Tag Archives: technology articles

Managing Online Health Information

By Joanne Cawley

During the last decade, the Internet has dramatically changed our lives. Information, services, products, and communication are now just a mouse-click away. Because of its accessibility to the public, the Internet is the method of choice in obtaining data on most any subject for many.

Over 100 million people turn to the Internet for healthcare information each year. The World Wide Web is flooded with information for the continuously growing number of health-seekers. Since the Internet is open to anyone with a URL, there is often incorrect, outdated, or misleading health information accessible to consumers. Not only can this type of information lead to adverse clinical outcomes, it can also tarnish the image of the site hosting the information.

The Truth is Out There: Healthcare organizations have a responsibility to make sure the information they have posted for online viewing is accurate and up-to-date. This holds true whether the content is:

  • Written by you or your staff,
  • Purchased from a reliable source, or
  • Made available via a direct link from your site to another site.

When managing online information, it is critical to review each Web page and verify that all information is not only correct, but also current. By keeping your content fresh and accurate, your customers know that you stand behind all the information on your website, thus growing their confidence in your organization. With confidence, loyalty follows.

One way you can assure your visitors that the content they are viewing is accurate and current is to apply for the Code of Conduct Seal from the Health on the Net Foundation. This self-regulatory, voluntary certification system was started as a means of raising the quality of medical and health-related information on the Web. The foundation’s Code of Conduct is based on eight guiding principles dealing with all aspects of information from attribution to confidentiality. It lets your readers know the source and purpose of the content on your site is reliable.

Avoiding User Error: Once you know your content is accurate and reliable, you need a strategy to attract your target market to your site. Whether consumers are researching physician referrals, information on medical conditions, legislation, or classes on healthy living, accessing your website can be an effective tool for you to keep users in constant contact with your organization.

The following are some ways to help you keep your website appealing while attracting repeat visitors:

  • Make sure your website is effortless to navigate. Keep the information and links simple to locate, and your viewers will want to visit your site since they can easily find what they are looking for without getting frustrated. To ensure this, have a few individuals “test drive” your site via a dial-up connection and look for slow loading pages or broken links.
  • Conduct an online survey to determine what type of viewer is accessing your site and any specific pages they visit regularly. Although many visitors will be searching for health information for themselves, be sure to consider the family health manager, caretakers, and treatment or medication information seekers. You may need to alter your Web pages to fit the demographics accordingly.
  • Keep current news and information right on the home page. Information on flu symptoms, vaccines, and other timely topics will reinforce your website’s reputation as being one step ahead of the needs of your customers.
  • Work with a local news station to develop a consumer health segment during a newscast. While providing helpful health-related information, you can also promote your website. Some call centers have paired up with a local network affiliates. They air a weekly segment with a physician who discusses a variety of consumer-friendly topics. During the segment, viewers are encouraged to visit their website to submit questions, to search for further information or contact the call center to discuss specific health issues with a nurse.

Offering Self-Service: Consider allowing your customers to:

  • Conduct physician searches
  • Register for classes
  • View health information

In a recently conducted survey by McKesson, 53% of respondents stated they currently use Web functionality in their call center to deliver everything from health information to triage. An additional 20% of respondents said they plan to implement Web functionality within the next 24 months. As this communication tool continues to grow in the health delivery system, it is increasingly important to differentiate your site by offering accurate, confidential, and unique services via the Web.

Joanne M. Cawley is the Marketing Communications Specialist for McKesson Health Solutions.

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

Who Dialed 911?

By Robert M. Charland

Providing a safe and secure environment for employees and visitors at your facility is one of an organization’s primary obligations and responsibilities. Have you considered how emergency services may locate a 911 or 9911 victim caller? This issue is often overlooked.

In a typical PBX (Private Branch eXchange) environment, the local PSAP (Public Safety Answering Point) identifies a 911 call by the trunk telephone number and the associated main billing address. This information may not be accurate enough to efficiently locate a victim caller on a campus or a multiple floor environment who cannot speak or properly identify his or her own location.

Legislation is in place in Colorado, Illinois, Kentucky, Mississippi, Texas, Vermont, and Washington that requires various degrees of compliance to Enhanced 9-1-1 or E9-1-1 (see www.nena.org/9-1-1TechStandards/state.htm). E9-1-1 requires accurate location information along with the telephone number for campus and corporate environments. For example, Washington State code (RCW 80.36.560) mandates that all businesses “exceeding twenty-five thousand square feet, or businesses on more than one floor of a building, or businesses in multiple buildings” provide ALI (Automatic Location Identification) information to E9-1-1 PSAPs. In other legislation, the phone has to be dialable from the PSAP, thus suggesting that all telephones require a DID (Direct Inward Dial) number. To address these issues, a number of products have emerged that solve many of these issues.

There are at least three major components to a complete solution: (1) passing the PBX Station’s unique ANI information, (2) updating the ALI database, and (3) notifying on-site security and staff.

The most important component, and the one that in most cases satisfies legal requirements, is passing the PBX station’s unique ANI (Automatic Number Identification) information to the PSAP. This may involve either the PBX or a third-party application terminating CAMA (Centralized Automatic Message Accounting) trunks. These special trunks deliver the 911 call to the E9-1-1 Tandem Central Office (CO) or Selective Routing switch.

This will include either sending the DID number of that PBX station or inserting the telephone number of the nearest DID-serviced telephone to the victim caller.

If employees and telephones always stayed in the same location, this would be an acceptable solution. However, as you well know, at many companies the telephone directory is highly dynamic and requires multiple moves, additions, and changes (MACs). As each MAC takes place, the PBX owner is obligated to send the new location information to the ALI database located in the Central Office (ALI database locations may vary depending on Local Exchange Carrier). This is an enormous task.

There are a variety of products that automate this process by providing an integrated solution to the PBX and public E9-1-1 network. In these cases, the telephone and associated location information is sent to the third-party system, which in turn provides that information to the telephone company or directly to the ALI database via modem or the Internet. This process is commonly referred to as private switch ALI (PS/ALI) upload or ALI update.

This covers the first two of the three components and may satisfy the PBX owner’s legal obligations in the aforementioned states. However, there is a moral obligation to the organization, its people, and its property. For this reason, a small number of products offer many types of event notification methods. The options vary from product to product; however, popular methods include radio pager, LED board, local alarm, remote printer and in a few cases, network broadcast or instant message-type notification that 911 has been dialed. These notification methods typically include information such as telephone number, building, floor and office. Event notification provides awareness and allows security and other staff members to assist emergency medical staff with whatever means necessary for that emergency.

There is yet another lesser-known feature that has recently been offered in conjunction with a third-party system. This feature, called real-time monitoring, takes the handling of a 911 call one step further by allowing the security staff to monitor the audio of a 911 call in progress. Since it is illegal to interfere with the transmission of a 911 call, this feature is a listen-only pathway.

As complicated as providing private switch E9-1-1 may appear, protecting people and mitigating liability are the two most important issues an organization faces. In the seven states listed, there are specific guidelines in place to help the PBX owner in their decision-making process and there may be hefty fines and lawsuits for law violators. In other states, the decision remains in the hands of the organization. In either case, there are now products available to address these issues.

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

Voice Logging Overview

By Peter DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStatVoice logging is an important and valuable call center technology, considered by many to be an indispensable support tool. Voice logging allows calls to be recorded for quality assurance, training, self-evaluations, verification purposes, and dispute resolution. Because of the terrorist attacks in the United States on September 11, 2001 there has been a surge of interest in voice logging. Although voice logging cannot be viewed as a detriment to terrorism, it is deemed as an essential part of everyone’s overall goal of increased security and safety.

Some centers record calls at random, many record all calls, and some continuously record all headset audio – both during and between calls. Past forms of voice logging equipment have ranged from reel-to-reel tape machines, to specialized audiocassette recorders, to modified VCR units, to today’s state-of-the-art computer-based implementations.

How Loggers Work: Voice loggers can be either external stand-alone systems or internal integrated software. Many of today’s CTI-enabled switches and call-processing platforms have voice logging as a built-in option, inherent in the system’s design and architecture. This provides for optimal performance and often allows the call record or captured data – be it a patient call, a telephone triage session, or a doctor’s instruction – to be directly linked to the voice file. This allows for a holistic review of all components of a particular call, as both the audio interaction and the information gathered can be easily accessed and reviewed congruently and simultaneously.

For other situations, stand-alone voice loggers can be interfaced to the switch or call-processing platform, tapping into audio paths at the agent headset, the switch destination port, or the source port. These later two configurations provide the ability to record voice mail calls as well. The advisability and desirability of doing so, however, is questionable and should be pursued only after careful thought and consideration of the ramifications and legal consequences.

Often vendors of stand-alone systems have designed universal interface adapters that allow audio to be easily tapped into at the handset or headset connection without affecting or degrading the audio level. For these external systems, a typical method includes tapping into the headset audio at the agent station and feeding it into the PC’s sound card.

For both internal and external voice loggers, the speech is digitized and often stored on the agent station hard drive, usually as wave files. At some point (either immediately or at a preset time or condition), the wave files are sent over the network to a central voice logging server where they are indexed and stored.

Indexes are commonly applied to all header field data, such as time, date, station number, agent login, source port, destination port, call completion code, and project ID. If needed, queries can be established to fine-tune the search even further. Searching by agent or time are the most common parameters. However, in the course of troubleshooting system problems, searching by specific ports, completion codes, or station numbers can be most informative.

The retrieval interface is a database, such as Access or SQL. As such, records of calls can be quickly sorted, filtered, and presented. Wave file access is then fast and efficient. If needed, archiving of voice files can be accomplished easily and quickly to CD-ROM or DVD.

Uses of Voice Logging: As mentioned, there are several possible reasons to record calls. These include quality assurance, training, self-evaluations, verification, and dispute resolution. Any one of these options often justifies the expense of implementing voice logger technology. The other features then become pleasant bonuses.

  • Quality assurance is the most often cited use of voice logging. With voice logging, supervisors and managers can easily and quickly retrieve, review, and evaluate agent calls. By integrating a program of silent monitoring, with side-by-side coaching and statistical measurements, an agent’s overall effectiveness can be evaluated and verified. Voice logging allows areas of deficiency to be discovered and items of excellence to be celebrated.
  • Training can be greatly facilitated using voice logging. One application is to capture examples of exemplary calls by seasoned representatives for trainees to review and emulate. Conversely, less than ideal calls can also be showcased for discussion and critique. Although both of these scenarios could be accomplished using fictitious examples or staged calls, there is great benefit in being able to demonstrate real-world examples.
  • Self-evaluation is a powerful tool of introspection whereby agents use voice loggers to retrieve their own calls and through a process of self-discovery learn how they can handle calls or situations more effectively. Although this is valuable during the training phase, it is also beneficial for seasoned representatives, as it allows them to keep their skills sharp and helps sloppy actions from becoming bad habits. Even more importantly, agents may specifically seek and review a specific call that had a less than ideal result so that a more desirable outcome can be determined and implemented.
  • Verification is another worthwhile use of voice logging, especially in an environment where critical information is shared and communicated, such as in telephone triage. By recording all conversations, the symptoms and nurse’s instruction to the patient is captured and verified that proper information was conveyed. Normally, the recording is never listened to unless there is an argument about the transaction.
  • Dispute resolution then comes into play. Whether it is a message, a medical emergency, or an accusation of improper phone behavior, the voice recording of that call essentially becomes an independent third party account of what happened and avoids the “he-said/she-said” disputes in which neither party can corroborate their own account of what happened. Though the agent is sometimes found to be in error in such situations, the consensus is that in the vast majority of cases the agent is vindicated; once the aggrieved party hears the recording, the problem resolves itself quickly and with little further effort.

User Input: It is rare to find a voice logger user who is not overwhelmingly positive about the benefits and value of the technology and what it means to their call center. “I wish I had a logger years ago,” is a sentiment commonly made within weeks of a new voice logger installation.

Others see how voice logging allows call centers to improver customer service. Interestingly, call center staff often initially view the recording of calls as a negative development, threatening the work they do and attacking their competency. It is only after voice logging technology is implemented that the agents begin to see it as a tool to protect their work and validate their quality. The reality is that only representatives with something to hide have a legitimate reason to fear voice logging.

Accounts abound from call centers that have increased the quality of their service, improved their training, and avoided a potentially costly lawsuit or a lost patient all because of voice logging. Although it may seem difficult to cost-justify a voice logger before it is bought, a high percentage of users indicate that it is one of the most important pieces of technology in their call center.

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 Fall 2003 issue of AnswerStat magazine]

Legal Considerations of Voice Logging

Compiled by Peter DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStatLegal issues regarding the recording of phone calls must be considered before embarking on voice logging. This varies on a state-by-state basis. Some states and countries require “one-party notification” in which only one of the two individuals needs to be made aware that the call is being recorded. This, of course, is most easily done by notifying the call center agents and staff.

This notice should be included in the employee handbook they receive when hired. By signing off on the handbook, it has been documented that employees have been duly notified that the recording will take place.

Check with a local attorney familiar with state employment law, as it may be advisable to have a separate sheet signed by each employee, which explicitly notifies him or her that calls will be recorded. (At least thirty-seven US States, the District of Columbia, the US Federal law, Canada, and England only require one-party notification. Note that there is some disagreement over the determination of the requirements for a few states.)

The other scenario requires that both parties be made aware that the call is being recorded; these are called “two-party notification” states. (Depending on the source, ten to thirteen US states fit this category.) This can be accomplished by playing a preamble recording on every call or inserting a periodic beep tone.

The preamble recording is common, but may prove to be a technical challenge to accomplish in a call center where multiple types of calls are taken and for various departments or clients. There is also the concern of how to respond to clients who object to an automated announcement before every one of their calls. Typical verbiage for the announcement or preamble recording is, “Thank you for calling ABC Clinic, your call may be monitored for training or quality assurance purposes.”

Alternately, many voice logging systems provide an optional beep tone. There are specific parameters to which this beep must adhere. According to VLR Communications, the beep tone needs to be a 1260 to 1540 Hertz tone, lasting 170 to 250 milliseconds, and broadcast for both sides to hear every twelve to fifteen seconds when recording is taking place.

The interesting part of this requirement is that both parties must be able to “hear” the beep tone; there is no measurable audio level specified. Therefore, it makes sense to set the beep level at a low volume, while still being audible to both parties. Still, many people find this beep tone to be disconcerting and distracting. Although call center agents typically grow accustomed to the beep tone, eventually tuning it out, this is not the case with callers, who generally find the ongoing beeping to be an annoying vexation. Callers may even discuss the beep tone or voice recording with the agents, thereby lengthening call time and decreasing the quality of service.

Several websites contain information about notification; unfortunately, they are not in complete agreement. This is shown in the chart below. Regardless of this information, be sure to consult a local attorney before recording any telephone calls.

Also, there are privacy concerns and issues. In general, one should take every possible precaution to avoid recording personal phone calls. A practical way of doing so is to only record conversations in the call center (and explicitly not in the breakroom or on any common area telephone) and to have an enforced policy against placing or receiving personal phone calls while in the call center.

These steps will help to ensure that personal phone calls are not inadvertently recorded and that privacy rights are not encroached. Again, obtain legal counsel before recording any phone calls. Voice logging is best used for quality assurance, training, self-evaluation, verification, and dispute resolution.

[For more information, see our Voice Logging feature article and Voice Logging Vendors.]

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 www.peterdehaan.com.

[From the Fall 2003 issue of AnswerStat magazine]