Tag Archives: telehealth articles

Using IVR to Improve Post-Discharge Patient Care



By Gary Hannah

Recent studies have shown that twenty percent of patients experienced adverse events following hospital discharge. Most commonly, these events are related to adverse drug effects, therapeutic errors, and nosocomial infections, those that are a result of treatment in hospital and secondary to the initial condition. One third of these events led to at least temporary disability, and three percent led to death. Other recent studies have estimated that between 44,000 to 98,000 deaths per year in the United States were related to hospital-related errors, many of which were preventable. In an era where regulations are holding healthcare facilities liable if these events are not adequately mitigated, hospitals are wondering how they can conduct effective post-discharge follow-up with patients when budgets and human resources are already stretched thin.

The good news is that one-third of these events can be prevented with proper post-discharge patient follow-up, and speech technology solutions can assist hospitals in providing consistent quality of care and patient assessment.

Best practices show that follow-up is important and if it is done often, it is the hospital nursing staff that is tasked with the responsibility of following up by telephone with patients who have been discharged. It can take as many as five calls to reach a patient, meaning nurses are spending inordinate amounts of unproductive time. This makes an already costly endeavor even more expensive and adds even more to a nurse’s already overloaded workday. Manual collection of data is not only time consuming, but it also often results in inaccurate data stored in disparate systems. This ineffective system relies on the independent analysis of data to recognize trends and determine the need for and specifics of any required medical intervention.

However, the fact remains that the proper follow-up process is imperative to ensuring top-quality patient care. What alternative is there to having RNs making these calls, and how can hospitals ensure that their nursing staff’s time is put to best use?

An interactive voice response (IVR) system, previously only associated with telemarketing or customer-service automated systems, can automate the post-discharge patient follow-up by using customized rules and call scripts to gather important data from the patient, ensuring that scarce nursing resources are used only where personal follow-up is required. Natural voice recognition speech technology has advanced to the point where the systems can determine with great accuracy the confidence levels of responses based on various terms and the positive or negative connotations of the particular words. Business rules can determine the course of action for the call, whether the patient is transferred to a live attendant at a medical call center, a notification is sent to a nursing station and pertinent callbacks can be conducted by a medical professional, or data is merely collected for statistical trends and patient satisfaction analysis.

A recent study showed that the incorporation of an IVR reduced nurse workload by eighty-eight percent and enabled nurses to focus their follow-up efforts on just those patients who truly required their attention. Surprisingly, the same study showed high patient acceptance rates for the new system, with two-thirds of patients expressing a preference for the automated system. With the automated system, patients felt that they could be more honest as there was no immediate judgment or bias associated with their responses.

An IVR can fit seamlessly into any health facility’s IT and phone systems, providing details on patient calls to help mitigate adverse events, as well as reduce liability. One-quarter of post-discharge emergency department visits, re-admissions, and deaths are due to adverse events. If these secondary care requirements are reduced, hospitals will enjoy tremendous cost savings and be able to allocate resources only to those in need.

In addition to post-discharge patient monitoring, the IVR can assist in a wide range of healthcare situations. Patients and nurses alike can respond to telephone surveys to indicate satisfaction levels, an important performance indicator for healthcare facility executives and an integral business variable in pay-for-performance situations. In pandemic scenarios, large groups can be monitored and statistics gathered to help predict outbreak models and treatment strategies. Ongoing monitoring of patients with chronic conditions like diabetes, reminder systems for elderly patients to take the proper amount of medication at the proper time, and outpatient monitoring for addiction management programs and rehabilitation can all be conducted using an IVR.

When choosing a solution, ensure that the IT footprint is minimal, that the vendor offers technical support, and that adherence to all privacy and compliance regulations relevant to the facility and healthcare jurisdiction are strictly enforced. Depending on the needs of the facility, the infrastructure setup, and IT resources, a hosted solution might be a better fit. A range of options exist with a range of prices and a healthy, due diligence process will help to find the right solution for every environment and telephone triage model.

As healthcare facilities move to an electronic health model, adopting technology solutions for everything from the identification of patients to point-of-care bedside diagnostic tools, the institution of an IVR to conduct patient follow-up makes good sense from both cost and patient-care perspectives. IVR does not replace the need for medical professionals and medical call centers; however, IVR improves processes and enables the most effective use of hospital and personnel resources.

Gary Hannah is the founder, CEO, and president of Vocantas Inc., a developer of advanced speech technology solutions that recently launched its CallAssure product line, an interactive voice response system optimized for the healthcare environment. The company also has products for the utilities, emergency preparedness, and customer service markets. For more information, visit www.vocantas.com.

[From the August/September 2008 issue of AnswerStat magazine]

The Medical Call Centers’ Role in Telemedicine



By Peter Lyle DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

AnswerStat magazine was present at the recent American Telemedicine Association (ATA) 2008 Annual Meeting. The event was held April 6-8 in Seattle Washington. Over 2,200 attendees were treated to a plethora of educational and informative presentations, as well as a packed trade show with more than 160 telemedicine vendors.

In addition to covering the event, AnswerStat magazine sponsored a half-day, educational session, entitled “The Medical Call Centers’ Role in Telemedicine.” Peter DeHaan, publisher of AnswerStat, served as the event’s moderator.

The course faculty included a stellar group of industry experts, including:

  • Peter Dehnel, MD, medical director at Children’s Health Network Triage Service in Minneapolis MN
  • Carol M. Stock, JD, MN, RN, principal at Carol M. Stock & Associates in Seattle, WA
  • Lois Scott, RN, BScN, MN, vice president for McKesson Canada, from Moncton, NB, Canada
  • Marlene Grasser, RN, regional sales director for LVM Systems, Inc., which is based in Mesa, AZ

Dr. Peter Dehnel started the day’s instruction with his presentation, “From Telephone to Telemedicine and Beyond…” In covering his topic, Dr Dehnel looked at the past in order to understand the present and envision the future.

Among many other talking points, he used two gripping analogies to give perspective. First, he asked us to recall a 60s muscle car. Although impressive and enviable at the time, it no longer possesses the same panache. As such, our industry is changing. Our industry must change. There are cost increases to manage and new technologies to embrace.

Secondly, he used the relative safety of air travel to point out that six sigma is not enough; one hundred percent accuracy is essential – both in air travel and in healthcare. Standardization can be implemented to result in increased reliability and greater accuracy.

Next up was Carol Stock who covered “Legal, Regulatory, and Licensure Compliance for a Successful Medical Call Center.” Carol pointed out that laws often lag behind technology and the current reality in which call centers find themselves. This requires diligence and thoughtful planning in how we implement technology today in the absence of guiding regulation. For call centers that handle calls from multiple states, nurse licensing – a state-by-state requirement – offers an added challenge that must be addressed. She also discussed HIPAA and call recording legalities, as well as emerging technologies, such as live nurse chat.

The “Evolution and Future of Telehealth Contact Centres: An International Perspective” was presented by Lois Scott. Lois enlightened attendees on correcting the myths of the Canadian health system. She also described how telenursing (both over the phone and through video) can greatly increase effectiveness and reach. In this regard, Canada leads the way, given its population is greatly dispersed over a large geographic area. This development is especially important given the growing shortage of nurses; it is a trend that will find worldwide adoption.

Marlene Grasser concluded the session with pragmatic direction in technology selection for medical call centers. Her presentation was entitled, “Decision Support Software for the Healthcare Contact Center.” Among many other topics, she discussed key call center differentiators, including triage, referrals, survey tools, and disease management. She concluded with guidance on selecting and using call center management tools, an often-overlooked element of successful call center management.

The international assemblage of attendees was then treated to an insightful Q and A opportunity that allowed all four speakers to respond to questions and comments from the audience. The entire set of presentations was well-received and highly-rated.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.   Read more of his articles at PeterDeHaanPublishing.com.

[From the June/July 2008 issue of AnswerStat magazine]

Moving Telehealth Forward Through Benchmarking



By Julie P. Cartwright, RN MBA

What tells us whether we made a good decision or if we are headed in the right direction along a defined path? Some would say we do so by measuring results. We look at maps drawn from the explorations of others. We compare the outcomes of our own experiences with the experiences of others. We set goals, and when we achieve them we know we made the right choices. Knowing where we are going in the practice of telehealth nursing is no different.

What is telehealth? The American Academy of Ambulatory Care Nurses (AAACN) Telehealth Nursing Practice Special Interest Group defined telehealth practice as a wide range of services delivered, managed, and coordinated by all health-related disciplines via electronic information and telecommunications technologies. The term telehealth represents the provision of health care beyond diagnosis and treatment to include services that focus on health maintenance, disease prevention, and education.

Within that framework, the subset of telehealth nursing has emerged. Telehealth Nursing, also known as telenursing, focuses on the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing. Telehealth nursing is a broad term encompassing practices that incorporate a vast array of telecommunications technologies such as telephone, fax, electronic mail, Internet, video monitoring, interactive video. Telehealth nursing is continually evolving. Telehealth nursing interventions encompass various types of nursing other than direct, hands-on patient care. Components of this practice, guided by nursing standards, include assessment, triage, consultation (such as information, advice, and symptom management), disposition, surveillance, and follow-up. Some established components of telehealth nursing are currently telephone nursing and tele-homecare.

Telehealth nursing has come into it’s own as a practice specialty and is recognized with its own certification exam offered by the National Credentialing Council (NCC). Have we been effective in moving a nursing practice modality, traditionally practiced hands-on and during face-to-face encounters, to the less traditional mode of Telenursing? In order to know that, we need to explore where Telenursing has been and where it is going.

One approach was to develop a web-based data collection tool that could address this gap in knowledge. As the practice strives to achieve quality programs, it continues to search for data on successful performance. In 1999, an AAACN colleague and I joined forces and developed a benchmarking survey tool (TBS-TelehealthSurvey) that was designed to do that.

TBS established an ongoing database that has attempted to capture the breadth and depth of telehealth practice. What the survey reveals is that there were so many more variations on the telehealth theme than it could possibly differentiate between in order to keep its promise. The promise was to make apples to apples comparisons. What was discovered in this process is that there are many different varieties of apples: Macintosh, Golden Delicious, and Granny Smiths, to name a few. Some apples are good for cooking and some are good for eating. So it goes with telehealth programs. Some telehealth programs are disease management focused, others community services focused (traditional telephone triage models), and some are marketing focused. The definitions, terms, and base of valuation changes over time and what was a “Macintosh” in 2001 may have become a “Granny Smith” by 2003. The biggest finding, however, was the challenge of relevance of aggregate data to individual varieties of telehealth programs. The more blended the data, the less relevant it becomes to individual program decision-making. That is why we at HMS Northwest (HMS) feel it is a time for change.

We have evidence of changes in gathering data, reporting of data, and managing data with other benchmarking providers for the call center industry. One example is that of Jon Anton’s work with BenchmarkPortal. BenchmarkPortal limits its core survey to that of 37 key questions. This process mainly identifies the source of the information (demographics) and key operational indicators. BenchmarkPortal then uses “one minute surveys” and audit processes to capture in-depth information for a specific target, client, or objective. HMS has also moved to conducting client specific audits that have met with great success. Audits are done on an individual basis identifying a specific type of “Macintosh” from among its clients and resources outside of telehealth that best matches the situation.

HMS dedicated TBS to serve the practice and in conjunction with AAACN, continues to support its original goals. Those goals are:

  • To document what is happening in the industry
  • To add to the body of research building within the industry
  • To contrast and compare reality in the field to the professional understanding of the work
  • To provide a venue for you to obtain peer group comparisons

The process establishes a record of the telehealth benchmarks (measurements) reported by various organizations/programs, from a single provider triage program to a large multi-state call center. The data collected permits differentiation among the types of services, populations, and resources to allow evaluation, exploration, and comparison of similar organizations or activities. In addition, by combining, the top reported performance benchmarks, best practices (that is, the top achievable levels of performance), are identified. This process is defined as the sharing of performance information to identify operational and clinical practices that lead to the best outcomes.

As HMS continues to move this initiative forward, it plans to look at new approaches in data collection and reporting. We have been asked to contribute relative findings and correlations found among the data collected as a regular feature in AnswerStat. Look for “A Piece of the Puzzle” in the next edition of AnswerStat. Please let us know if you have a specific request, we will try to address it in future publications.

Julie P. Cartwright is a Certified Call Center Auditor (CCCA), an RN, and holds an MBA. She is president and CEO of HMS Northwest Inc. in Port Angeles, WA.

[From the Fall 2004 issue of AnswerStat magazine]