The healthcare system has a large population of elderly patients, many with multiple healthcare issues or chronic conditions. Taking part in a care management program can help these patients become healthier by educating them about their disease processes and the importance of medication compliance, regular blood work, annual tests, and preventative measures such as flu and pneumonia shots and mammograms, and colonoscopies.
Care management services provide patients with contact to inform them of their conditions in terms they understand and to involve them in personal healthcare goals. In this way, patients are more likely to want to be involved in reaching their goals and becoming healthier. The intent is to keep these patients out of the emergency room and hospital as much as possible.
What is Care Management?
“Care Management programs apply systems, science, incentives, and information to improve medical practice and assist consumers and their support system to become engaged in a collaborative process designed to manage medical, social, and mental health conditions more effectively. The goal of care management is to achieve an optimal level of wellness and improve coordination of care while providing cost effective, non-duplicative services.” (“Care Management Definition and Framework,” Center for Health Care Strategies, Inc., 2007.)
1. Transitional Care Management is a Medicare service that became effective Jan. 1, 2013, per cms.gov. The care management team or nurse navigator will call a patient or caregiver within two days of inpatient discharge to discuss medication, a new diagnosis, or important follow up appointments with the purpose of reducing and preventing readmissions and medical errors.
2. Chronic Care Management (CCM), according to The Centers for Medicare & Medicaid Services (CMS), is a chronic care management services, which are a critical component of primary care that contributes to better health and care for individuals. The goal is to provide the patient and family with the best care possible to keep them out of the hospital and emergency room and to minimize overall medical cost. The program is used to help patients achieve a better quality of life through continuous care and management of their chronic conditions. Patients collaborate with healthcare providers to set healthcare goals, thus making it more likely they will accomplish those objectives.
One patient I worked with is a successful participant in the CCM program. He initially visited the emergency department because of unstable vital signs, weakness, dizziness, and uncontrolled hypertension. He had been out of his medication for three months, was admitted for congestive heart failure and atrial fibrillation, and spent four days in the hospital. He also had uncontrolled diabetes with a Hemoglobin A1C of 10.7 percent and his average fasting blood sugars at home were running in the 300s.
The patient consented to the CCM program for his chronic conditions of atrial fibrillation, congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension, and obesity. He was very eager and willing to learn about his disease processes and to take his medication on a regular basis. He was given information on Medicaid services to help with medication expenses and was educated on Metformin titration and use of his insulin.
I also regularly contacted him for a report on his blood sugar and blood pressure readings. In just two short months the patient has stopped smoking and his fasting blood sugars are now running in the low 130s. He has a better relationship with his son and granddaughter, is more physically active, and is making better food choices. He is due for a repeat Hemoglobin A1C level next month.
This is just one of many examples of what care management can do for a patient. As a nurse navigator, my patients become like a part of my family. I am blessed to be able to educate and support our patients and their families and to help them to make better healthcare choices that can potentially save their lives.
Terri Hibbs, BSN, RN, CCCTM is a care navigator for Baptist Health Hardin Family Medicine.
According to a survey published by the American Hospital Association (AHA) in 2016, there are 3,231 community hospitals in the United States that are a part of a larger hospital system.
The AHA defines these enterprises as either a multihospital system where two or more hospitals are owned, leased, sponsored, or contract managed by a central organization; or a single, freestanding hospital that includes membership of three or more, and at least 25 percent, of non-hospital healthcare organizations. These sizable healthcare systems are often the result of mergers. Hospitals announced a total of 115 merger and acquisition transactions in 2017 alone and this trend is on the rise.
No matter how large the hospital enterprise, call centers are often the first point of contact when a patient or prospective patient contacts a healthcare organization. It’s essential that callers have a helpful, positive interaction with the operators they speak with because medical call center representatives often serve as the face of a health system.
Communications within these large hospital systems were already incredibly complex before the coronavirus began to spread. When the pandemic began, many hospitals sent their call center workforce home to safely handle calls while in isolation.
Call center software gives hospital organizations the flexibility to turn any computer into a fully functional operator workstation. Callers have a seamless communication experience with their provider, even if their hospital has various campuses or locations across multiple states, all while the person they are talking to is working from home.
Using a Virtual Server Brings Multiple Hospital Call Centers Together
Healthcare systems with multiple hospitals, clinics, and call centers can run on a single virtual server located anywhere in the country to function together seamlessly—even if they all use different PBX telephone systems.
This enables hospital call centers to pivot during uncertain times, such as the current coronavirus outbreak, and also grow without adding additional server hardware. Using a virtual server means less equipment needs to be maintained. This saves an organization time and money, which has become even more crucial with pandemic-related budget crises.
To streamline call flows, hospital enterprises are combining and scaling their communication systems virtually. This allows them to take advantage of running their call centers in a virtual server environment or in the cloud, while keeping staff safe.
Other benefits of running call centers remotely:
Ability to route calls to another center in the event of an emergency
Offering longer operating hours by taking advantage of call centers or agents located in different time zones
Easier for supervisors to get fill-in operators if an agent is sick
Ability to handle more calls during peak hours by overflowing calls to other centers during their non-peak times
Tap other labor markets such as retired nurses, students, or a lower-cost workforce and hire people who are located outside of expensive city areas with high compensation rates
Secure Messaging Apps Remotely Support Care Teams
Secure organizational communication is crucial for protecting patients, medical staff, and hospital organizations. Care teams use these apps to send secure text, photo, audio, and video content related to a patient’s electronic protected health information (ePHI), via smartphones, tablets, and desktop computers.
These apps simplify healthcare communications to provide a better patient experience and speed the process of patient admissions, lab results, and patient transport within a hospital. Call center agents working from home also use cloud-based secure messaging apps to contact on-call medical staff via their computer.
“As a healthcare system, we need a secure messaging platform for our clinical staff to share critical health information quickly and easily,” says Steven Spachtholz, director of information systems for Butler Health System in Butler, PA. “For us, the advantage of using the platform is its tight integration to our call center system that we use to provide answering services to our physicians.”
Steven explains, “We started using secure messaging with our internal answering service, but it grew to become our only secure messaging platform. What makes the secure messaging app we use different, is its integration with our call center software for on-call data and the integration engine we use which allows us to inject messages from other systems. All routine consults now flow from our electronic health record (EHR) database to our secure messaging app automatically.”
Secure texting apps can also keep track of all message activity with an audit log and a message log, complete with message histories, indicating whom messages were sent to, when messages were read, and who replied to a message. These logs can be made into reports for call center supervisors and hospital management.
Future of Web-based Hospital Communication
Hospital staff must be able to access the information they need at any time from any place. It’s a fundamental and critical part of any healthcare organization’s communication protocol. This is especially true during a pandemic since it’s more likely that both call center and medical staff may be working from home or from different hospital locations.
Web-based applications that are specifically developed for the healthcare industry have proven to be incredibly effective in providing fast and secure communication, improving communication times, adding efficiencies through remote access, and reducing the number of potential errors caused by miscommunication.
Some hospital call centers already had a select group of operators working from home, but the COVID-19 crisis forced more hospitals to take advantage of having a virtual call center. Many studies have since been published about the benefits and cost-savings of having staff work from home. Some organizations have already decided to keep their call center staff remote, and the latest trends indicate this once temporary solution is going to be a permanent shift in the industry.
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.
Your phone starts ringing, you drop what you’re doing, look at the screen, and see a call from some odd number from a faraway place. Or worse yet, it says “Scam Likely!” I’m rarely in the mood to listen to some foreign language robot or get rich pitch. Phone calls that matter have increasingly become the minority.
According to estimates, US mobile phone users were exposed to 48 billion robocalls in 2018, which means that every time the phone rings, there’s a 50 percent chance it’s a spam robocall.
Training the Masses to Decline Calls
There are few viable solutions available for blocking 100 percent of these annoying intrusions, so the best option when that unknown phone number shows on the caller ID is to simply hit the decline button and move on with whatever you were doing. Robocalls are creating anti-call center muscle memory across the entire mobile phone user population.
The shunning of annoying telemarketing cold calls is not a new thing. But thanks to robocall automation, the surge of incoming noise has become so intense, there’s little chance a consumer will pause and consider the possibility that an incoming call might actually matter. This is a problem for the healthcare industry.
Call centers have always been a big part of the healthcare patient experience. Challenges with being on hold, ineffective agents, and general customer dissatisfaction with call centers are well documented. But what about the outbound side?
The Challenge for Healthcare Call Centers
The healthcare industry is investing heavily in engaging patients, and call centers are a big piece of that strategy. Outbound calling campaigns help patients navigate their care, set appointments, take medicines, or check in after a visit. These are potentially important touch points. If people stop answering their phones, what happens? Email outreach is frequently intercepted by spam filters, secure messaging is clunky, and most patients don’t log into their healthcare portals.
At call centers, human capacity has always been a constraint. When it comes to dealing with healthcare situations, there have not been a lot of viable automation options that blend a quality, well-designed engagement experience with a high-scale system. Anybody that has received a robocall doctor’s appointment reminder knows how disengaging it is.
The healthcare industry faces a challenge when it comes to reaching out to patients, often for critical issues.
Providers and pharma companies need to reach out and connect with patients.
Most patients have a mobile phone and prefer to communicate through them.
Robocalls have trained consumers to avoid answering their phones.
Healthcare mobile apps are too clunky and remain unused.
Consumers prefer text messaging.
Heavy investment in call center technology that’s focused on intelligent patient information and agent enablement is still key. But is there a new opportunity for call centers to reach out to patients as part of a patient engagement effort?
Digital Conversations at Unlimited Scale
Conversational chatbots that interact with people in a way similar to text messaging are finding their way into many industries. What would happen if an interactive text front end, first touch was woven into the outbound call center approach? The bot could completely handle simple tasks, such as reminders and information gathering. Or it could start on some of the more advanced workflows, such as monitoring care progression or providing drug background information in advance of a human to human interaction.
As they stand today, call center agents are premium level expenses when compared to a well-designed chatbot that can run 24/7. Imagine a call center not constrained by human capacity.
If the virtual dimension of a modern patient engagement strategy requires outreach and interaction with vast populations of patients, the answer isn’t to hire more agents. Rather, you must find a way to make the agents you already have handle an increased volume, with conversational chatbots conversing and engaging patients across a spectrum of workflows. And the entire process would be in the medium that consumers increasingly prefer—text-based messaging.
With this chatbot technology, the odds of reaching someone and helping them with their care can only increase.
Each year, approximately 16 percent of patients in United States hospitals are readmitted within thirty days of discharge. Readmissions and the additional treatments they entail are costly to both patients and insurers. Increasingly, they are costly to hospitals as well.
A portion of readmissions is unavoidable, such as a planned readmission for chemotherapy or an unexpected adverse event unrelated to the original diagnosis. However, many other readmissions are preventable through high quality clinical care and effective patient education and discharge procedures.
The Financial Impact of Hospital Readmissions
To reduce hospital readmission rates nationwide, the Centers for Medicare and Medicaid Services (CMS) began financially penalizing hospitals with higher than expected readmission rates via their Hospital Readmissions Reduction Program (HRRP) that began in 2012. The cost of those penalties across United States hospitals increased significantly from a total of 290 million dollars in fiscal year (FY) 2013 to an estimated 563 million dollars in FY 2019.
Failure to reduce readmissions has become more expensive over the program’s lifetime. In the first year of the HRRP, the maximum penalty was 1 percent of Medicare reimbursements withheld. By design, that maximum penalty has since increased to 3 percent.
National hospital readmission rates have dropped since the program launched, but not enough to decrease penalties. Of the 3,129 general hospitals evaluated in the HRRP in 2019, 83 percent received a penalty.
The increases are due in part to additional health conditions included in the program. In the program’s first year, CMS evaluated the readmission rates of patients with heart attacks, heart failure, and pneumonia to determine whether a hospital faced penalties. Today, CMS also measures readmission rates of patients with chronic lung disease, hip and knee replacement, and coronary artery bypass graft surgery. Scheduled readmissions are not counted.
Additionally, the program is set up such that CMS evaluates each hospital’s readmission rates relative to the national average for each condition. Even as readmission rates drop overall, there will always be hospitals that have more readmissions than the national average.
A 2016 study on hospital profitability published in the journal Health Affairs found that most hospitals in the United States are not profitable, and the median acute care hospital is losing 82 dollars per discharge. Given those numbers, it’s imperative for hospitals to reduce readmission rates and reduce the amount of Medicare reimbursements left on the table.
Readmission Rates and Causes in the United States
Some patients will always be readmitted after discharge. However, the wide range of readmission rates across hospitals suggests that there are addressable factors behind readmissions. In some cases, a readmission may be related to what happened during the original hospitalization. In other instances, patient readmission ties to what happens after discharge from the hospital.
A study on preventability and causes of readmissions published in JAMA Internal Medicine in 2016 reviewed the cases of 1,000 general medicine patients readmitted within thirty days of discharge across twelve United States hospitals from April 1, 2012 to March 31, 2013. Of those 1,000 readmissions, 26.9 percent were potentially preventable.
According to the study, common factors in potentially preventable readmissions were related to what happened at the time of discharge and after the patient went home. The authors cited emergency department decision making at the time of readmission, patient failure to keep important follow-up appointments, premature discharge, and lack of patient awareness about who to contact after discharge as the most common factors.
The study’s authors concluded that “High-priority areas for improvement efforts include improved communication among health care teams and between healthcare professionals and patients, greater attention to patients’ readiness for discharge, enhanced disease monitoring, and better support for patient self-management.”
CMS’s steep penalties are motivated by a desire to provide better patient care and, in doing so, to reduce healthcare costs. One of the best ways for hospitals to prevent unnecessary readmissions is by calling patients after their discharge to check in on symptoms, review medications and treatment plans, and offer patients an opportunity to ask questions about their recovery.
Post-Discharge Patient Education
Often, a patient is readmitted because they didn’t follow the correct medication regimen, lacked understanding of the treatment plan, or failed to follow up with their primary care physician after discharge.
Ideally, patients receive thorough education about medication regimens and treatment plans throughout their stay and at the time of discharge. However, literacy and comprehension rates vary across patient populations, and patients don’t always understand written or verbal discharge instructions.
Additionally, at the time of discharge, patients are preoccupied with the logistics and excitement of going home. Attempts at patient education might not be effective, no matter how well delivered. Once patients have arrived home, the complexity of managing their new medications and daily routines on their own becomes much more apparent.
Several studies have found that other factors, including the patient’s social support network, marital status, gender, and income can affect a patient’s ability to follow discharge instructions and manage their care at home.
Whether it’s addressing a lack of comprehension regarding a patient’s treatment plan or addressing a lack of support in enacting that treatment plan, a post-discharge phone call can provide a way for hospitals to help patients stay well at home.
Using Calls to Reduce Readmissions
Hospitals have many opportunities throughout a patient’s healthcare journey to reduce the chance of readmission. One commonly cited way to reduce readmissions is by improving patient education around managing their care after discharge.
Specifically, implementing a post-discharge phone call to review medication regimens and treatment plans, discuss symptoms and other concerns, and check in on home health services and follow-up appointments helps reduce readmission rates.
A paper published in the American Journal of Medicine in 2001 found that when pharmacists called patients two days after discharge to review whether they had obtained and understood how to take their medications, patients were much less likely to visit the emergency department within thirty days of discharge. Ten percent of those who received a phone call from a pharmacist went to the ED, compared to 24 percent of patients who did not receive a call.
In another program, IPC The Hospitalist Company (IPC) tested the effect of post-discharge call center outreach on readmission rates. Nurses at the IPC call center called 350,000 discharged patients from October 2010 through September 2011. During the calls, nurses talked through each patient’s symptoms, medications, home health services, and follow-up appointments. The nurses answered patient questions about discharge instructions and, if the patient had a serious medical need, contacted the patient’s hospitalist or primary care physician.
Nurses successfully reached 30 percent of patients. This program prevented an estimated 1,782 avoidable readmissions over the course of a year.
Setting Up a Post-Discharge Call Program
Research suggests that the best time for a post-discharge call is within the first two to three days after a patient arrives home. At this point, the patient has had the opportunity to settle in, fill medications, make follow-up appointments, and it is still early enough for a nurse’s call to make an impact. Many patients won’t answer on the first try, so nurses should plan to call more than once.
The first step in setting up a post-discharge call program is to ensure that call center staff have the best number to reach each patient. Sometimes the number in the patient’s record is different from their home or cell phone number. IPC The Hospitalist Company found that by asking patients for the best number to reach them or their caretaker, they were able to increase their successful call rate from 30 percent to more than 40 percent of discharged patients.
Customized Care Call Scripts
Providing nurses with diagnosis-specific scripts can help make care calls more efficient and effective, as many conditions have standard red flags nurses should check in on, such as weight gain after discharge for heart failure. Virtually any type of script is easy to create, including common scripts for post-surgery, diabetic, and pediatric post-discharge calls. Setting up a unique script with detailed questions for each, helps to ensure patients understand discharge instructions, address any medication questions, and help ensure the patients are not experiencing symptoms that would cause them to be readmitted.
Nurses should also have access to physicians’ discharge notes to review patient-specific follow-ups. Physician discharge notes must be completed in a timely manner to give nurses the information they need for the calls.
To supplement the post-discharge nurse phone call, organizations can also use HL7 integration to receive discharge notifications and set up automated appointment reminder calls. This helps increase the likelihood that patients make it to their appointments and receive the prescribed follow-up care.
To avoid penalties and help patients to stay healthy at home, hospitals can leverage call centers and post-discharge phone calls with customized scripts to check in on symptoms, review medications and treatment plans, and remind patients of follow-up appointments. Studies suggest that such measures reduce the rate of readmissions.
For hospitals, implementing a discharge call center program can help avoid or reduce Medicare readmission rate penalties. For patients, the program can improve their post-discharge care management and health.
The 1Call Division of Amtelco is a leader in developing software solutions and applications designed for the specific needs of the healthcare call center marketplace. 1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, save an organization’s limited resources, and make them tremendously efficient, helping them bring wellness to their members and their bottom line.
In recent years, hospitals have become increasingly familiar with the merits of providing a superior experience to patients and consumers. Studies show that organizations with successful patient experience strategies see up to a 5 percent increase in new patients, a 15 percent increase in patient retention, and an 18 percent decrease in out-of-network referrals.
It’s no wonder why 81 percent of executives consider patient experience a top priority. And yet, many health systems haven’t created an actionable strategy that genuinely improves the experience across all touchpoints along the patient journey. In particular, they fail to acknowledge the importance of marketing communications and outreach in these strategies.
Even if patients are part of a vast health system, they expect experiences tailored to them as individuals throughout the care continuum. This is why health systems need the right technology in place to craft data-driven patient experience plans—messaging that directly addresses a patient’s needs both inside and outside the health system’s four walls.
By improving the patient experience with personalized communications and data-driven outreach, health systems enjoy increased loyalty and satisfaction, higher ROI, and improved margins. Here are a few strategies that health systems can employ to build an actionable, strategic patient experience plan:
Integrate the Right Technology
To design an effective patient experience strategy, health systems must first ensure that the right marketing technology is in place to reach patients at the right times, over the right channels.
Consider the following four solutions:
1. Healthcare CRM: A healthcare-specific customer relationship management platform (HCRM) is an absolute necessity for a successful patient experience plan. A HCRM is the centralized hub for all precision marketing. With an HCRM, healthcare marketers collect and compile data in a centralized location, monitoring important information such as recent communications, changes to demographic information, and clinical details and propensities. This information is key to crafting the hyper-personalized experiences that today’s patients expect.
In practice, a healthcare marketer may use the HCRM to understand the various touch points along the patient journey, including understanding which resources were engaged with before that first appointment was scheduled. An analysis as simple as this reveals valuable information as to which messages, channels, and tactics resonate with which demographic—and which are less effective. The longer a patient stays within the health system, the more data is integrated into their CRM profile, setting the stage for improved targeting and a better overall experience, along with the ability to apply those learnings to other consumers in the same cohort or segment.
2. Marketing Automation: A marketing automation platform orchestrates the execution of personalized engagement plans. It allows healthcare marketing teams to send messages at the ideal time following specific customer interactions or touchpoints—for example, sending an email invitation to a diabetes management seminar the day after a user downloads an e-book about Type I Diabetes on the health system’s website. It’s simply not feasible to deploy this type of patient nurturing campaign at a large scale without marketing automation software, especially since the data within a HCRM only grows more complex over time.
3. Patient Engagement Center: First impressions are everything—and often hospital call centers are the first interactions with consumers. To meet consumer expectations, call center representatives need to not only be personable, efficient, and conscientious, but they need to be proactive, demonstrating that the health system knows the caller, why they are calling, and can provide the best care. With that comes the need to prioritize first call resolution, as opposed to forcing the consumer to call back multiple times to ask follow-up questions.
To deliver proactive and world-class customer experiences, call center representatives need access to a dashboard containing all relevant caller information and proactive alerts about the caller. For existing patients, this includes details from the patient profile contained within the HCRM as well as clinical and demographic data sourced from the EHR. Other tools that provide insight into consumer data and marketing engagement history (even if the caller is not a registered patient) are also worth investing in.
4. Business Insights: With a business insights solution, healthcare marketers unlock the most valuable opportunities—such as a specific demographic, geographic market, or service line—on which to focus their initial patient experience campaigns. By examining a service line or geographic area with cross-sectional data, health systems begin to understand the basic needs and desires of this set of consumers. They can then shape lists of target consumers that fit the ideal persona, supporting informed, hyper-segmented engagement campaigns with messaging that speaks to those needs and characteristics.
With the right technology, a health system ensures messages deployed across consumer touchpoints meet each patient’s needs. Using historical data to inform outreach, marketers improve patient experience while creating a seamless, convenient approach to care.
Create Personalized Patient Experiences
Personalization is one of the most effective ways to improve patient experiences. One of the easiest ways for healthcare marketers to leverage personalization is by simply asking patients and consumers what they prefer. For example, they can indicate their preferred method of contact (such as phone, email, or text message) and set a time of day that works best to receive communication from their provider. Short online or emailed surveys are another great way for marketers to gather information about patient preferences and personalize campaigns accordingly.
Keep in mind, however, personalizing patient interactions helps build trust, but it’s important not to go too far. For example, if a consumer has passively searched online for oncology services, the call center representative should not mention their browsing history during a call.
Use Precision Marketing to Deploy Consistent Messaging
These principles apply to acquisition and retention. Once a patient has already converted to a health system, precision marketing campaigns continue to be effective in encouraging ongoing engagement with unique content. These campaigns leverage HCRM-connected workflows that strategically guide communications, track engagements with marketing materials, and monitor a patient’s journey from, for instance, pre-screening to specialist consultation to surgical procedure.
This strategy includes integrating decision points that influence the patient’s journey based on their actions, or lack thereof. If a patient registers for an upcoming cardiology seminar, they should be included in cardiology-related emailing lists. These workflows don’t just allow the most relevant messages to be sent, they record these non-clinical engagements, and support patients in their healthcare journey.
Today’s consumers expect seamless, personalized interactions from all businesses with whom they interact—and this includes their healthcare provider. Unsurprisingly, patient experience recently became the centerpiece of many health systems’ strategic growth initiatives. Healthcare marketers play a critical role in crafting a great healthcare experience, so it’s important they employ the right tactics to ensure positive interactions throughout the patient journey.
They must tap advanced marketing technology to organize and analyze information from all aspects of the organization, both inside and outside the health system. With a comprehensive view of patient needs and demographics and a deep understanding of the experiences that they value most, health systems will enjoy improved ROI, sustainable growth, and a sharp competitive edge.
Gary Druckenmiller, Jr. is vice president of customer success at Evariant. With almost twenty-five years of digital makeover efforts behind him, he functions as a lead business strategist, a digital marketing thought leader, and a C-level executive sponsor for all Evariant enterprise clients, primarily focused on advising health system leadership of opportunistic methods to find, guide, and keep patients for life.
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.
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.
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 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.
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.
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.
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 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
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
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
Traci Haynes, MSN, RN, BA, CEN, CCCTM, is the director of clinical services at LVM Systems, Inc.
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.
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 email@example.com or 800-782-7835.
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.
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.”
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.”
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.