the possible amount of dollars lost due to poor patient experience is a significant number. In 2017 alone, approximately 1.7 billion dollars in reimbursements were withheld from hospitals.

Healthcare call centers play a critical role in patient satisfaction surveys, because they function as a virtual lobby for a hospital and are often the first point of contact with a patient. The patient’s experience with coordinating their care via call center agents can positively affect their feedback on the survey.

Reduce Readmissions: The CMS reports that nearly one in five Medicare patients are readmitted to a hospital within 30-days of discharge, yet a recent study from the University of California San Francisco (UCSF) and published in JAMA Internal Medicine found that twenty-seven percent of all 30-days hospital readmissions are preventable.

Medicare’s Hospital Readmissions Reduction Program (HRRP) lowers payments to Inpatient Prospective Payment System (IPPS) hospitals who report too many readmissions. According to the CMS, 2,573 hospitals received penalties in 2018 and had around 564 million dollars in payments withheld.

Studies indicate that a post-discharge call program can help hospitals reduce their readmission rate. IPC Healthcare (IPC) tested the effect of post-discharge calls on readmission rates from October 2010 through September 2011. The IPC call center contacted 350,000 discharged patients to check symptoms, review medications and treatment plans, and remind patients of follow-up appointments. Successful contacts occurred with thirty percent of patients, with an estimated 1,782 avoidable readmissions prevented over that year.

1Call, a division of Amtelco

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

Balancing Patient Care with Data Security and Privacy Starts with the Contact Center



By Tim Critchley

The stakes have never been higher for healthcare providers to deliver a positive patient experience. According to a recent study by Prophet, 81 percent of consumers are unsatisfied with their healthcare experience, while only 40 percent believe providers are best meeting their needs. At the same time, data breaches in the healthcare sector are at an all-time high—occurring at a rate of more than one per day in the United States.

These security incidents not only jeopardize patients’ privacy but also put both patient trust and brand reputation at risk.

All the while, medical practitioners, hospitals, and insurers are pressed to keep up with the ever-evolving regulatory compliance landscape. This not only includes the Health Insurance Portability and Accountability Act (HIPAA) but also the Payment Card Industry Data Security Standard (PCI DSS), the EU General Data Protection Regulation (GDPR), and a long list of individual state regulations and data breach notification laws.

With HIPAA violations alone incurring fines as high as 50,000 dollars (for each violation or exposed record), healthcare organizations are finding themselves wedged between conflicting objectives: how do you protect patient data and maintain compliance, without losing sight of providing the best possible patient experience? Data security and privacy are key to providing positive interactions with your customers and patients. Click To Tweet

Contact Center Security

While you can’t please every patient, you can strike a balance between care and data security. The first place to address this is your contact center.

Although online interaction tools and patient portals are gaining in popularity, you can’t underestimate the value of the voice channel. Research by PatientPop shows that 58.5 percent of patients still prefer to schedule an appointment via phone.

As such, your contact center is often the go-to point of interaction for your patients and can set the tone for their entire experience. But this also means that your contact center intrinsically holds, processes, and stores copious amounts of personally identifiable information (PII), from medical records to payment card data. This makes the contact center an alluring target for fraudsters and hackers.

However, it’s not only devious cybercriminals who threaten your patients’ data. Company insiders, such as rogue patient service representatives (PSRs) or contact center agents, pose a massive threat, especially if they have access to patient data given over the phone or stored in desktop applications. In fact, 58 percent of all healthcare data breaches and security incidents are the result of insiders, according to Verizon’s Protected Health Information Data Breach Report.

Security Best Practices

With inside and outside threats, as well as vulnerable legacy systems serving as entry points for enterprise-wide breach incidents, contact centers are undoubtedly a weak link in your security chain. But protecting PII, maintaining compliance, and providing a positive patient experience first involve a hearty dose of security best practices:

  • Treat all data as potentially toxic: The more information that is available in the event of a breach, the easier it will be for a malicious insider or cybercriminal to steal a patient’s identity or access their private medical records.
  • Train all employees and always perform thorough background checks: Go beyond basic employee vetting and background checks, especially when hiring for your contact center environments. Educate PSRs and customer service agents on data security best practices and how to spot social engineering and phishing tactics.
  • Prepare your response management policy: Have an incident response management policy and process in place, preferably as part of an information security management system. Prepare for a worst-case scenario, and test your incident response plan at least annually.
  • Tokenize data: Replace PII with a meaningless equivalent, so even if a breach is successful, the hacked data will be of no value to the cybercriminal. This approach can also assist in the event of a social engineering attack, which can put even the most trustworthy employee at risk for exposing PII.
  • Enforce the principle of least privilege: Give employees the minimum level of access required to perform their job function at the appropriate time. Introduce exception procedures for when emergency access is needed.
  • Authenticate the user to authenticate the service agent: Prevent PSRs and agents from accessing patient data until the PSR has received the right data from the user. This means that until the caller has been successfully identified using the appropriate secure authentication approach, deny access to detailed PII.

Descoping Technologies

With these tactics creating a foundation for security in your contact center, you can introduce descoping technologies. Such technologies not only strengthen data security and compliance by removing sensitive data from your infrastructure, but they also garner a positive patient experience and journey.

For the voice channel, in particular, dual-tone multi-frequency (DTMF) masking solutions hold great promise, allowing patients to discretely enter numerical PHI, such as payment card, insurance, or account numbers, using their phone’s keypad. The keypad tones, however, are masked with flat tones, so they are not exposed to anyone but the patient. The data collected is encrypted and sent to a compliant third party, bypassing the contact center’s environment completely.

While this process may invoke notions of automated interactive voice response (IVR) systems, it is not quite the same. Here, agents and PSRs can remain on the line in full voice communication with the patient, guiding them through the transaction, answering questions, and even handling wrap-up tasks. There are no challenges with misheard or miskeyed data, which can lead to premature hang-ups and abandoned calls. In addition, patients have full control over inputting their information and can enjoy peace of mind that their data is protected. This makes for a better overall customer experience.

Conclusion

Data security and privacy are key to providing positive interactions with your customers and patients, and there really is no longer any need to compromise in either area. A combination of security best practices, strategies, and emerging descoping technologies are ideal solutions to achieve both. No matter which route you take, the less PII you hold and handle, the better off you’ll be. Remember, no one can hack the data you don’t hold.

Tim Critchley is the CEO of Semafone.