When You Don’t Know What You Don’t Know

By Gina Tabone, MSN, RNC-TNP

As a healthcare leader you cannot afford a failed initiative. When precious dollars are allocated for a strategic project, success is the only acceptable outcome – your job and reputation are on the line.

Consider an organization planning to open its own centralized contact center. There’s no question about the value to the organization: one point of contact, standardization and integration of services, improved efficiencies, and satisfied patients. It seems like a simple task: hire some operators, buy some phones, rent space, and you’re ready to go live, right? Nothing could be more wrong.

To ensure the success of this type of initiative, you must consider the unique knowledge base and expertise required and the people, processes, and technology needed. Leaders are at a disadvantage when they don’t know what they don’t know, so after funding has been approved, it’s best to seek the help of a call center industry expert to ensure that no time, money, or talent is wasted.

The success of a call center hinges on the right mix of talent, logical processes, and intelligent technology. Labor costs are the greatest ongoing expense, so recruitment and hiring efforts must result in a workforce of bright, customer-focused, sustainable employees. Retention is key – not only from a financial perspective but also for growth and succession planning as the call center expands. Managers and directors should have proven track records of exceeding expectations, an understanding of your organizational goals, and the ability and desire to assemble and lead a team. Call center consultants can work with you to create job descriptions that will attract viable candidates and help you interview and hire team members who have a high probability for success.

The “call center process” is a phrase used synonymously with “call flow,” which is the route the caller follows to achieve resolution of an issue. You don’t want callers to feel like they are jumping through hoops, repeating the same information to different people or being transferred into a dark abyss. Experience in process optimization is crucial, so involve an expert to oversee the work of an integrated task force assigned the job of defining your call center’s strategic expectations and what success looks like for your organization. If possible, assign roles and responsibilities to key stakeholders from the C-suite, operations, IT, human resources, compliance, finance, and nursing. A call center consultant should be able to engage the team in mapping the path the caller will follow in various situations.

The goal should always be to have a call handled by the first person the caller speaks with; this “first-call resolution” requires frontline staff to have knowledge and resources to serve the callers’ needs. First-call resolution can be achieved with robust, dynamic, interactive training programs and tools. Enabling call center agents to succeed is your job as the organization’s leader. If you have limited experience in the world of call centers, collaborate with an expert to get it right the first time.

The result will be a center that starts without faltering and with you being credited with the accomplishment. The final component of call center operations is the technology that forms the center’s infrastructure. Today’s market provides hardware, software, and applications that provide vast telephony capabilities, and it’s essential to define your organization’s requirements for the technology purchases that will be made. You need to have answers for questions such as:

  • Does your organization want every call to be recorded? This is a common practice in medical call centers and is valuable from both a risk management perspective and as a quality monitoring tool.
  • What about Interactive Voice Response (IVR)? (For example, “To hear this message in Spanish, press 1,” or “To talk to a nurse, press 2.”) These voice responses support efforts to route the caller to the right person the first time.
  • Do you know what CRM, CTI, AWI, ASA, ABD, UTIL, and AHA stand for? If you’re familiar with those contact-center-specific technology terms, that’s great! If not, it’s never too late to start learning.

Do your homework when choosing vendors and equipment – it can be costly if you don’t make the right choices at the beginning of the process. If you “don’t know what you don’t know,” bring in an expert to educate you and your team. That expert can help you develop, design, and implement your emerging contact center and provide ideas that can mean the difference between success and failure. A good consultant takes the “training the trainer” approach when facilitating the “Go Live” process and will step away after the team has some experience, confidence, and demonstrated successes.

Healthcare is multi-dimensional, and no one knows everything because there are so many specialty areas, so many subject matter experts, so many achievements and accomplishments, and so much to learn and gain. A courageous leader is one who can admit when they don’t know what they need to know. A humble leader is someone who knows enough to solve the problem and get the expected solution-based results by engaging a call center expert. Don’t risk finding out too late that you did not know what you did not know.

Gina Tabone, MSN, RNC-TNP, is director of clinical solutions at TeamHealth Medical Call Center. Prior to joining TeamHealth, she served as the administrator of Cleveland Clinic’s Nurse on Call 24/7 nurse triage program.

[From AnswerStat October/November 2015]

IVR Optimization: A Small Investment for a Great Payback

By Donna Fluss

Business managers in most North America-based contact centers with more than 150 agents consider voice self-service solutions mission-critical, and they are growing in importance in India, Western Europe, and other parts of the world. These solutions have a clear, simple, and highly profitable value proposition. When interactive voice response (IVR) applications are well-designed, implemented, and maintained, they automate anywhere from 20 percent to more than 90 percent of incoming calls. Many enterprises would face a major financial hit if they had to employ agents to handle the calls that are automated by their IVRs.

Despite these facts, IVRs are often neglected and under-resourced. Too many companies have IVRs that were implemented years ago and are enhanced only when something breaks or there is a major change in business requirements. Additionally, IVRs are often relegated to the non-essential category by CIOs, who were happy to “outsource” them long before hosting became acceptable for other mission-critical contact center solutions.

Dichotomy – IVR Dependability Results in Its Downfall: While this is a seeming contradiction, the success and dependability of many IVR solutions has caused them to be treated as “second-class citizens.”  IT groups take them for granted because they generally do not require a great deal of support to keep them in production.

However, while call processing continues without interruption, the vast majority of IVRs in North America are not performing at optimal levels, according to recent DMG Consulting research. It estimates that more than 80 percent of IVR users around the world would be able to improve their automation rates and dramatically increase customer satisfaction if they invested in routine optimization of their IVR solutions. Another way to look at it is this; if an IVR was installed more than three years ago and has not had an overhaul of its script or voice user interface (VUI) since then, it’s time for a full “health checkup.”

Scenario – IVR at Work: The following example proves the point. A financial service organization receives a million calls per week. This organization has an IVR that automates 60 percent of their calls, or about 600,000 calls weekly. Their non-fully loaded (variable) cost per agent-handled call is $5.50. If they automated as little as 2 percent of the remaining 400,000 calls per week, they would displace an additional 8,000 calls from agents. This would save them $44,000 per week, or $2,288,000 per year. At the same time, the quality of their service would increase, and complaints would decrease.

Of course, there are additional factors to consider. By automating some of the easier calls, agent’s average handle time is likely to increase for the remaining calls by an average of two to three seconds. Assuming a 200-second average handle time, this will increase the cost per call by approximately 1 percent, although this gain could easily be offset by a corresponding reduction in average handle time due to a decrease in customer complaints about the IVR. (Note that during wrap-up, agents generally record the reason callers need help, so the volume of complaints about IVR applications may be underappreciated.)

Additionally, there is also the cost of the optimization project to consider, which runs from approximately $50K to $150K, depending upon the resources required. The payback period from an IVR optimization, with a cost of $150K for the project and a 1 percent increase in the cost per call, was less than one month. (It saved the organization almost $1.9 million during the first year.)

What Are Organizations Holding Back? Given these returns, one would expect many organizations to jump at the opportunity to enhance their IVRs. There are three primary reasons why end-user organizations are not making the investment, all of which are based on fear:

  1. Vendors scare away prospects by pushing them to make major investments in expensive speech recognition-based platforms.
  2. Enterprises do not have the appropriate resources available in-house and are trying to avoid using “expensive” professional services for an “uncertain” return.
  3. End-users do not see a compelling enough reason to take a chance on disrupting what they already consider to be a highly effective solution.

Separating Fact from Fiction

Myth 1: End-users with touch-tone or non-VXML-based speech recognition applications must upgrade to a new platform in order to realize benefits from an IVR optimization.

Fact:No, they do not need to upgrade to a new platform. In some situations, upgrading to a new IVR platform could be a good idea, but if the application works, it is not a necessity. As long as there is a way to evaluate the performance of the IVR application by putting in trackers that identify where and why customers drop out and/or request an agent, the current environment can be optimized without replacing the underlying system.

Premise-based IVR vendors make most of their money from selling new and upgraded solutions and charging maintenance fees, so this is what they push. Moving from a touch-tone IVR application to a VXML-based speech platform may have substantial long-term benefits, but it often requires a hefty up-front investment that could cost more than $250k, particularly if speech-recognition application-development fees are included.

While many organizations see the benefits of a self-service platform refresh that may have a payback in one to two years, it is often very hard to justify when the current solution still works, the CIO has a tight budget, and there are other critical investment priorities. In other words, the vendors often price themselves out of a job. Instead of helping organizations undertake an optimization initiative, they scare off prospects by pushing an expensive “rip and replace” solution. This is one of the major reasons why sales of premise-based IVR solutions have fallen during each of the last few years and why this downward trend is expected to continue for the near future. (The opportunity has been seized upon by more flexible hosted/managed service IVR providers.)

Myth 2: End-users have little to gain and a great deal to lose from trying to improve an IVR application that delivers an acceptable automation rate.

Fact: As long as experts are used to implement the improvements, the benefits should be significant, relatively rapid, and mostly risk-free. An IVR optimization exercise includes two major components: figuring out what does not work well in the current application (i.e., where people get confused or stuck and drop out) and identifying agent-related tasks that can be automated. The first step is to identify and document the problematic activities and new automation opportunities. The second phase, which has some risk, involves rewriting the application to take advantage of these opportunities.

The Bottom Line: IVR is not a new or sexy application. It’s perceived as a dependable core contact center application that runs without requiring a lot of attention. Most contact center leaders would prefer to invest in new solutions, like speech analytics, rather than in their old and dependable IVRs. The “catch” is that a small investment in IVR might result in major cost savings.

Any organization that has not optimized their IVR application in the past three years should undertake an IVR assessment to identify ways to improve their existing system and estimate the potential long-term benefits of an optimization initiative. If IVR optimization would be highly beneficial, find a vendor that can help deliver savings on an ongoing basis.

IVR optimization should not be a one-time exercise. Leading IVR users continuously strive to enhance the performance of their solutions; it’s part of their annual budget and their corporate culture. If the necessary resources are not available in-house, find a hosted/managed service IVR provider that can help enhance the operating environment with little up-front investment and risk. The world of IVR has changed dramatically in the last five years, as have many business requirements.

Donna Fluss is the founder and president of DMG Consulting LLC, a provider of contact center and analytics research, market analysis, and consulting. She is the author of industry reports on contact center hosting, IVR, speech analytics, performance management, workforce management, surveying and analytics, and quality management/liability recording. Contact Donna at donna.fluss@dmgconsult.com.

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

SaaS Gives Clinics and Hospital Increased Capabilities

By Justin Wampach

The Software as a Service (SaaS) delivery model has been steadily growing as high-speed Internet access becomes a standard and as the healthcare industry looks for ways to streamline its operations. The shift from boxed software to Web-based software allows clinics and hospitals to perform essential daily tasks, like scheduling, faster and easier with increased flexibility.

Although some software lends itself to a box because it requires the horsepower of a personal computer, the majority of software programs such as accounting, customer relationship management (CRM), and physician call scheduling can provide better capabilities through SaaS programs accessed over the Internet.

Web-based software and cloud computing are fast becoming the standard way of doing business across most industries today. Anticipating these technological shifts, vendors – some over a decade ago – began developing programs to give the healthcare industry the software they needed as a service using a standard Web browser. Instead of loading the software on to a personal computer and saving the information there, this new service securely stores all the information in a database on remote servers.

Rapid Clinic Adoption: Many clinics quickly adopted this new SaaS delivery model. Some of the reasons they shared for choosing this type of application include:

  • Instant access from any computer with Internet access anytime, anywhere
  • The ability to create, maintain, and publish a call schedule electronically from any location
  • Eliminates the worries and time spent backing up data
  • Automatically installed upgrades and patches

A broad range of clinics moved to SaaS packages, but they would send electronic schedules to hospitals only for them to be printed and placed it in a three-ring binder. That led to the development of an on-call management product to meet the unique needs of hospitals.

Hospitals Save Time: Hospital SaaS software gives hospital telecom centers and emergency departments the ability to easily and more effectively manage on-call information. This new technology allows hospitals to interact with each specialty’s on-call schedule within the entire medical community. SaaS-based on-call management systems selectively merges and aggregates all of the schedules together to create a virtual “daily on-call roster” that is accessible from a secure location on the Internet.

Hospitals particularly appreciate when clinics update and maintain their own calendars themselves. This not only saves hospitals time but also ensures the schedules are accurate and current. There are several key results hospitals that have experienced with the SaaS on-call management process:

  • Improved patient care with better access to accurate on-call information.
  • Increased physician satisfaction, particularly by eliminating the wrong doctors being called in the middle of the night.
  • Ensured compliance of federal EMTALA (Emergency Medical Treatment and Active Labor Act) regulation that requires the maintenance of accurate on-call information and an on-call log.

IT Made Easy: For both clinics and hospitals, SaaS gives them more control while reducing their overall risk. They no longer need to make large up-front monetary investments for the software and rely on IT staff to manage it. This allows organizations of all sizes to make buying decisions faster and know that they always have the technology they need to create, publish, and maintain the schedules necessary to deliver quality patient care.

Justin Wampach is president of Adjuvant, LLC, which develops and markets solutions for critical scheduling challenges in healthcare environments. They provide online tools and technology to help ensure availability of the right provider, in the right place, at the right time. Adjuvant specializes in on-call software and on call management.

[From the June/July 2011 issue of AnswerStat magazine]

Cut Costs and Improve Care with Nurse Call Integration

By Chris Heim

Nurses are essential to providing quality care and assuring patient safety. But with fewer nurses per shift and less time spent at the bedside, hospitals face a variety of issues– and nurses face burnout. Unfortunately, relief is not on the way, as nursing shortages are expected to continue. The U.S. Department of Health and Human Services predicts that the country will need 2.8 million nurses by the year 2020– one million more than the projected supply. So how does a healthcare facility improve quality of care with fewer caretakers?

Increase Nursing Efficiency: Critical Alerts in Two Seconds or Less: According to the Institute for Healthcare Improvement, nurses only spend between 20 and 30 percent of their time in direct patient care. Keeping nurses in closer contact with patients and easing their ability to contact doctors, aids, and other colleagues can have a significant, positive impact on their productivity and effectiveness. Wireless communication solutions, integrated with existing nurse call and patient monitoring systems, can help provide those capabilities, thereby improving patient safety and increasing staff retention.

By using fully integrated wireless telephony, nurses can communicate with patients from wherever they are within a facility. More importantly, nurses can be alerted to emergencies within seconds and can escalate an event notification, if needed. This ability to communicate or forward messages, while allowing nurses to meet the needs of multiple patients without having to walk to each room, increases efficiency and reduces caretaker stress by eliminating the feeling of being needed in all places at once.

Meet and Exceed Joint Commission Audit Guidelines: Automated wireless communications solutions offer alarm integration with nurse call systems and provide the ability to deliver an audit trail of events and how they were handled. This saves nurses hours of paperwork documenting various patient activities. As hospitals now face unannounced audits by the Joint Commission, automating paperwork means reports are ready at the click of a button. In addition, this automation increases caretaker productivity and accuracy but more importantly, it puts the nurse back at the bedside, improving quality of care and patient safety.

Increase Patient Satisfaction and Improve Survey Results: Finally, integrating wireless communications solutions with current nurse call and patient monitoring systems can increase patient satisfaction, thereby increasing hospitals’ opportunity for favorable post-visit reviews. As Medicare now pays based on performance, hospitals are always looking for ways to improve the patient experience. Providing patients the ability to communicate with their assigned nurse within seconds of a call offers a less stressful environment for the patient. Knowing that a caretaker is close and health is being closely monitored can relieve a patient’s anxiety.

The quality of care is also increased by alerting nurses within seconds of a patient emergency. This keeps the number of sentinel events to a minimum. Better healthcare in the hospital means a happier, healthier patient at discharge.

Improving patient communication, increasing staff efficiency and retention, and enhancing documentation, as well as enabling nurses to focus on patient care, are just a few of the many benefits fully integrated communications solutions can provide medical facilities.

Chris Heim is CEO of Amcom Software. Sixteen of the top nineteen hospitals in the U.S. rely on Amcom Software to run their mission-critical communications. Solutions include call center communications, emergency management, mobile messaging middleware, and paging.

[From the June/July 2009 issue of AnswerStat magazine]

Disaster Recovery for the Call Center



By Jim Becker

Not every disaster is as horrific as Hurricane Katrina, but call centers can also be affected by lightning, fire, water damage, telephone and electrical outages, and other natural and man-made catastrophes. All can impact your center, but the bigger impact may be on your callers.

How can you lessen the affect? First of all, good planning and communication are essential. No one expects a problem, but if one occurs, a center should be prepared. Trying to cope with an outage or worse, without prior planning, can be disastrous for a medical call center. No one expects a problem, but if one occurs, a center should be prepared. Click To Tweet

Where do you begin? Start with involving your staff in preparing a detailed plan. They can help identify specific areas of your business and clients that need to be addressed in case of an emergency. Then, perform regular system backups. Depending on your call center’s needs, once a week might be an acceptable practice schedule. Those who are “critical”, such as medical and emergency-type calls, should back up their system more often; maybe even daily. Store the back-up information away from your main call center. Alert your managers and key staff as to where it is and what to do if there is a need to use the backup.

Electrical outages due to lightning and power interruptions can be a problem. Make sure you have reliable back-up power. Test the back-up power system at least once a month. It is not uncommon for batteries and other parts of the system to fail over time. Be sure to replace batteries according to your manufacturer’s recommended schedule. Again, make sure your managers know what to do if you lose power. If the power goes out for an extended period of time, you may have to supplement your battery-based power back-up unit with a generator. Not all off-the-shelf generators will meet the power needs of a call center. You may need to run the power through a line conditioner to minimize power spikes, surges, and variations in voltage.

Also, key components in your system could fail. Power spikes, heat, and time all take their toll on computer components. Be sure to have spares of critical parts, such as the processor board, power supply, and disk drives. You may also opt for key telephony interface cards for operator station ports, T1, ISDN, DID trunks, and business lines. You may also want to consider pooling spares with other call centers in your area that use the same system. Don’t rely on counter-to-counter deliveries of key components. Heightened airport security makes this difficult, if not impossible.

You may consider a small back-up telephone system as a standby unit. If your primary system fails, having a small back-up system can provide your operation the opportunity to take calls for key lines or functions. Again, make sure your managers know the switchover procedure if your primary system fails, as well as the method to contact your local telephone company to redirect lines to your back-up system or to another location. You may want to set up an agreement with another medical call center that if they have a problem, or if you have a problem, either could redirect lines to the other call center so that service would be continued.

Having remote agents may also be part of your plan. Inclement weather could prevent call center agents from traveling to a central location. Staff members who have the ability to work from home would still be able to process calls and provide your callers with the service they expect. Remote stations can work via direct telephone lines or over the Internet. Some system manufactures provide both options. Neither can be set up on short notice. Plan ahead and have the capabilities in place before an emergency so that remote access is available when you need it.

Considering today’s complex computer-based systems, having a service contract in place with your system vendors could be some of the best insurance available. There is nothing more frustrating than having a problem with your system and then finding that technical support is not immediately available, or if it is available, it is very expensive.

Keep in touch with your power company and telephone company. Have key contact information readily available. Make sure your managers know how to contact them in case of an emergency. If you rent or lease space, make sure you work with the property manager so you can get immediate access to the power relay area and the telephone junction area. Make sure you have adequate insurance to cover fire, water, or electrical problems that could cripple or destroy your system and operations.

Once you have developed your emergency plan, be sure to share it with your managers and employees. Keep a copy of the plan, with all contact information, readily available at your call center and another copy off premise. You may need to share your plan with your key stakeholders and your financial institution or insurance company. Review the plan every six-to-nine months and update contact information for the telephone, power, building management, insurance, and technical service immediately when it changes.

Having a well thought out and readily available emergency plan can be some of the best insurance your center can have. You may never need it…but if you do, it could save your operation.

1Call, a division of AmtelcoJim Becker is the Vice President of Sales and Marketing at Amtelco. He can be reached at 800-356-9148.

[From the August/September 2007 issue of AnswerStat magazine]

PC Console Software Providers

By Peter DeHaan

Peter DeHaan, Publisher and Editor of AnswerStatPC-based consoles are designed to replace a standard PBX telephone console set on large phone systems. The PC-based console uses CTI (computer telephony integration) to answer calls and manage call flow. Screen-based information replaces standard PBX console buttons, lights, and small display screens. This allows for the quick and direct access to computer databases, listings, and directory information. Also, functions that may have been cumbersome or lengthy on a standard console set can be streamlined on a PC-based console, often to a single keystroke.

In busy medical environments where quick and reliable communications can be a life or death situation, the timesaving and accuracy-improving benefits of PC consoles are a required tool. SDC Solutions, 1Call (division of Amtelco), and Amcom Software provide PC console software, designed for high-pressure, fast-paced medical call centers and hospital phone reception centers. Here is more information about their PC console software:


Amtelco’s 1Call Division offers PC-based console software solutions that provide complete console functionality. The 1Call Infinity system features multiple call handling, one-key call transfer capabilities, and an easy-to-follow screen layout that ensures operators quickly find the information they need to provide faster, more efficient service to patients and staff.  Infinity offers advanced digital switching, state-of-the-art voice processing, true unified messaging, and complete statistical reporting.  Using 1Call’s integration with existing telephony, legacy computer networks, and systems, 1Call provides one source for information and communications, providing operators with instant access to information from any database for professional, efficient, and accurate call handling.

Infinity’s call-routing software directs calls to the correct operator or location, helping to effectively manage call traffic.  Using skills-based routing, calls can be directed to specific groups of operators, specific operator stations, or even routed to specific extensions or numbers.  Priority calls, such as Code Calls, can override other non-urgent calls, appear in red, and even include a different ringing sound to ensure priority calls receive instant attention.

The complete line of 1Call systems boast a large suite of healthcare-specific features and modules that allow you to select the exact components you need for improved communications and increased customer satisfaction.  1Call’s modular PC-based console call handling solutions include:

  • Physician’s answering service
  • Physician referral
  • Paging
  • Overhead paging and announcements
  • Meet-Me orbit paging
  • Real-time employee directories
  • Patient ADT (admission, discharge and transfer) information
  • Patching
  • Class registration
  • On-call scheduling
  • Registry and roster
  • Conferencing
  • RED Alert emergency notification
  • Speech recognition

1Call gives you the power to streamline demand management functions at the operator level, as well as enterprise-wide, using 1Call’s browser-enabled applications. 1Call systems keep track of all call activity, and provide you with the exact information you need to create any type of report, including quality assurance reports and traffic reports.

The 1Call Division of Amtelco specializes in offering enterprise-wide communication solutions for healthcare and higher education organizations. Amtelco, 1Call’s parent company, has been a leading provider of telemessaging equipment since 1976. 1Call and Amtelco are well known in various industries for continually developing innovative call center solutions, backed by superior 5-star service and support. 1Call’s modular solutions are specifically designed to streamline communications throughout your entire organization and save your limited resources, making your organization tremendously efficient, helping you bring wellness both to your members and to your bottom line.


Amcom’s Smart Console application automates operator tasks allowing them to answer more calls in less time, reducing costs, staffing burdens, and operator fatigue. Smart Console provides efficient operations through screen-based interactive functions, single button call transfers, conferencing, speed dialing, and other telephony functions. Built around a central Oracle relational database, Smart Console offers complete integration with other communication systems and applications.

With a solid communication infrastructure, codes can be sent more quickly, doctors respond faster, costs are reduced, and lives are saved.  Not surprisingly, within the next five years, 85 percent of healthcare providers plan to improve their communication centers, with 53 percent planning to automate.  Additionally, 47 percent also intend to consolidate and 12 percent plan to increase staffing.

“Communication is the lifeblood of any medical organization yet. Disparate processes can lead to miscommunication, critical delays, costly mistakes, and increased liabilities. We take great pride in the professionalism, speed, and accuracy with which we communicate internally and externally,” said Yvonne Parker, Telecommunications Manager from Cleveland Clinic. “Since partnering with Amcom, we’ve been able to set higher standards and improve overall efficiencies.”

In the wake of increasing complexities, growing organizations are investing in standardizing systems and processes throughout their enterprise to achieve communication technology consistency, higher performance, and scalability. As a result, they significantly reduce the risk of a communication breakdown. Amcom can develop and tailor enterprise applications for an organization’s unique needs and integrate them into a central system. These include a PC attendant console application, speech recognition, web-based directories, and on-call schedules, as well as an integrated emergency notification system. “With a standard system in place as the foundation, we’re able to expand our network much more efficiently,” said Julie Barr, Banner Health Systems. “Now, we can justify operational growth.”

[From the April/May 2007 issue of AnswerStat magazine]

PC-Based Consoles: Addressing Critical Communications with Proven Technology

By Joseph Jarnutowski

In no other industry is efficient and accurate communications more important than in healthcare. Making sure the right personnel are contacted at the right time and in the right manner can literally be the difference between life and death. Today, healthcare organizations are increasingly challenged to increase patient safety, address physician satisfaction, and satisfy a highly mobile workforce with secure, streamlined communications. Faced with tight budgetary constraints, many healthcare providers are turning towards innovative and cost-effective call processing technologies to address their communications challenges. On a smaller scale, succinct, reliable, and efficient communications can shave minutes off hold times, eliminate frustration, and improve the overall experience for patients, staff, physicians, and operators alike. On a larger scale, efficient communications can save lives, diffuse emergencies, and reduce costly errors.

The Challenges: The benefits of adopting a communications solution begin at the operator’s desk. Currently, hospital operators manage a variety of tasks that range from managing internal and external calls, to updating on-call schedules, to alerting key staff in times of emergency. In an average situation, the operator utilizes a combination of resources to correctly route each incoming call. This can include a PC with access to a homegrown directory, paper on-call schedules, procedure binders, and printed emergency processes and information. If not properly managed, this disparate set of duties and unwieldy amount of information quickly results in a chaotic operator environment, which then leads to wasted time and compromised communications. The results are longer hold times, increased customer frustration, and diminished attention paid to callers who need assistance that is more involved.

Further complicating matters is the inability for many hospitals to update directory and on-call information in real-time. Directory data and on-call schedules are often inaccurate, primarily due to the lengthy manual process used to update this information. Relying on several individuals to update contact information, employee status, and on-call schedules for each department creates a delay in getting the correct information to the operators. Ultimately, caller and staff aggravation is increased due to incorrect paging and call forwarding.

Finally, and more importantly than the obvious problems of wasted time and caller and employee frustration, is the issue of safety. As operators are increasingly responsible for monitoring facility alarms and launching emergency procedures, it is imperative that the emergency procedure information is correct and easily accessible. In the majority of cases, operators engage in a timely process of looking up procedures in one of many available binders or posted notes. They must then manually launch the proper procedure, often dialing multiple extensions or sending a host of individual pages. This process is not only tedious and time consuming, but leaves a great deal of room for error.

The Solution: Luckily, in response to the critical need for enhanced communications, healthcare organizations can look to a proven and reliable technology designed to improve communications at the operators’ stations – the PC-based console. Designed to automate operator tasks, PC-based consoles integrate caller and directory information in one robust PC-based application and enhance operator performance through screen-based interactive functions. This streamlined approach to call handling eliminates the need for continually updated extension lists, printed on-call schedules, and cumbersome binders filled with emergency procedures and additional critical hospital information. Ultimately, operator productivity and accuracy is increased while staffing, printing, data entry, and overall costs are reduced.

Also, because it is network based and typically on a local area network (LAN), a PC-based console solution is easily integrated into the existing telephone platform and can access information across the network from a single database. This allows operators to quickly retrieve a variety of information in order to handle multiple calls as efficiently as possible. The flexible features of PC-based console communications systems can be programmed to perform a large range of useful call-handling tasks. Especially in large organizations and in situations where operators are answering numerous lines for different groups or departments, a PC-based console solution can vastly improve the way healthcare organizations handle their communications.

What to Consider: Several companies currently offer a PC-based console. When choosing one for your facility, it is important to consider which features will translate to optimum call handling specifically in a healthcare environment. Below is a list of key features to consider and the benefits they provide.

Call Pop-Up Screens: One of the most useful features of the PC-based console is the call pop-up screen, which helps expedite call handling by automatically “popping” relevant information or instructions based on incoming call identification. For example, the console can automatically present specific directories based on the characteristics of incoming calls, allowing the operator to quickly navigate the proper directories and route the call appropriately. Additionally, the console can present relevant information about the client for whom the call is intended, such as their status or schedule, and it can provide the option to record a message or schedule an appointment.

Perhaps the most important feature to the healthcare industry, call pops can also be extremely useful in handling emergency calls. For general emergency calls, the console can bring up a menu of pre-defined emergencies from which the operator can easily select the appropriate destination for the call. This can include overhead or pocket paging with automatic voice or text messages or immediate call transfer to the closest available emergency responders. On the other hand, if the call comes in on a line designated for a specific type of emergency, it can be immediately transferred to the appropriate parties. Emergency call pops can also be enhanced to include features such as on-screen instructions and color-coded directories to help ensure that operators are able to handle the calls as quickly and accurately as possible.

Call Distribution Groups: Call distribution ensures customers are handled in the most efficient and accurate way possible by allowing operators to be divided into groups based on certain areas and levels of expertise. This ensures that incoming calls are routed directly to someone who can most effectively handle them. For example, operators can be placed in different distribution groups based on their level of experience so that simple transactions can be directed toward newer employees, while the more complex transactions are routed to senior staff or managers. In large organizations implementing a console system, distribution groups can be set up to handle calls based on the departmental structure of the organization, allowing certain types of calls to be automatically routed to specific operators with the relevant knowledge to assist the caller. Call distribution groups can also be used internally to ensure that certain groups or individuals, such as physicians, always have a priority line open for immediate access to an operator.

Pre-Recorded Greetings: Pre-recorded greetings are an ideal feature for busy call centers or for operator staff that work long hours. The pre-recorded greeting functions as a voice saving feature that enables the operator to answer incoming calls with a variety of pre-recorded messages. This not only saves operators from having to repeat themselves hundreds of times per day, it also ensures that the phone will be answered in a consistent, professional manner regardless of the operator’s state of mind. Furthermore, because it can support numerous messages and be programmed to answer different lines with different messages, it can prevent operators responsible for multiple lines from making mistakes, which will reduce operator stress. Additionally, in busy call centers where operators work in close proximity to one another, voice-saver messages can provide a significant reduction in the overall noise level, reduce anxiety, and create a calm, quiet environment which is most conducive to optimum call handling.

One-Button Functionality: One-button functionality simply means that an operator can perform a task by pushing a single button on the keyboard. It is a significant time saving feature that results in operators being able to manage more calls in less time. In the best scenario, certain keys are pre-programmed for highly used functions, and the customer is able to customize additional keys to meet their specific needs. This functionality expedites the manner in which operators are able to access directory information, transfer calls, launch pages, and launch emergency procedures. Once a call is answered, the PC-based console application allows the operator to easily navigate through the application in order to assist the caller as quickly as possible. In a standard healthcare environment, pre-programmed one-button functionality applies to the following tasks:

  • Paging: The critical task of paging is significantly simplified using one-button functionality. Rather than having to dial a pager number, operators are able to use one button to launch a page to an individual, group, or team. To further expedite this process, the PC-based console can offer paging masks with pre-filled standard messages. This further reduces the time it takes to launch a page by eliminating the need to type a message.
  • Incoming call park and retrieve functionality: Incoming call park and retrieve functionality ensures that any operator can confidently process calls on hold. When a call is answered, the operator is able to quickly enter key information on a paging template. Once the information is entered, the caller is put on hold and the intended recipient of the call is automatically paged. When the paged party calls back, the call can easily be connected by any operator. This can be done even more efficiently with a one-button function “Meet Me” paging function in which the paged party is assigned a call-back number that will connect him directly with the caller.
  • Messaging: Using a single keystroke, operators are able to choose one of a series of pre-defined messages and send it to the proper recipient. Message templates may be designed to require that the operator enter specific information based on a department’s needs. This ensures that messages always contain the critical information necessary for physicians and staff.
  • On-call schedule access: Operator access to accurate on-call schedules directly impacts patient safety and physician satisfaction. With on-call communications being critical in a hospital environment, efficiency and accuracy cannot be compromised. One-button access to up-to-date on-call schedules expedites physician contact and response.
  • Emergency processing: Immediate action during an emergency is critical in any environment. A preferred PC-based console will supply operators with one-button access to pre-defined emergency lists, proper procedures for each emergency, and immediate paging and auto-dialing to pre-defined emergency teams.

Directory Updates: The accuracy of the data a PC-based console accesses directly affects the benefits it can deliver. To ensure patient, physician, and staff contact information is up-to-date and to reap the time-saving benefits of eliminating duplicated efforts, PC-based consoles must integrate with patient and HR directories. Ideally, this integration will deliver real-time updates to your directory. In this way, the accuracy of directory information is increased as the updating process is automated and streamlined.

Reporting: Having access to a large selection of reports ensures that an organization can gauge everything from the effectiveness of their PC-based console to the exact date and time a physician was paged. In an industry where legal disputes can damage the reputation of a hospital or result in malpractice suits, having transaction reports and logging all actions performed though a PC-based console provides definitive accountability and ensures the organization is protected in times of dispute.

Enterprise/Multi-site: The final consideration in choosing a PC-based console is ensuring that it has enterprise capabilities. With the increased frequency of mergers, acquisitions, and partnerships, healthcare organizations are increasingly suffering the loss of a significant investment when their technology does not match that of its new partners. Adopting a flexible solution with enterprise capabilities helps guard against this concern and allows for a unified solution across diverse technology platforms.

Conclusion: In an industry where efficient and accurate communications are critical, proven communications technologies are an affordable way to address communications challenges. By adopting PC-based console technology, your organization can start realizing the benefits of streamlined communications starting at the operators’ stations. Benefits realized by incorporating PC-based console technology include:

  • Increased patient safety due to improved accuracy of communications
  • Increased operator efficiency, responsiveness, and productivity
  • Higher accuracy of call transfers, paging, and message delivery
  • Increased efficiency of launching emergency procedures
  • Reduced hold times for external callers
  • Fewer hang-ups because long on hold times are reduced
  • Enhanced customer service due to lower call volumes for each operator
  • Friendly, consistent call handling 24 hours a day, 7 days a week

The ultimate payoff of these improvements comes with creating a dramatically improved patient experience, improving overall hospital safety, and creating a more pleasant, efficient, and productive work environment for employees.

Joseph Jarnutowski is President and CEO of SDC Solutions, Inc. For more information, contact jjarnutowski@sdcsolutions.com.

[From the April/May 2007 issue of AnswerStat magazine]

Choosing the Right Notification System

By Kathy Veldboom

Are you confident that the right people in your organization can be contacted to respond to any number of possible scenarios? Can you do it quickly and reliably, every time? Software solutions that automate the notification process are now powerful and reliable enough to implement and manage the notification process enterprise-wide. The choices are many, however, and deciding which one to buy can be a daunting task.

The best systems are flexible and template-driven, allowing administrators to pre-plan the notification process including “calling trees” for any number of scenarios such as national emergencies, code events, hazardous material spills, staffing shortages, natural disasters, and fires. They also allow users to communicate “everyday” notices such as public announcements and meeting notices.

Critical Procedures: Critical events require critical notification and response assessment procedures including:

  • Notifying the right people quickly and accurately.
  • Providing the right information.
  • Executing in an effective and timely manner.
  • Obtaining information from the respondents.
  • Escalating to additional respondents if needed.

The entire notification process must be managed, monitored, and tracked.

Features of an automated system: When looking at various emergency notification software packages, be sure that the system is scalable, standards-based, and highly configurable to meet your evolving needs. A robust notification system should be capable of integrating to virtually all phone switches and paging systems and support a multitude of protocols, devices, and rules. Other key factors to consider:

  • Notification Process Definition – Does the system enable you to build templates that spell out the various people and groups who should be notified when a critical event happens or an alarm is triggered? What tools are available to quickly and accurately notify the right people? Are your institution’s “best practices” codified in the standard procedures?
  • Message Delivery – What’s the best way to contact each person on the list? Alphanumeric pager? Cell phone? PDA? Can the system send messages to any and all of these devices? What if some recipients have asked a colleague to cover for them—can the notification system adapt and send the notification to the covering person?
  • Response Collection – The notification is out; now people are calling in for further instructions. Can the system take the calls and tabulate the responses? Can respondents use means other than the phone to respond, such as two-way pager, PDA, or web? Can the system cancel the notification if enough responses are received?
  • Escalation – If a recipient doesn’t answer a page, can the system automatically call the recipient’s cell phone? If a group has been notified, but not enough responses have been received, does the system “know” whom to notify next?
  • Monitoring – You’ve sent a notification. Now you want to know how many messages have been sent, how many responses received, and what the responses were. What tools are available to monitor these processes?
  • Alarms Integration – Can the system be set up to monitor your alarms and automatically notify critical personnel when the alarms are triggered?

Premise Systems or Hosted Services? Most notification providers offer a hosted model, providing a web-based notification package requiring no special equipment at the customer site (other than standard computers and browsers) and charging fees based on usage.

For organizations whose notification needs are mission-critical and complex, a dedicated premise system might be a better solution. Premise systems reside at the customer site and are completely “owned” by the customer, providing the utmost in flexibility and control. They are ideal for users who have everyday notification requirements in addition to emergency planning needs. Some organizations will want a “blended” package incorporating both a premise system and a hosted service. Ask your system provider if a blended solution is available.

System data: The notification data – recipient names, contact devices and numbers, and more – is key to the functioning of the system. Be sure to evaluate the robustness of the database underlying your vendor’s notification system.  A market-proven relational database such as Oracle or Microsoft SQL will ensure optimum reliability and programmability, while “flat” databases will limit a system’s ability to handle complex procedures, locate people on the move, and process incoming responses.

System protection: What if an emergency event disables portions of your on-site notification system? Your system vendor should provide resiliency options such as an off-site standby server. In the event that the actual emergency event disables portions of the system, traffic would be re-directed to the standby. Additionally, an offsite hosted notification service can serve as a backup for premise-based notification systems.

Provisioning the system for major events: Your system provider should lead you through provisioning to ensure that your notification system is properly sized. Also ask about options to ensure system availability such as specifying a fault tolerant hosting infrastructure, hosted service backup, and working with your organization’s disaster recovery experts to determine how the system will be protected during an event.

Not Just for Emergencies: FEMA defines an emergency as “any unplanned event that can cause death or significant injuries to employees, customers, or the public; or that can shut down your business, disrupt operations, cause physical or environmental damage, or threaten the facility’s financial standing or public image.” However, notification and response systems can also have a time and budget-saving role in everyday communications along with training, testing, and measuring communication plans for critical events. Some systems include components such as on-call scheduling and group messaging. Routine uses of these systems, such as calling responders to see if they’re available for duty or notifying staff of a meeting, can be key factors in justifying purchase of the software.

Kathy Veldboom is Chief Operating Officer of Amcom Software. She has held prior positions as a trainer, installation technician, and systems analyst. She can be reached at 800-852-8935.

[From the April/May 2005 issue of AnswerStat magazine]

Selecting a PC Attendant Console

By Gary DuPont

If you are a regular reader of AnswerStat magazine, you are probably familiar with the basic concept of a PC-based attendant console. This category typically includes products that either integrate with or replace the traditional telephone operator console and include features such as an organizational directory, patient information paging, and all attendant telephony features.

Over the years, this category of products has witnessed multiple operating system advances and technology improvements. The market leaders in this space can all make claims as to why you should chose their product. MASCO Services Inc. (MSI) selected a PC attendant console solution eleven years ago and over the years has upgraded the platform as required in order to supply our customers with enhanced features and efficiencies. It has also given MSI a competitive edge in its hospital paging and physicians’ answering service businesses. Here are some of the features, benefits and advancements to help guide you and your organization toward selecting the vendor appropriate for you.

Some of the questions you should ask:

  • What CTI (Computer-Telephony Integration) methodologies are used for integrating the telephone system with the PC? Some vendors recommend server based CTI solutions versus client-based.
  • Does a failure of one link (server-based) jeopardize your entire call center?
  • Does the integration support ACD (Automatic Call Distributor) features and true attendant console features?
  • Does the system provide a proprietary telephone system in front of the hospital telephone system and create another link in the communications chain?
  • What is most important to your organization?
  • What is the product life cycle of your current PBX (Private Branch Exchange)?
  • When is your existing Centrex contract up for renewal?
  • Is your telecommunications department considering a move to an IP-based (Internet Protocol) platform?

Features and Functionality: An important way to distinguish one product from another is to review the features offered by each vendor and determine which ones are important to you. Is the software architecture based on industry standards making it open to growth, new technology, and standards? As mentioned earlier, each system available uses an attendant to answer a telephone call, perform a directory lookup, and transfer the call. An important way to distinguish one product from another is to compare each vendor’s features and functionality, then determine which features provide you and your clients the best service in a cost efficient manner.

Return on Investment: A current trend in cost justification is the return on investment model. Vendors have identified this trend and have focused on specific feature to address this, such as:

  • Voice Assisted Transfer: Over time this can reduce call traffic to the operators, since callers will hear the DID or extension number prior to being connected.
  • Recorded Agent Greetings: Operators prerecord answer and progress report phrases, such as “One moment please,” “Still searching.” From a quality assurance perspective, this can be an invaluable tool.
  • Physicians’ Answering Service: This feature allows the same hospital contact center to serve both the hospital’s needs and the needs of the physicians that work there. Often this is provided on a fee basis, but the real cost justification is tying the physicians to the services of the hospital. If you are in this business or plan to be in the future, determine if the vendor has a proven track record in the field. You don’t want to be a beta site for a newly developed or unproven product.
  • Delivery of Messages: This category has been dominated by radio-paging, faxing, email, and voicemail. However, with the advent of in-building wireless systems such as SpectraLink Wireless, Symbol Technologies, and Vocera, the traditional delivery methods are being replaced by devices that can receive a text message. PC-console systems with applications based on these formats will provide even more functionality to the users within the hospital. Features such as this help to provide cost justification by streamlining the communications process and often eliminating the use of an operator.
  • Web-Based Directory, Paging, and On-Call Scheduling: With the advent of the browser interface, more organizations are choosing this feature and giving staff self-service options for directory look-up, paging, administration of on-call schedules, and directory changes. The measurable costs and benefits to this module are recognized by the reduction of the printed directory and calls to the operator. Also, by making the database content public, incorrect entries are noticed sooner, leading to a more accurate database.
  • Speech-Recognition: Speech-Recognition has become the most talked about feature in recent years. This technology is now commercially viable and relatively economical to be used within the healthcare communications world. MSI uses speech-recognition on internal calls to route them to an individual’s office or pager without operator assistance. The reduction in call volume over time to the operator group allows for more time being spent on sensitive calls, providing other non-traditional tasks, and redeployment of FTEs (Full Time Equivalents). Your ACD or PBX reports will also confirm this by comparing before and after historical call data.

There are many other modules and features that can be included within the category of PC-Console. As you do your own research, take the time to compare your finalist to your current needs, your near-term plans, and your long-term strategy. Then compare telephony integration, features, and functionality along with product references. Once this has been completed, your vendor of choice will emerge.

Gary DuPont is Director of Telecommunications and Customer Care at MASCO (Medical Academic and Scientific Community Organization, Inc).

[From the Winter 2004 issue of AnswerStat magazine]

PBX Attendant Consoles

By Peter DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStatPBXs (and ACDs) are generally configured with an attendant console. Though a console can take on different forms and appearances, at its most basic, it is a fancy telephone which is given “permissions” to do advanced features that cannot be accomplished by other phones and users on the system.

Traditional Attendant Consoles: Historically, consoles were electro-mechanical devices, with a dizzying array of buttons that took up considerable space on a desk. Over time, these consoles have become less mechanical and more electronic, nevertheless they still function as an expanded telephone.

Many readers, no doubt, still have and use these types of consoles in their hospitals and call centers. Designed for efficient and effective answer-transfer activity, these phones have additional buttons – sometimes a hundred or more – to minimize the number of actions required per call. Additionally, some buttons are “smart keys,” processing multiple actions with a single push (such as “hold” current call and “connect” to new call) or changing function depending on the situation (such as “answer” if not connected to a call, but “hook-flash” if connected).

PC Attendant Consoles: Although these standard, entry-level consoles are vastly superior to the functionality and efficiency of a standard PBX phone set, they pale in comparison to the ease-of-use and feature-rich effectiveness of a PC attendant console. As the name implies, PC attendant consoles are computer-based call-processing units with a familiar Windows interface.

A basic PC attendant console is available from virtually all PBX vendors. There are several benefits provided by PC attendants. First and foremost is that calls can be processed faster, requiring less arm movement and with touch-typing speed. This implies labor savings and cost reduction. If even one FTE (full-time equivalent) is saved per year by using a PC attendant, then it has more than paid for itself. However, the labor-saving effect is often greater than one FTE – and occurs year after year.

A second benefit is the Windows interface. Trainers generally concur that training is easier and faster on a familiar-looking computer screen with intuitive actions, than on a intimidating and foreboding traditional console. In fact, unless advanced functions are repeated frequently on a traditional console, they tend to be forgotten, performed incorrectly, or done without confidence. With the user interface of a PC attendant, these concerns are greatly minimized.

A third benefit is added functionality. Even at its most basic, a PC attendant includes a directory feature, allowing for instantaneous access to hospital extensions and room numbers. This speeds answer-transfer functions and greatly increases accuracy. Therefore, for the one-time cost of purchasing a PC attendant, there are ongoing labor savings, training efficiencies, and additional functionality.

Advanced PC Attendant Consoles: More sophisticated PC attendants are available from third-party providers. These include both software-centric solutions and hardware implementations. Whereas a PC attendant is an adjunct offering from a PBX vendor, it is a core competency and primary focus of third-party providers. Although the details vary, along with their respective labels, here are some features you can expect from a third-party PC attendant:

  • CTI (Computer-Telephony Integration) directly links a call with the information needed for that call or that is gathered from the caller. There are various levels of sophistication with CTI, but most third-party providers have implemented this at its most optimum level. (See Information Transfer and ANI.)
  • Directory Services which are available enterprise-wide, assist agents in quickly and accurately locating members of the organization.
  • Agent Greeting goes by many different names such as Operator Saver, Perfect Answer, Answer-with-a-Smile, and Personalized Auto-Answer. It provides automated greetings in the attendant’s voice. This allows an agent to record a “perfect” greeting and then use it repeatedly throughout the day, guaranteeing that every call is optimally answered. Other benefits are less agent fatigue and a stronger voice at the end of the shift. This is a requirement in hospital and call center environments.
  • Messaging Options enable operators to type messages into their computer and to send them, at the touch of a keystroke or two, to any destination including voice mail, email, fax, printer, pager, or text-enabled cell phone. Third-party PC attendant providers put great emphasis on the messaging aspects of their systems, providing a powerful array of message processing features and options. This also provides the platform on which to offer telephone answering service.
  • ANI (Automatic Number Identification) displays the caller’s number (when it is available) and copies it into the call record or message form. This streamlines message taking and reduces errors.
  • On-Call Scheduling enables agents to reach the right people no matter how often their schedules and availability may change.
  • Call Recording lets agents selectively record a phone conversation.
  • Call Logging (Voice Logging) digitally records all calls, of all agents, 24 x 7. Recordings are available as needed for training, verification, and problem resolution. (Without corroboration, the agent is always blamed for errors and quality concerns, but amazingly when a recording of the call can be accessed, the agent is vindicated over 90 percent of the time.)
  • Information Transfer allows information and data that an operator enters into the computer to be retained with and accompany the call if it needs to be transferred to another agent or supervisor for call completion or resolution. This keeps callers from needing to restate pertinent information, such as their name, PIN, account, address, call-back number, and so forth.
  • Administrative Monitoring and Reporting provides real-time monitoring of call center activity and reporting procedures, including call statistics and messaging activity.
  • Database Functions helps administrators maintain internal, up-to-date information that is available to all agents, as well as accessing external databases, which can be displayed on the agents’ computer station. Databases can be either read-only or allow updating and data-entry capabilities.
  • Speech Recognition streamlines various functions and can automate repetitive tasks.
  • Text-To-Speech allows callers to automatically listen to database information without an operator needing to read it. One prime example is an employee or client automatically retrieving messages without operator involvement.

Healthcare Applications that have been designed and implemented specifically for a medical or hospital environment include

  • On-Call Calendars
  • Patient Directory
  • Physician’s Referral
  • Physician Registry/Locator
  • Physician’s Consult
  • Class Registration>
  • Wake-Up Calls

This is a summary of the key features available today. Other items are also available and the list is growing as vendors make their products more robust, powerful, and feature-laden.

Integrating Third-Party PC Attendant Consoles: PBX vendors may be apprehensive about third-party PC attendants. Obviously, most sales staff would rather sell something they will make a commission on, as opposed to recommend another company’s product. From a pragmatic standpoint, however, concerns do exist about working with another vendor to make a solution function as expected and the inevitable finger pointing that occurs should something not work.

As such, third-party vendors go to great lengths to minimize this concern and to ensure that the installation and interface goes as planned and works as represented. Even so, many purchasers insert a clause into the contract or purchase order to address this very issue. Vendors who are confident in their product and their capabilities are open to accept any reasonably worded clause relating to equipment interfaces and inoperability.

See our listing of PC console software providers.

Peter DeHaan is the publisher and editor-in-chief of AnswerStat magazine and a passionate wordsmith. Connect with him on his personal blogs, social media sites, and newsletter, all accessible from peterdehaan.com.

[From the Winter 2004 issue of AnswerStat magazine]