Simulating Traffic Helps Hospital Address Contact Center Traffic

By Claire Cordeaux

A healthcare phone system can quite literally be a lifeline to the patients who need access to medical professionals. The challenge of any healthcare contact phone system is to identify the calls that need immediate attention and make those a priority. The ideal system would mark each call according to need, and – while ensuring a basic level of good customer service and care – deal with the calls in order of priority.

For the NHS24, which is part of the UK National Health System, getting this level of prioritization was essential to its survival. The 24-hour national health call center was launched to serve a population of five million people, but it quickly became overwhelmed with the needs of callers. How this health call center identified its problems and used business process analytics and simulation to garner a solution holds lessons for every hospital, healthcare line, medical services institution, and others that deal with phone calls concerning patient health and care.

What caused problems for this contact center was the added demand of general physicians’ forwarding their phones to the general contact center after hours. At peak times, the service was handling in excess of 14,000 calls per day. This demand outweighed the metrics that had led to the contact center’s design, resulting in low patient service and accompanying criticism in the public sector and among the press.

Of issue was the callback procedure that was designed for a much lower call volume. The procedure for an urgent call was to have a handler pass it on to emergency services, ambulatory services, or to an internal nurse advisor. If a nurse was not immediately available, arrangements were made to have the nurse call the patient back within a set time, with the order of callbacks determined by the need of the patient.

With the extra volume of callers, the callback system was experiencing delays of up to an hour, which was unacceptable for both the patients and the healthcare staff. The staff undertook a simulated analysis to improve the overall contact center’s efficiency, but they started by focusing on the callback program.

The simulation was able to take the regular flow of calls to the center and place them in a context that included all of the resources that are used, as well as the time it takes to complete the various functions that make up the call center’s processes. One of the main benefits of a simulation is the ability to run “what if” scenarios. These scenarios lead to the breakthroughs in understanding that enable organizations to optimize their resources.

Specifically, in the case of the contact center, the simulation allowed the staff to identify what resources were needed at all stages of the callback process. From here, the staff was able to quantify the most appropriate resource and skills mix that was involved in the callback procedure and also identify demand throughout the process. This resulted in the creation of new local hubs to meet the high demands at peak periods and changes in shift patterns and staffing. Through this exercise, the staff was able to find other solutions for certain types of calls, taking these types of inquiries out of the callback process.

Claire Cordeaux is the health and social care vertical lead at SIMUL8 Corporation. In this capacity, Claire works with clients in the healthcare and pharmaceutical industries. She holds a bachelor’s degree in languages from the University of Bristol.

[From the April/May 2012 issue of AnswerStat magazine]

Healthcare Paging: It’s a Perception, Not a Device

By Jason Stanaland

Critical messaging and communication are important in a hospital environment and are key to employee and patient safety. Communications occur between doctors and nurses, patients and employees, and many other groups working together throughout the hospital. For a long time, paging has been the backbone of this communication. It has been the glue that has held communications together. When all other methods of communication have failed, whether by technical failure or lack of acknowledgment, paging has often been what people have used. For a long time, one-way paging fit well in the healthcare communications environment.

There are several key reasons pagers have worked. Paging systems are reliable, redundant, secure, fast, auditable, and low in cost.  Paging systems also support ensured disaster recovery capacity and common capcodes, offering the ability to send a message to a single address and have it received on many devices simultaneously.

In addition, communication on pagers has also offered an environment for people to interact that is separate from all other communications media, such as email, text messaging, and instant messaging (IM). This unique environment represents important, hospital-related messages only.  No texts from friends, moms, or kids – just messages related to the job.

Pagers have also offered the ability for critical messages, such as code blue (heart attack), to emit a different tone than other messages, indicating to the receiver of the message that this particular notification was of the highest priority.

All of these functions are still relevant today when planning and developing new paging systems in healthcare environments.  With mobile messaging (paging, text messaging, and mobile instant messaging), there is a need for a type of communication that is reliable, redundant, secure, fast, auditable, and capable of group messaging from an enterprise level.  I call this type of mobile messaging, “paging.”  To me, paging is no longer a device, an infrastructure, a messaging protocol, or a method of transport.  Paging is a perception.

There are three important things to consider when designing paging solutions for today:

Ensure Reliable and Quick Delivery to Any Device: We must ensure that we accommodate all of the traditional requirements for paging systems when we are considering “paging” on a smartphone.  Using a mobile messaging solution, such as Amcom Mobile Connect, affords several compelling opportunities:

  • Reliability and redundancy of “paging” on a smartphone supporting a messaging system that is capable of seamlessly failing over between messaging platforms, such as BlackBerry Enterprise Server (BES), short message service (SMS or Google Push), and networks (cellular and Wi-Fi).  This is similar to the system reacting and recovering in the way that the human body does, by using alternate resources and repairing broken parts when necessary.
  • Secure paging to smartphones can use encrypted SMS, BES, or other protocols.
  • Cellular paging offers full two-way messaging and auditing, affording users the ability to maintain full text conversations that can be archived for auditing purposes.  This provides both accountability and protection for employees.
  • Data push technologies helps save on ongoing costs, as SMS charges are not required.
  • Under normal conditions, cellular messaging, even using SMS, is faster than an in-house paging network.  (This is from my observation and empirical studies, not assumptions.)
  • Due to message retries, I’ve found that cellular messaging is more reliable in many cases and requires less in-house coverage to be successful.
  • Smartphones do not offer a “common capcode” technology that is widely supported on phones in the U.S. (such as SMS-CB in Europe), but rather rely on software-based, one-to-one serial messaging.  At first glance, this seems like it would be a major pitfall of a cellular messaging solution. However, serial messaging actually offers a strong benefit, as it has more flexibility to send messages to more targeted groups.  By automating these groups and updating some business practices, serial messaging can become more of a strength than a limitation.

Ensure That Important Hospital-Related Messages Standout: This is key to “paging” and is why paging is a perception.  The receiver must perceive the message with the same priority as the sender intended.  Priorities are important in healthcare communications, and we must designate between patient-related pages, normal hospital-related pages, and critical/time-sensitive pages.  These messages need to offer different screen pops, alert tones, colors, or reminder tones to communicate the level of importance to the receiver.  This becomes, in a sense, a tone of voice for the message.

Consider New Strengths of Smartphone Capabilities: On a smartphone we can integrate other applications, Web services (such as weather alerts or RSS feeds), built-in cell phone functions and features (like calling, email, instant messaging, Web, camera, or GPS), middleware (nurse call, lab systems, and fire alarms), and location-based services (for presence, status, and location-based messaging).  Tablets offer another dynamic to this in terms of integration with patient charts and enhanced video content.  At this point, the possibilities are endless.

Not all of what I have mentioned is offered by a single solution today, but things are certainly headed in that direction. You can’t directly compare the cost of “paging” to pagers with “paging” to smartphones.  If you just look at the cost, smartphones will be more expensive, and pagers will win out.  But, if you weigh the cost and the demand as you would with any economic assessment, you might find a different outcome.  The demand along with the ROI provided by increasing capabilities for smartphones is rising, and the demand and ROI for pagers is decreasing.  The cost for pagers can only go up as the demand continues to shrink, while cost of operations remains static. The cost for smartphones will go down over time as demand continues to grow, providing more revenue to cellular providers and driving the increases in supply and lowering consumer costs.

At Emory, we approach new technologies with a bit of caution in practice; in healthcare, we must sometimes be conservative.  However, our thoughts are forward-looking with communications technology, and we are eagerly awaiting the future, as it is quite near.  I predict that pager devices and networks will soon enough become a relic, but paging, as a perception, will remain a part of healthcare communications environments.

Jason Stanaland is with Emory University. The Emory Office of Information Technology supports a hybrid paging system which includes pagers and cell phones, but it is migrating away from pagers, with an eye on healthcare technology trends.  

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

Amcom Software Study: Understanding the Emergence of Smartphones in Healthcare

In October 2010, Amcom Software surveyed more than 300 healthcare organizations about the use of smartphones in their facilities to better understand the healthcare industry and how mobile devices are making an impact. Survey participants were from hospitals of all sizes across North America and included clinical leadership, IT, telecommunications, and call center supervisor titles.

The responses revealed that there is a communications revolution occurring in hospitals today. With highly mobile staff members and the increasing use of smartphones, new ways to share and act on information abound. The slight majority of survey respondents, 54.5 percent, are currently sending job-related alerts or pages to personnel on their smartphones. With these technology changes, the need for fast, accurate messaging remains crucial to maintain patient safety at all times.

Of the individuals who do not currently send job-related alerts to smartphones, over 70 percent stated their organization either has plans in place or is considering messaging to smartphones in the future. As more hospitals incorporate smartphones and they become the standard, it’s important to consider these realizations to ensure a smooth transition over the long run. It is vital to remember the most important goal is to get the right message to the right person on the right device at the right time.

Diverse Array of Devices Needed

Perhaps the insight from the survey is that there is great diversity in the devices being used today. Paging overall has declined very little in actuality. So, it’s not an either/or question when it comes to pagers versus smartphones. Healthcare organizations need to communicate with a variety of devices, including pagers, smartphones, traditional cell and desk phones, Wi-Fi phones, voice communication badges, email systems, and tablets. In fact, different staff members tend to need different things. Nurses often rely on Wi-Fi phones, housekeeping on pagers, and physicians on smartphones. It doesn’t have to be all or nothing. As long as messages reach the right people on the right device at the right time, patient safety standards can be protected and staff can be satisfied.

When it comes to smartphones in particular, there are many popular models and platforms to support. There’s no true standard. Because of this, BlackBerry®, iPhone®, Android®, and other smartphone types all need to be included. IT needs an easy way to allow staff to message to everyone, regardless of the smartphone carried or the type of cellular provider. In the end, sending a message to a smartphone should require only a phone number; nothing else should matter. They also need to add/remove users easily and be able install a simple application on the smartphone that is intuitive to all users.

As far as the device types leading the smartphone pack in the healthcare industry, BlackBerry is the current leader in the survey, with notable growth from Android and iPhone. The Windows Mobile platform does not appear to be gaining much traction at this point.

Integration with Other Systems

Mobile event notification middleware has been around for many years. This allows alert systems such as nurse call, patient monitoring, pulse oximeters, and many others to be centralized in a hub and sent directly to the mobile device of the appropriate staff member. The idea is that staff members can respond more quickly to these alerts, improving patient safety as well as their own efficiency.

More than 50 percent of survey respondents stated their hospital has the ability to send notifications from their nurse call system to staff’s mobile devices. More than a third stated they send messages from bed management systems and alarm systems to mobile devices. Overall, this means there is good progress toward an interconnected enterprise of devices to endpoints. Survey respondents indicated a wide variety of possible connection points are being used.

Looking forward, it would be possible to have a patient setting off a nurse call system and having the nurse receive notification on his or her smartphone. By streamlining the communication process between the patient and nurse, organizations could reduce falls and increase patient satisfaction.

Barriers to Smartphone Adoption

Hospitals are filled with sensitive information about patients and staff members, from health records to billing information to social security numbers. Communication devices, such as smartphones, can access much of this data, and information can also be stored in the technology itself. Likewise, messages can contain sensitive patient details and should not be viewed by anyone other than the intended recipient.

Security was noted as a concern with smartphone messaging given the sensitive nature of healthcare communications. Amcom’s smartphone messaging solution excels in this area by sending encrypted messages, which are then decrypted by the application on the smartphone. Even the message inbox can be password protected. This helps you with HIPAA and the HITECH Act and keeps staff and patient details protected.

Lack of coverage emerged as a relatively minor issue, with only 28.8 percent of respondents mentioning it. This is interesting in light of a similar survey Amcom performed a year prior to this one, showed that the major barrier to adoption was cellular coverage. This shift is most likely due to the ability of smartphones to use the local Wi-Fi network and hospitals working with cellular carriers. Amcom has also worked with customers on several scenarios to handle this; some hospitals have improved cellular coverage using distributed antenna systems in their facilities.

Amcom Mobile Connect: Simplifying Communications

Many organizations are undertaking a long-term approach to replacing the majority of their pagers. This means supporting a variety of communication devices for the near future. Amcom Mobile Connect™ enables hospitals to do what makes sense based on their staff and messaging requirements. An approach like this enables some staff members to consolidate devices using smartphones, while others may continue to use pagers or other devices as required. With Amcom Mobile Connect, hospitals can simplify communications and strengthen care by using smartphones for code alerts, patient updates, lab results, and consult requests.

Technology will continue to change, but the need for fast, accurate staff messaging remains constant. Ultimately, hospitals need to message to the right recipient without worrying about which device is being carried. The entrance of smartphones offers an opportunity to reevaluate everyday interactions and find ways to make healthcare organizations a safer place for patients, staff, and visitors.

For more information, call 800-852-8935 or go to www.amcomsoftware.com.

[From the April/May 2011 issue of AnswerStat magazine]

Moving the Needle: Enhancing the Patient Experience Through Technology

By Mario Ochoa

Are you aware of the importance of flu shots? When was the last time your children had their annual wellness examinations? Have they received their latest immunizations? The growth of healthcare as a business first, and a means of care second, has ensured that people must endure an inundation of information that spells confusion and disconnects the end user.

Telemessaging, a pre-recorded messaging system that can be personalized and targeted to a specific population, is finding its niche with healthcare experts who seek touch points for patient education as a part of their on-going communication efforts.

The system offers highly personalized, cost-effective, and efficient solutions that have been identified by many professionals as ideal for resourcefully communicating messages to a wide audience. Telemessaging is one key in providing members from different areas of the healthcare industry unmatched industry knowledge and support.

Carenet, a Texas-based healthcare support services center, utilizes the system as one of its key components to information distribution and has found success in its application. According to Carenet’s executive vice president, Vikie Spulak, “It is flexible in that our clients can record their own messages and have them instantly delivered to his or her members, who now become engaged with the provider in a way that is personalized for them.

“As an example, the medical director of a health plan wanted to disseminate important information such as prevention tips, vaccination locations, or other relevant information on the swine flu to 200,000 people in a matter of hours through this system. Telemessaging was the best option available. This technology allows information to reach a larger percentage of people in a more efficient manner.”

“The use of telemessaging often includes notifying members of pharmacy changes, such as a new generic drug that is currently on the market, or reminding members to have their children’s immunizations kept up-to-date,” said Carenet president, John Erwin.

“Overall, it allows for more productive communication in that it conveniently and efficiently delivers messages that are important to the recipient. However, that’s not the only benefit. As we have seen in healthcare, if you can empower your patient, you can be more effective in your care. It allows the patient to ask questions that are more informed, evaluate the responses, and find the best method of treatment. We are enhancing the patient experience through technology.”

Through telemessaging, companies are able to create targeted campaigns to ER frequenters, informing them that there are other convenient resources, such as local urgent cares available to help them with their healthcare needs.

By and large, telemessaging has the capacity to enhance customer relationship management by keeping companies connected, allowing information to become liquid and flow from one channel to another, and enhance the confidence a client, member, or patient has in his or her investment.

“Providing compassionate and knowledgeable healthcare solutions should be the mission of every healthcare provider,” said Erwin. “Telemessaging is a piece of the puzzle, and it reflects an idea that is slowly making its welcome return to our industry: passion and a commitment to helping people navigate their health, coverage, and obstacles to achieving peace of mind.

“These goals are significant to the patient and should be as important to healthcare professionals. Technology combined with personalized customer care can be a cog that helps move the needle towards a collective ‘Eureka’ when we find communication solutions that keep people informed and empowered.”

[From the October/November 2010 issue of AnswerStat magazine]

855 for Toll Free Services to be Implemented

The Wireline Competition Bureau of the Federal Communications Commission(FCC) authorized opening the 855 toll free code on October 1, 2010. The announcement was made on June 25, 2010.

The 866 and 855 NPA (Numbering Plan Areas) codes for toll-free service were assigned in1999, supplementing the 800, 888, and 877 NPAs.  The 866 NPA code went into service in July 2000, but implementation of the 855 NPA was deferred until now.  The Database Service Management Inc. forecasted that the current supply of toll free numbers was expected to reach the90% threshold in the fourth quarter of 2011, serving as the impetus for this action.

Earlier this year, the 544 NPA was assigned for personal communication services (PCS) and overlays were announced for Western Quebec (873 to overlay 819), Oklahoma (539 to overlay 918), New York (929 to overlay 718/347), Quebec (579 to overlay 450), and Arkansas(327 to overlay 870).

An overlay means that a new area code is assigned to the same geographic region as existing code(s).  With an overlay, no one needs to change area codes; however, ten-digit dialing becomes required for all calls.

[Posted by Peter DeHaan for AnswerStat magazine, a medical healthcare publication from Peter DeHaan Publishing Inc.]

Telecommunications in Healthcare: Combating Cost Pitfalls

By Rudain Arafeh

Since the old days of expensive private line, frame relay, or ATM technology, telecom technology – especially as it applies to the healthcare industry – has progressed to cut costs dramatically while giving organizations the benefit of a much richer communication experience. Unfortunately, the sheer volume of telecom contracts that healthcare organizations now are tasked with managing has made planning an infrastructure intrinsically more complicated.

With remote care, telecare, and telemetry, mobile networks have played a greater role in transmitting and receiving key patient data, bringing about a drastic increase in spending on mobile network subscriptions. The amount of contracts telecom and infrastructure managers have to manage makes it difficult to monitor the details of each contract and find unnecessary expenditures.

While telecom expense management (TEM) software and applications can save any large institution money by detailing each bill and making a determination on accuracy, it holds varying degrees of effectiveness in different industries. In the healthcare industry, the role of TEM is growing rapidly due to these new industry trends.

The Quick Progression of Corporate Telecom: In the old days of network infrastructure, healthcare organizations would employ private networks built and operated by phone companies to establish a direct connection. Although these lines were naturally more secure than many of today’s conferencing options, they were also substantially more expensive and offered less flexibility.

Then, healthcare companies began migrating private networks to the Internet to take advantage of higher bandwidth, more widespread availability, better connectivity, and lower costs. The ability to conference came into play in a big way with video, audio, and combination options, as well as more collaboration tools like WebEx, GoToMeeting, and NetMeeting.

While the dawn of online conferencing produced missing words, echoes, jerky video, and sometimes poor call quality, today’s networks can prioritize traffic for better quality calling and video. Nevertheless, problems that must be addressed still exist.

Today’s healthcare providers are moving further into remote care, and more devices are released daily that provide telecare or telemetry. These devices usually transmit a small amount of data back and forth and have a fixed monthly mobile rate based on how much data is transmitted and received. Providers of such devices are now faced with standard data rates plus overages if the device exceeds the allotted usage.

So how do you manage, monitor, and control every single mobile network subscription to make sure you’re utilizing each contract to its fullest? How do you decide who gets charged for what in the event of an outside conference call? Perhaps most importantly, how do you avoid overage charges and needlessly high-priced contracts when your infrastructure team has too many daily responsibilities to consistently monitor usage?

Telecom Expense Management’s Role in Healthcare: By using TEM software capable of drilling down into large bills, healthcare providers can determine who and what application is exceeding its allotted usage amounts. This data can then be used to pass the charges on, reconfigure the offending application, or use other rate plans for certain applications that require larger usage limits.

Usually, TEM employs some form of software platform that gives healthcare users the flexibility to input and track contracts, collect crucial analytics, compare contracts, and use a dashboard for a better overview of telecom costs.

Assuming a provider with 10,000 devices of which only 30 percent are above allotted usage, the monthly savings can be extremely significant. Finding out what devices and which users are above the plan can quickly translate to savings of more than $1,000,000 in extra fees over the contract period.

Implementing a TEM strategy takes a lot of the pain out of managing numerous contracts with multiple vendors, but it also gives greater accountability in terms of who is charged for what, especially in the case of a conference call with a third party. With strict management of these contracts, healthcare organizations can more easily answer infrastructure questions like “How do I implement the right access, equipment, and quality for cost-sensitive remote locations?”

If you have to spend too much time corralling your telecom maintenance contracts from any number of different vendors, each one can suffer. Controlling and comparing inventory and billing from a central location helps eliminate money wasted on duplicate contracts, obsolete equipment, and non-competitive pricing.

At the same time, TEM understands the complexity of multiple payers. If you’re conferencing with an external physician and he benefits from the call, do you charge him a portion of the costs? Healthcare organizations often have different locations and remote outliers that need access to their networks. With TEM software, you can manage and allocate the costs and charges that make sense.

Quick Conferencing Q&A for Network Professionals: Below are several questions to ask about your existing conferencing system or if you plan to implement conferencing in your network infrastructure.

  • Does your organization have the right conferencing hardware? You should have hardware that supports, at minimum, current H.323 conferencing standards and compression standards like H.264.
  • Do you have the right network bandwidth? Can your network handle the extra traffic? Video conferencing and IP-based voice calls including audio conferencing can affect your bandwidth in a negative and substantial way.
  • Does your network support QoS? Your network hardware and your telecom provider should both be able to support quality of service (QoS) routing. This allows you to prioritize packets based on their significance and urgency: video and voice packets first, email last.
  • Have you implemented QoS properly? The devil is in the details.
  • Who’s paying for your added expenses? Depending on how you use your video conferencing, you might be able to offset some of your added expenses by implementing an expense sharing agreement. To do this correctly, you will need to understand how you are being billed by your telecom providers. TEM software can help you put your arms around telecom billing and may help you reduce spending significantly.

Rudain Arafeh is founder, president, and CEO of Configure, Inc. He established Configure in 1996 after leaving AT&T to assist clients with complex telecommunication contracting and billing matters. Configure has grown rapidly and services many large clients. Mr. Arafeh served on the AT&T advisory council for many years and has numerous publications. Mr. Arafeh also co-founded Cygnet Labs, a medical documentation software company.

[From the June/July 2010 issue of AnswerStat magazine]

Getting Beyond the Telephone with Patient-to-Provider Interactions

By Bill Loconzolo

Recovery Act…Meaningful Use…Sound familiar? With President Obama in office, the healthcare industry is being forced to pay attention to technology. And with the stimulus legislation underway, physicians are taking bold steps to adopt the best technology to enable them to qualify for incentive funds, as well as improve service to patients. Similarly, patients are demanding more convenient ways to interact and communicate with their physicians.

The Recovery Act has opened the floodgates for physician practices to adopt electronic health records (EHRs). An EHR (also referred to as an EMR) is a patient’s digitized medical record, but it doesn’t enable communication between the patient and the physician. What does enhance the communication between the physician and the patient is a patient portal – an online, self-service application that brings simplicity, speed, and convenience to patients, while increasing practice service levels and meeting patient communication demands. In essence, a patient portal extends the value of an EHR.

So what does this mean for the call center? A call center has the opportunity to generate more revenue by upselling their services to the practice by offering a patient portal. The practice would receive value by having the call center automate manual traditional processes that can remedy workflow challenges and increase office efficiencies.

Using a patient portal that is integrated with EMRs, call centers can service their clients using applications like Appointment Reminders, Appointment Requests, and Ask a Staff. Traditional appointment reminder methods such as a written reminder on a small card can result in a no-show due to the patient misplacing the card. Or perhaps the physician’s office uses valuable staff time and energy mailing appointment reminders, or making the appointment reminder call. Either way, the practice is losing money.

What if the call center could service the practice by automatically sending appointment reminders via text to voice, SMS (Short Message Service), MMS (Multimedia Messaging Service), email, or an IM (instant message)? Well, they can. The practice would transmit an automated patient list from their practice management system to the call center’s patient portal, and through seamless integration, the call center would send automated patient reminders using any one of these unified communications.

Through the patient portal, a basic call center has the core capability to connect the patient to a qualified professional (nurse practitioner or doctor). If a patient calls into the call center with symptoms of coughing or shortness of breath, the patient would be able to go online and complete a symptom assessment or request a Virtual Office Visit (VOV) that would then be seamlessly connected to the practice for the qualified professional to respond. These types of interactions liberate the practice from the traditional paper and physical process of the in-office patient visit. Ultimately, patient-provider interactions provide convenience for the patients and new revenue opportunities and efficiencies for the doctor’s practice.

Call Centers are about efficiency, data analytics, and metrics – which are exactly what the health care system is lacking. Imagine if all patient interactions were logged, as well customer service calls with AHT (average hold times), FCR (first call resolution), Quality KPIs (key performance indicators) and recordings of these interactions into the patient’s personal health record and the practice’s PM/EMR systems. This historical analysis that drives overall improvements of personal health plans is what the health care system needs to enable better interactions with a practice. All of these metrics could be measured on every interaction. And that’s exactly what lies at the center of a call center – metrics.

Patient interactions are the key to reforming our health care system. The only way to increase the utilization of such systems is by increasing patient convenience with technologies, Web, VoIP, and unified communications. If practices empower patients to manage their health by providing patients with the analytics that show the interactions with their doctors and with their personal health habits over time, then practitioners will experience greater office efficiencies. They will also increase the convenience of communicating with patients, which in turn may promote the overall quality and longevity of a patient’s life.

As the call center has shown over the years, analytics and interactions drive behaviors (learned from Performance Management solutions), and defines response from corporations to address and adapt KPIs to meet the behaviors of the customers’ needs, in this case the providers. This is the closed loop informational analytic approach that the call center can and will bring to health care via patient portal communication infrastructures. And in doing so, the call center will experience a new stream of revenue.

There isn’t any doubt the call center isn’t just about the telephone…the call center can dive right into the 21st century and beyond to provide patient portal services to their customers – services that will add value to the call center, the provider, and the patient.

Bill Loconzolo is the chief technology officer for Medfusion, a provider of patient portals.

[From the October/November 2009 issue of AnswerStat magazine]

The Next Generation of Office Phone Systems

By Harprit Singh

We rarely think twice about picking up the phone and hearing a dial tone on the other end. Yet behind this simple technology is a massive infrastructure and decades of technology investments to ensure you can communicate as clearly and as efficiently as possible. However, office phone systems were largely ignored by the industry for a number of years, but today, the concept of such a system is beginning to go through a dramatic transformation.

Hosted phone systems, also referred to as hosted PBX (Private Branch eXchange) services, are just beginning to get the attention of businesses. It has the potential to assist businesses and business growth in previously unimaginable ways. It’s especially important for small businesses. With this new phone in place, businesses can now acquire a system that’s professional sounding and immensely scalable at an affordable price. As recent as a few years ago, this was relegated to larger businesses.

Hosted phone systems are grounded in a simple concept: outsource the phone system to the experts and utilize the phone system as a service available on demand. These services can be implemented along two different paths. The first is where you employ a service provider that supplies hosted PBX services over IP (Internet Protocol), which allows both VoIP (Voice over Internet Protocol) and a PBX (phone system) service. This permits IP phones (or traditional analog phones connected via an analog telephone adaptor) to use VOIP calling plans that often offer flat rate calling plans.

Although VoIP based hosted PBX services offer business grade features, VoIP has typically been associated with inferior quality audio. However, VoIP technology has improved the quality of sound over the years and is well on its way to becoming a mainstay in the telecom network. When looking for a VoIP based provider, you will want to pay attention to QoS (Quality of Service) issues and flexibility when adding or removing add-ons as your business grows or scales down.

The second approach is a hosted PBX service that will work with landlines, cell phones, and VoIP phones, and will provide phone switch management in place of a dial tone. In such a service, inbound calls are handled by the provider, usually through a virtual phone number given by the service provider. In this case, the caller is presented with a professional sounding auto-attendant describing various options, and the call is then routed to the appropriate destination (be it your desktop phone or cell phone). This system is beneficial in its flexibility, ease of use, affordability, and quick implementation. On the other hand, you will have to work with multiple providers—one for the PBX service and another for the dial tone (whether it is a landline, mobile, or VoIP carrier).

When considering hosted phone systems, look for features such as: auto-attendant, multiple mailboxes call routing, find me-follow me, music-on-hold, call screening, call transfer, find by name and full listing directory assistance, voicemail to email, and fax to email. These features facilitate small businesses in leveling the playing field with their larger counterparts. Small businesses are at an inherent disadvantage because of their size, but by using hosted phone systems, you can send a message to customers and prospects that you are just as efficient and capable as some of the larger enterprises in the industry.

With a mobile workforce becoming more common, hosted phone systems play a major role in promoting both mobility and flexibility. This, in turn, contributes to a higher satisfaction level among your customer base. With features such as find me-follow me, the system can be directed to reach you at the office, on your cell, or at any other number of your choice based on the order and routing rules specified. Small businesses find this feature especially useful when it forwards customer calls to the right employees, regardless of their location.

Hosted phone systems may also be used in conjunction with call center activity. For a support voicemail line, systems can collect all voicemails via email and feed them to an email response queue. This eliminates the time-consuming task of constantly checking voicemails. You can also forward a voicemail to someone else via email—something that is convenient, but non-existent, in most phone systems. Similarly, you can also route all incoming faxes to email and avoid the wait and unpredictability associated with waiting for a fax.

In addition, most hosted phone systems allow you to control and manage features online through a web interface. Not only is this convenient, but it also makes it easy for businesses to seamlessly incorporate additional capabilities as they become available.

You don’t need to be a telecom expert to program an office phone system anymore and the affordability, flexibility, and versatility of these systems can certainly be used as a competitive advantage.

Harprit Singh is the founder, President, and CEO of Intellicomm Inc., an enhanced communications service provider. Intellicomm is the developer of Innoport® mobility enhancing unified communications service.

[From the December 2007/January 2008 issue of AnswerStat magazine]

IP Telephony Deployment

By Robert Winder

It wasn’t long ago that very few contact centers worldwide were operating with a complete Internet Protocol Telephony (IPT) infrastructure all the way to the agent desktop. However, this has changed considerably in recent years. With its promise of cost savings, simplified management, and greater business agility, IPT is rapidly becoming the platform of choice for upgrading contact center networks or deploying new contact center facilities.

In fact, according to results from a 2006 global research study commissioned by Genesys, sixty percent of all respondents expected to deploy IPT in at least one contact center within a year, rising to eighty-two percent within two years. The study, which involved 500 contact center technology managers from twenty industries and fifty-three countries, revealed valuable insight into the technological expectations, architecture choices, and future deployment plans of new contact center applications.

Also notable among the findings was the fact that among organizations with IPT being deployed or planned, almost ninety percent said they expect to activate their first IPT contact center within one year – although most will only migrate some contact centers initially. This staged approach reflects the industry’s traditional caution about any organization-wide technology change. As a result, most technology managers expect to employ a mixture of traditional circuit-switched telephony and IP-packet switching telephony across their operations for some time.

As the deployment of IP contact centers continues to grow, infrastructure architecture has become one of the most important technology considerations. So far, the majority of IPT deployments have been hybrid solutions that add IPT capabilities to existing time-division multiplexing (TDM) switches. Until recently, proprietary IP solutions have been popular. Recently, a clear trend toward open standards IP as developed, particularly among those planning or investigating IPT architecture to replace existing contact center infrastructure.

The widespread emergence of open standards, such as Session Initiation Protocol (SIP), is helping to promote the adoption of IP telephony and is delivering many economies of scale. With a telephony framework based on SIP, for example, contact centers are able to separate the voice application software from the underlying hardware infrastructure, allowing them to purchase and deploy best-of-breed solutions.

With this approach, telephony functionality is provided by an application server on a company’s network and hardware based on industry standards, replacing expensive proprietary systems. As a result, contact centers no longer need to tear out an old system to add functionality, eliminating a large amount of the switching cost and risk of data loss. In fact, seventy-five percent of all respondents in the study see great value in being able to retain and leverage existing infrastructure. Almost ninety percent consider it highly or extremely valuable to retain existing applications as they migrate.

Flexibility Drives Decisions: Choosing the right architecture for an IPT solution is vital for any contact center. A wrong choice can limit future technology deployment options and restrict the performance of a contact center as it evolves and grows. Equally important is the ability to retain compatibility with existing infrastructure and to ensure the flexibility to deploy new applications.

For example, eighty-five percent of the technology managers surveyed in the study expect to retain their current analytical routing capability when they migrate to IP. Likewise, eighty-one percent believe it is very important to retain the flexibility to select and deploy new business applications without being limited by infrastructure. Balancing flexibility, reliability, functionality, and cost is critical – and different architectures balance these parameters in different ways.

Proprietary platforms offer potentially greater reliability, easier integration initially, and lower upfront costs, but they also limit flexibility and functionality and grow increasingly expensive over time. Conversely, open standards-based platforms can offer greater flexibility and functionality, including increased application portability. While the benefits and drawbacks of each architecture type differ from product to product, potential limitations need to be considered when deciding which option to deploy.

Most contact centers have already made significant investments in a stable and efficient technology environment to support quality customer service delivery. Therefore, there is a general reluctance to make significant changes unless substantial new benefits are expected. Still, the importance of having a flexible telephony infrastructure that can accommodate technological shifts is magnified by the expectation that the business requirements of the contact center are likely to change in the near future. This rapid – and inevitable – pace of change reinforces the value of open platforms and helps explain the rising popularity of open standards IP.

Until recently, cost savings has been the main driver of business cases that support IPT implementation. However, broader benefits are emerging from the experience of early adopters. These benefits can help build stronger business cases for organizations whose recent investment in telephony infrastructure is holding them back. These benefits include:

  • Ability to mix legacy TDM hardware with IPT infrastructure components and still create an integrated contact center environment
  • Business improvements resulting from centralized, consolidated operations management
  • Easy virtualization of resources – providing a single point of enterprise-wide call control and routing
  • Application portability
  • Ability to purchase technology from multiple vendors
  • Flexibility to work with external, third party systems

Strong Business Drivers: Until recently, the business case for deploying IPT in the contact center has been based on the same two parameters for deploying IPT across the corporate network – network and toll cost savings and easier operational management. However, the broad business benefits of IPT lend credibility to business cases that look further than simple cost savings, especially those that take into account opportunities to deploy new business applications and features and extend the functions of the contact center beyond the enterprise.

For example, deployment of IPT can be used to flatten and consolidate the contact center infrastructure, reduce network facilities, and control multiple locations from a centralized set of applications. This supports the creation of a single solution to incorporate contact centers, remote agents, satellite locations, and outsourced resources, all of which can be centrally managed and maintained. Moreover, centralized call processing means quicker deployment and significantly reduced maintenance costs.

The cost of implementing such a “virtualization” scenario using a traditional voice network is prohibitive. The combination of IP networks with IP telephony applications makes it possible for users located anywhere on a company’s network to have access to voice and data – at a fraction of the cost. In addition to the software now available, today’s commoditized hardware, including gateways between traditional voice and IP networks, media servers, and IP phones, plays an important role in widening the choices available to companies and reducing the overall cost of the solution.

Flexibility, compatibility, and protection of business continuity are distinctly the most important considerations for many organizations. It is not surprising, then, to find that hybrid IP remains the most common type of telephony architecture, while open standards IP is rapidly growing in popularity.

The Pathway to Deployment: While IPT seems to be inevitable for the majority of contact centers, the way to proceed is less clear. Each organization needs to develop a migration strategy that maps closely to their overall goals and current infrastructure needs – one that can create a best-of-breed communication solution with reduced total cost of ownership and without sacrificing existing capabilities. Fortunately, because IP runs on a standards-based SIP infrastructure, it can be seamlessly integrated into the contact center.  Organizations can easily make the transition in a phased approach, bringing value to the customer at each new phase.

A key point in the implementation of IP technology is that it’s not an all-or-nothing proposition – that is, there’s no need to migrate your entire environment to a single-vendor IP solution to begin leveraging the advantages of IP. By choosing vendors that support an open standards-based approach, organizations can deploy multiple technologies from multiple vendors in different places and use SIP to enable all of these pieces to work together. The good news is that the benefits of IPT can be leveraged even with a small initial deployment.

When considering return on investment (ROI), organizations should look beyond the short-term, easily measurable elements. The true measurement of return must take into account the long-term opportunities that IPT enables. Implementing IPT should be seen as a strategic move, rather than just a cost-cutting exercise.

By designing a strategy around business needs and taking a phased approach, companies can ensure existing investments are not compromised and that the implementation will not disrupt current business processes. Ultimately, the best approach to ITP implementation is to view it as a long-term investment – one that will provide returns in capital savings, productivity, and future innovation.

Robert Winder is the Vice President of Business Development, IP for Genesys Telecommunications Laboratories, Inc.

[From the June/July 2007 issue of AnswerStat magazine]

Test Your Way to VoIP Success

By Jeff Fried

Voice over IP (VoIP) is here to stay. A recent Empirix survey indicated that 98 percent of enterprises surveyed have already deployed or have plans to deploy VoIP; 2005 will be a year in which the number of new VoIP phones will exceed the number of TDM (Time Division Multiplex) phones shipped to enterprises. Clearly, the number of VoIP deployments is accelerating.

Like the technology itself, the business benefits of VoIP have evolved over time. Originally, VoIP projects were justified on the basis of reduced operating costs, either for toll bypass or the lower operating costs of a “single network.” The single biggest justification was “virtualization,” the ability to work anywhere and tie geographically dispersed and mobile employees into a single system. These justifications remain strong, but enterprises have found that the strongest recurring value is in the applications themselves, such as contact centers, messaging, auto-attendants, CTI, and conferencing – traditional applications made more manageable, more cost-effective, and more uniformly available by VoIP.

While VoIP can offer tremendous benefits, to deploy the technology successfully, an enterprise must overcome several challenges. First, because VoIP is an emerging technology, there are evolving standards and competing approaches, which can lead to interoperability issues. Second, typical characteristics of IP networks – like latency, jitter, and packet loss – can affect voice quality. Finally, the successful deployment of VoIP often requires new organizational structures and the consolidation of voice and data IT teams.

In spite of all these challenges, the expectations for VoIP deployments are high: five 9’s availability, toll quality, clean interoperability and applications, and dial tone even when the lights go out. Consistent, comprehensive testing of both the VoIP infrastructure and the applications running on it can enable enterprises to meet these challenges head-on.

Take a Lifecycle Approach to Testing: The vast majority of VoIP deployment issues are avoidable with proper planning, training, processes, and tools. By viewing deployment as a lifecycle with distinct phases and by being ready for each phase ahead of time, enterprises can ensure smoother rollouts and achieve benefits more fully while saving significant time and money. A lifecycle approach includes:

  • Baselining the current network via a network assessment
  • Testing the network infrastructure multiple times as the network is prepared for VoIP
  • Testing vendor solutions during the procurement process
  • Testing applications and infrastructure during installation and through cutover
  • Ongoing testing, troubleshooting, and management after the cutover

Keep in mind that while ideally testing occurs early in the process, it is never too late to test. Many organizations find they need to turn to baselining or network testing mid-project, after they run into problems.

Ensuring Voice Quality: Voice quality is extremely important, especially for contact centers where poor quality can turn away customers and burn out agents. But voice applications are demanding. They are very sensitive to packet-level impairments such as packet loss, delay, and jitter – all of which are specific to a given environment and change with traffic load. At the same time, voice quality depends on these packet-level characteristics, as well as on echo, codec quality, application, and individual users’ perceptions. Quality can vary within a call, and the type, make, and model of “endpoint” (traditional hardphone, soft-phone, PDA, or wireless VoIP phone) can make a huge difference.

Since voice quality is subjective, quality measurement is a key practice for any VoIP deployment. The state of the art today requires multiple kinds of voice quality measurements, carried out on a periodic basis both before and after deployment. VoIP-specific testing with voice quality measurement is a critical, often overlooked practice to check a variety of key factors, including:

  • Capacity and specific “normal” character of a given environment
  • Proper network configuration
  • Detection and resolution of any interoperability issues
  • Sensitivity of voice quality to traffic load and infrastructure parameters

Testing at the Application Level: Voice applications such as conferencing, voice mail, call routing, voice self service, teleworking, and click-to-talk are what typically provides value from IP telephony. They all benefit from another layer of testing, over and above infrastructure testing.

Applications tend to have a number of potential paths and many configuration parameters. IP telephony applications are no exception, and they have the additional twist that the way they interact with a new infrastructure can change the effectiveness of the application – sometimes dramatically. Once the VoIP infrastructure is tested and good baseline measurements are captured, application-level testing can be done effectively. Typical areas to test are:

  • Signaling latency (speed of dial tone, speed of call transfer)
  • Reliability of application information delivery (screen pops, information elements use for routing)
  • Application performance (IVR responsiveness, application performance under load)
  • Impact of VoIP on applications (speech recognition accuracy with packet loss, conference bridge loudest-speaker detection)
  • All-paths testing (correct configuration of all forwarding, hunting, routing, voicemail, and messaging configuration)

Be Prepared for Troubleshooting: While proper preparation and testing can help organizations avoid the majority of problems that occur in production, ongoing monitoring, management, and optimization are important as well. Troubleshooting tools and techniques can speed resolution and minimize the impact of problems that do occur. Enterprises that plan for this from the start have all their bases covered and will have the best experiences with VoIP deployments.

There are many moving parts to manage in enterprise VoIP deployments, so troubleshooting is especially important. Most VoIP deployments are multi-site and multi-vendor, so interoperability remains somewhat problematic even after cutover. Subtle interactions between infrastructure and applications often surface with changes in traffic or configuration. Many VoIP-related problems are transient in nature and can occur at multiple places in the infrastructure. For this reason, a skilled troubleshooter needs a variety of tools at his or her disposal. For example, an analyzer capable of tracing and troubleshooting VoIP at the call level can be indispensable.

Careful planning throughout the entire lifecycle can help enterprises meet the challenges of VoIP deployment before they turn into Quality of Service issues. The best way to prepare for and combat the quality issues inherent in a converged network is to test the network thoroughly before rollout. The best way to prepare for VoIP application rollout and troubleshooting is to baseline VoIP applications and then test across a range of conditions to anticipate and resolve problems before they arise in production. When good tools and processes are used, VoIP deployments can go smoothly and provide great business benefit.

Jeff Fried is CTO of the Enterprise Solutions Group at Empirix Inc. He can be reached at jfried@empirix.com or 781-266-3200.

[From the April/May 2006 issue of AnswerStat magazine]