Tag Archives: Healthcare Call Center Articles

How Telephone Triage Nurses Act as An Extension of Physicians and Practices



By Ravi K. Raheja, MD

In an era where there are multiple sources of medical advice and people frequently use Google to get answers, telephone triage nurses need to be mindful that they play a critical role in ensuring that patients get the customized care directed by their physician. This is vital for consumer-focused patient care. That is why sophisticated triage systems have custom instructions and standing orders. These tailored directions are based on physician or practice preferences for triage nurses to follow once the appropriate care for the patient has been determined.

Telephone triage nurses are important in establishing that the patient’s doctor cares about their problem. Click To Tweet

What Are Custom Orders?

Custom orders are additional instructions that physicians and practices add to existing protocols. An example would be telling the patient to take ibuprofen over Tylenol or sending them to a certain ER or urgent care facility. Custom orders are designed to help the triage nurse function as an extension of the doctor without having to always call the on-call doctor. With custom orders, patients are provided continuity of care, reassurance, and the ability for the physician to follow up with their patient the next day.

How to Properly Represent the Physician and Group

Through the triage process of assessing the patient and choosing the highest acuity protocol, disposition, and advising the patient per protocol guidelines, triage nurses need to keep in mind that they represent a specific physician or practice.

Since they never see the patient in person, it is important that triage nurses provide the empathy and care that will make patients feel better. Patients are not just a voice over the phone with a problem for nurses to solve. Every phone call has an impact, and one of the best ways nurses can care for patients is to establish and affirm the trust they have in their provider.

When giving the protocol advice, triage nurses should first check for any specific practice orders that apply to the situation. Then, as they advise, they should use phrases such as, “Your doctor would like you to . . .” or “Your doctor cares very much about his patients and would want you to . . .”

Summary

Telephone triage nurses are important in establishing that the patient’s doctor cares about their problem. They are a crucial link to the patient trusting the care and advice of their physician. Since triage nurses are only with a patient for a few moments, it is vital that they gain their trust and provide the best care possible. 

When the patient call ends, their continuity of care is in the hands of their physician. Telephone triage nurses help the patient beyond the call when they nurture trust in the doctor they represent.

Ravi K. Raheja, MD, is the COO and medical director of the TriageLogic Group. Founded in 2005, TriageLogic is a URAC-accredited, physician-led provider of high-quality telehealth services, nurse triage, triage education, and software for telephone medicine. Their comprehensive triage solution includes integrated mobile access and two-way video capability. The TriageLogic group serves over 7,000 physicians and covers over 18 million lives nationwide. For more information visit www.triagelogic.com.

The Future of Healthcare is Here with Help from Telehealth and Hospital Call Centers


Amtelco

By Nicole Limpert

Those in the healthcare communication field already know the value of telehealth and virtual care. As the COVID-19 pandemic evolved, telemedicine gained worldwide recognition as a critical healthcare tool to keep both patients and medical staff safe.

Telehealth has been used to bring healthcare to rural areas or isolated populations, such as overseas military personnel and those who work in the maritime industry. Until recently, the Centers for Medicare & Medicaid Services (CMS) placed certain stipulations on telehealth providers and would only reimburse for services provided in rural areas with specific audio-visual equipment.

However, due to the COVID-19 pandemic, on March 6, 2020, CMS relaxed restrictions and removed many of the conditions to which clinicians had to adhere in order to supply telehealth services to patients across the entire United States. Later, CMS expanded its telehealth adoption to include eighty-five new telehealth services to their covered list and set provider reimbursement rates for telehealth visits to be the same as in-person services.

Are We Ready for Telemedicine?

Many people are new to the concept of telemedicine. On July 31, 2019, J.D. Power reported that nearly three-quarters of Americans weren’t aware of telehealth options or didn’t have access to technology to partake in telehealth. Yet the American Hospital Association states that 76 percent of U.S. hospitals were already using telehealth before the coronavirus pandemic. Currently, forty-eight states require telehealth coverage in insurance plans.

Healthcare-related industries already had infrastructure in place and were prepared for the use of telemedicine and telehealth. However, few, if any, expected how quickly the use of these virtual tools would grow or how they would be used in new ways when COVID-19 began to spread. 

The coronavirus pandemic has dramatically accelerated the adoption of telemedicine usage. Telehealth visits skyrocketed by 50 percent in March 2020 according to data from Frost and Sullivan. Analysts at Forrester Research estimates that virtual healthcare interactions will reach more than 1 billion by the end of 2020.

Hospital Call Centers Experience Increased Telehealth Calls

The use of telehealth has undeniably shown what a critical tool it is in supporting a healthy population.  Click To Tweet

The pandemic has affected call centers in every industry. Most business websites have placed a message at the top of their home page warning of long hold times and delays in service. In healthcare, communication setbacks can mean life or death. Understandably, hospital call centers experienced a substantial increase in calls early in the pandemic. Many healthcare call centers help with telehealth efforts, and they also serve as a hub for their healthcare organization during a crisis.

“We played an immediate role in the hospital’s corporate response to the coronavirus pandemic,” explains Shelley White, MS, CHAM, FACHE, director of patient access services for State University of New York (SUNY) Upstate Medical University. “A COVID-19 hotline was established, and we took calls from multiple counties in our area. Within two weeks, our call volume drastically increased, and we needed more space in our call centers to work while practicing social distancing. We used free operator licenses from our vendor to set up more remote operator workstations so more of our agents could work from home. This kept our staff safe while serving the community.”

Running a call center in a virtual server environment, or in the cloud, is giving hospitals the ability to stay flexible and available by using remote operators. These tools are scalable and result in fully functioning call handling to transform any personal computer into a professional telephone agent station.

Call Center Software Assists Telehealth Communication

Using telehealth for virtual appointments with medical staff and patients has been essential during this pandemic. But there are other ways healthcare systems use telehealth communications. Hospital call centers tap their communication software, often in new ways, to provide their communities and staff with correct information, quick responses, and in some cases, hope.

  • Nurse Triage Centers: Agents use a customized script to triage calls.
  • Improved Navigation Menus: Callers are directed to additional, updated information.
  • Nonclinical Services: Telehealth also refers to remote, nonclinical administrative uses such as establishing and maintaining on-call shifts for COVID-19 volunteer pools and even creating announcements using a song, tone, or message to broadcast throughout the hospital when a coronavirus patient is released. It’s a wonderful way to spread hope and encouragement to patients and staff.

Many telehealth agents are working from home, and it is crucial for them to have access to the IT support they would normally use when working in the call center. Jennie McWhorter, information services operations manager for Ephraim McDowell Health in Danville, Kentucky, explains how the system can help here as well. “We have entered a telehealth support hotline in the call center software that allows the operators to connect to our help desk directly,” says Jennie. “This is very important, as our main help desk line is usually a voicemail-only system that creates a ticket in our help desk software.” 

Remote Operators Help Medical Staff

Shelley White’s team has also been able to aid staff who still work in the hospital. SUNY Upstate Medical University is the only ACS-certified Level I Trauma Center in the region and serves about 1.7 million people and twenty-eight referral hospitals. Shelley says, “During this coronavirus crisis, our ER registration is short-staffed, but we are able to help by watching our track board, which is tied into the EMR system with Epic. When a COVID-19 patient is admitted, we can call the patient to register them and verify insurance information over the phone. This process would normally be done in person by ER staff, but we can do it remotely and ease some of their workload.” 

According to numbers reported from Becker’s Hospital Review on April 7, 2020, employees from 243 hospitals have been furloughed during the pandemic. Hospitals are taking steps to save supplies, suspend elective procedures, and focus on treating COVID-19 patients. 

To avoid layoffs, some healthcare organizations are reassigning their medical staff as remote call center operators. “We were able to redistribute existing staff from other departments and tap into their skills to cross-train them to work for the switchboard,” states Shelley. “In our situation, patient access staff and medical answer teams were trained on easy calls and were then able to work from home as remote operators. These staff members are now even more valuable to our organization.”

Kathleen Kerrigan, BSN, RN, and manager of medical communications center, radiology contact center, and pager services for Nebraska Medicine, mentions her experience. “Nebraska Medicine has created a Flex Pool for employees that work in areas of the organization that have closed or severely cut their workflows due to COVID-19. I was able to add nineteen of these employees to my team, including both nurses and agents.” 

Telehealth as the New Normal

Telehealth has suddenly become crucial for patients and healthcare organizations. The use of telehealth has undeniably shown what a critical tool it is in supporting a healthy population. 

Hospital call center and healthcare professionals have already shown agility in adapting communications software in new ways to improve telemedicine applications while enhancing patient care, even during a pandemic. Advances in technology and our ability to use it could soon make the use of telehealth a standard healthcare practice. 

Amtelco

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.

The Importance of a Secure Messaging Platform



By Nicole Limpert

COVID-19 has made huge impacts on our health and day-to-day life throughout the world. The virus has been overwhelming to all, but particularly among the teams who are supporting and caring for those who are sick. Now more than ever, secure messaging platforms are critical to ensure communications are sent securely and quickly across these care and support teams. Here are the top three reasons why a secure messaging platform is an essential tool during these unprecedented times.

1. Communicate Sensitive Information Quickly

Whether you’re an operator relaying an important message or a doctor tending to a patient, fast and reliable communication is critical to ensure the safety and well-being of those involved.

Hospitals should consider updating their pager system to a secure messaging platform. Pagers have been shown to waste a considerable amount of time among healthcare teams. Compared to legacy paging technology, secure messaging can save staff up to two minutes per message.

Secure messaging offers features such as persistent alerts, event-driven notifications, critical alerts, and high-priority settings Click To Tweet

When it comes to the safety of sensitive information, a secure messaging platform is paramount. Most secure messaging platforms use end-to-end encryption, which can ensure that personal health information (PHI) in the form of text, photo, video, and audio stays secure. Look for a secure messaging platform that doesn’t store messages on the device. Also critical is being able to remotely disable the app on lost or stolen devices to prevent unauthorized access.

2. Accountability with Time Stamps and Reports

It can be difficult to stay organized and keep a level head when things are moving quickly and staff is getting overwhelmed. Imagine that you’re a doctor, and you just sent a message to a lab tech via a secure messaging app requesting some lab results for an ICU patient. With the app, you can see if your message was sent successfully and when the lab tech read the message. Time stamps add an extra level of reassurance and accountability to your team, which is critical in times of crisis.

Most secure messaging apps also keep track of all message activity. This should include an audit log and a message log, complete with message histories, showing to whom messages were sent, when the recipient read the message, and who replied.

3. Urgent and Emergency Notifications

During times of crisis, it can be easy for alarms, notifications, and messages over a public address system to overwhelm healthcare workers. Conversely, some hospital staff may fall victim to alarm fatigue. One study records an average of 1.2 alarms are heard by a nurse every sixty seconds, or as many as 359 alarms per medical procedure. In addition, recent studies estimate as many as 90 percent of alarms in critical care settings are either false or clinically irrelevant. This leads healthcare providers to believe that many devices are crying wolf, delaying practitioner response time when a real emergency occurs.

To combat the effects of alarm fatigue, secure messaging offers features such as persistent alerts, event-driven notifications, critical alerts, and high-priority settings to ensure that vital messages receive a prompt acknowledgment.

COVID-19 has placed an elevated level of responsibility and pressure on healthcare and call center staff. These demands become easier with the help of a high-performing secure messaging platform that can meet their needs to combat the disease and ensure the safety of patients. 

Amtelco

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications—such as their miSecureMessages secure messaging platform—designed for the specific needs of healthcare organizations.

Preparing Your Contact Center for a Pandemic



By Donna Fluss

As the coronavirus pandemic fills the news headlines, contact centers are striving to continue to deliver service to their customers. Many companies have disaster recovery (DR) and business continuity (BC) plans to address the ability to operate if a disaster—such as a hurricane, earthquake, or fire—were to occur. Some companies may even have plans to cope with the impact of a major flu outbreak, but few contact centers have a BC plan to handle a pandemic where employees are at risk if they sit closer than six feet from each other, which is the situation in most service organizations.

Business Continuity for Pandemics

Planning for business continuity in case of a pandemic is different from preparing for a natural disaster scenario. In the case of weather-related disasters, the main consideration is often employees’ safety when driving to and from the workplace. For a pandemic, however, the main issue may be people’s reluctance to leave home at all. Keep in mind that it’s not fair for companies to require their contact center staff and other service employees to report to work under these circumstances when other departments may be advised that it’s unsafe to come to the office.

Companies should prioritize keeping their employees safe and healthy so they can be there to assist their customers. Click To Tweet

Allow Contact Center Staff to Work from Home

Companies should make it as easy as possible for their contact center staff to work from home. Provide employees with PCs, headsets, and secure access to operating systems so they can perform their job in the safety of their home. This reinforces the benefit of investing in cloud-based contact center infrastructure solutions that are accessible from most locations, including employees’ homes.

Supervisors should also be set up to work from their homes. To mitigate the risk of leaving contact center agents unsupported during a widespread health crisis, it’s a best practice to establish a structure where managers and supervisors share responsibilities, and it can be especially helpful to have them in different geographies. All systems should be capable of being managed from remote locations.

Communication Is Key

It’s important for businesses to have a documented DR/BC plan that addresses healthcare emergency scenarios. A communications plan is the most essential element during any crisis situation. The plan should inform staff members how to stay in touch with the business, and to let them know what is expected of them. It’s advisable for a company to have two ways of reaching each employee, such as email and SMS, to ensure that they receive each communication on a timely basis. 

Another essential element of the communication plan is a process for interacting with customers to let them know that your company is there for them and the most effective methods for receiving assistance. The customer communication should also set expectations for customers. If service response times are slower due to an increase in volumes or decrease in staff, advise them of this.

Enhance Self-Service Solutions

To decrease the volume of interactions that require live agents, companies should enhance their voice and web-based self-service solutions by adding options that don’t require human assistance. Companies can either enhance an existing interactive voice response (IVR) system or use a next-generation intelligent virtual assistant (IVA) that can be set up to manage multiple channels, including voice, websites, SMS, and more.

Final Recommendation

Social distancing has proven to be the most effective method to date for limiting the rapid spread of the highly contagious coronavirus. Companies should prioritize keeping their employees safe and healthy so they can be there to assist their customers. For contact center employees, this means allowing them to work from their homes.

Donna Fluss is president of DMG Consulting LLC. For more than two decades she has helped emerging and established companies develop and deliver outstanding customer experiences. A recognized visionary, author, and speaker, Donna drives strategic transformation and innovation throughout the services industry. She provides strategic and practical counsel for enterprises, solution providers, and the investment community.

Healthcare Call Centers Help Bring Care to the Medically Underserved



By Nicole Limpert

A person who is medically underserved is someone who does not have health insurance. Estimates from the Centers for Disease Control and the National Health Interview Survey cite that in 2017, 29.3 million, or 9.1 percent of the population were uninsured.

Vulnerable Populations: Multiple studies have found that vulnerable populations in the United States, including the elderly, low-income, ethnic minorities, migrants, and people who received limited education, are also medically underserved.

People with various life experiences may interpret symptoms differently, such as thinking a seizure is a spiritual issue rather than a medical complaint or expressing concerns about depression as anger rather than sadness.

Medical call centers play a critical role in helping to serve the medically underserved. Click To Tweet

Poor Access to Healthcare: Living in a rural location and having inadequate transportation present challenges when trying to access healthcare. Rural areas are sparsely populated, resulting in a lack of available services. Rural communities comprise roughly 20 percent of the United States, yet less than 10 percent of doctors practice in these communities.

People in rural areas rely on their own transportation to and from health services. A report released in December 2018 from Pew Research Center found that the average travel time by car to the nearest hospital for rural Americans is about seventeen minutes compared to ten minutes in urban areas. 

However, even people in urban areas have difficulty visiting their doctor’s office. Transportation can be a challenge for people with disabilities, those with chronic illnesses, the elderly, and people who are considered low-income. Approximately 3.6 million Americans, from both rural and urban areas, experience missed or delayed medical appointments due to transportation issues.

Support from Healthcare Call Centers

Technology enables medical call centers to effectively become an extension of a hospital or clinic’s operations. The communication software used by medical call centers can securely access a patient’s electronic medical record (EMR), update EMRs with notes, and record calls needed for insurance claims and workmen’s compensation. Because everything is documented, detailed reports can be generated for reporting purposes.

Medical call centers can provide or facilitate healthcare-related services twenty-four hours a day, seven days a week. They play a critical role in helping the medically underserved by addressing two of the biggest barriers to healthcare: language and transportation.

Language: Healthcare staff work with an enormously diverse patient population. Understanding a person’s language leads to better healthcare. Multilingual call centers hire operators to assist non-English-speaking patients or use confidential over-the-phone interpreting (OPI) services for access to hundreds of different languages.

Transportation: Patients with mobility challenges or those who live in rural areas don’t have to leave home for some services. Operators can coordinate care, make follow-up calls, schedule visits, contact on-call medical staff, and manage referrals.

Some call centers staff nurses or multidisciplinary teams (such as a resident, pharmacist, and social worker) who are qualified to make health assessments, give medical advice, and escalate critical concerns. These call centers can offer nurse call helplines, emergency mental health counseling, and other critical support.

Helping Hospitals that Help the Underserved

Reduce Penalties: A recent study done by Harvard University suggests that hospitals located in low-income areas are more likely to receive penalties due to Medicare and Medicaid’s survey-based reimbursement programs. Patients are asked to provide information about their healthcare experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Unacceptable survey outcomes can result in hospitals losing some reimbursements.

The American Medical Association Journal of Ethics reports that the Centers for Medicare and Medicaid Services (CMS) can currently withhold 1 percent of Medicare payments—30 percent of which are tied to HCAHPS scores. When Medicare and Medicaid account for more than 60 percent of all care provided by hospitals, the possible amount of dollars lost due to poor patient experience is a significant number. In 2017 alone, approximately 1.7 billion dollars in reimbursements were withheld from hospitals.

Healthcare call centers play a critical role in patient satisfaction surveys because they function as a virtual lobby for a hospital and are often the first point of contact with a patient. The patient’s experience with coordinating their care via call center agents can positively affect their feedback on the survey.

Reduce Readmissions: The CMS reports that nearly one in five Medicare patients are readmitted to a hospital within thirty days of discharge, yet a recent study from the University of California San Francisco (UCSF) and published in JAMA Internal Medicine found that 27 percent of all thirty-days hospital readmissions are preventable.

Medicare’s Hospital Readmissions Reduction Program (HRRP) lowers payments to Inpatient Prospective Payment System (IPPS) hospitals who report too many readmissions. According to the CMS, 2,573 hospitals received penalties in 2018 and had around 564 million dollars in payments withheld.

Studies indicate that a post-discharge call program can help hospitals reduce their readmission rate. IPC Healthcare (IPC) tested the effect of post-discharge calls on readmission rates from October 2010 through September 2011. The IPC call center contacted 350,000 discharged patients to check symptoms, review medications and treatment plans, and remind patients of follow-up appointments. Successful contacts occurred with 30 percent of patients, with an estimated 1,782 avoidable readmissions prevented over that year.

Amtelco

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.

[This article first appeared on AnswerStat.]

Use Telehealth to Extend Healthcare and Save Money



By Nicole Limpert 

The Health Resources Services Administration (HRSA) defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”

One of the most common forms of telehealth is a nurse hotline. Most U.S. health insurance companies offer a toll-free nurse advice hotline to their customers. Other types of telehealth services include virtual appointments, medical staff consults, remote health monitoring, and nonclinical services.

Removing Barriers to Healthcare

Telehealth not only makes access to healthcare easier for the public, it also has proven to be a necessity for both large organizations and niche markets.

Members of the United States military and their families are stationed all over the world. The Department of Defense’s (DOD) Military Health System (MHS) provides healthcare to more than 9.4 million people through a network of fifty-six hospitals, 365 clinics, and other facilities worldwide. Telehealth programs connect military patients to providers across the world to deliver direct access to quality healthcare, tele-radiology, and tele-pharmacy services.

The United States Department of Agriculture (USDA) is heavily involved with providing telehealth services to rural communities and administers telecommunications telehealth grants through two major programs: the DLT Program and the Community Connect Program. Similarly, the United States’ Indian Health Service uses telehealth to assist with accessing health services for American Indian and Alaska Native populations living in outlying communities.

Other isolated niche markets use technology to improve healthcare. Alaska’s maritime industry uses a telehealth platform to enhance access to care for those who work in the dangerous waters off Alaska. Internet connections are unreliable, so they primarily use a phone-based system to instantly connect with doctors. The Federal Bureau of Prisons (FBOP) uses telehealth to expand their internal healthcare program by consulting with external healthcare providers via collaborative practice agreements. 

Telehealth and Medical Call Centers

Regardless of where people are located, telehealth is a critical tool that brings the best possible care to patients. Medical call centers play a significant role by providing the technology and medical expertise needed to bring remote healthcare to patients.

Technology enables medical call centers to effectively become an extension of a hospital or medical center’s operation. The communication software used by medical call centers can securely access a patient’s electronic medical record (EMR), update EMRs with notes, and record calls needed for insurance claims and workers’ compensation. Because everything is documented, detailed reports can be generated for reporting purposes.

Medical call center operators can coordinate care, make follow-up calls, schedule visits, contact on-call medical staff, and manage referrals. Some healthcare call centers staff licensed medical professionals who are qualified to make health assessments, give medical advice, and escalate critical concerns.

The services provided by medical call centers are available twenty-four hours a day, seven days a week. Medical operators can work different hours and be located anywhere in the world, in any time zone. For example, if a medical center on the East Coast of the United States is closed, operators on the West Coast are still available.

Telehealth services may become more of a healthcare necessity rather than a convenience. Click To Tweet

Telehealth Benefits Hospitals

In the 2017 American College of Healthcare Executives’ (ACHE) annual survey, hospital CEOs ranked their ten biggest challenges for the year. Telehealth services can address six of these ten concerns—specifically, financial challenges (first), personnel shortages (third), quality of care (fourth), patient satisfaction (fifth), access to care (seventh), and population health management (ninth).

Multiple small- and large-scale studies cite the use of telehealth as a cost-effective method to deliver quality care, improve outcomes, enhance the patient experience, and expand access to healthcare. The patient’s experience with their healthcare team plays a critical role in their satisfaction. Patients are asked to provide information about their care experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Unacceptable survey results can result in hospitals losing some reimbursements. In 2017 alone, approximately 1.7 billion dollars in reimbursements were withheld from hospitals. 

The cost savings are also passed along to patients. Call center data from Health Navigator cites that the top five reasons for calling a nurse hotline are fever, vomiting, stomach pain, cough, and head pain. Less than 10 percent of the cases were high-risk. On average, telehealth appointments for nonemergency reasons cost approximately forty-five dollars, as opposed to one hundred dollars for an in-person visit at a doctor’s office or 160 dollars at an urgent care clinic.

The Future of Telehealth

The population growth for the United States from 2008 to 2030, is estimated at 20 percent, totaling 363 million people. This spike in population will exacerbate an already strained shortage of healthcare professionals. Telehealth services may become more of a healthcare necessity rather than a convenience.

As technology advances, telehealth can become more complex by not only connecting patients with expertise in real time, but also by enabling computer-assisted medical procedures in remote locations by specialists thousands of miles away, thus creating global care teams for patients.

Amtelco

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.

Mitigating Medical Call Center Risk



By Traci Haynes

Does the word risk evoke an emotional connotation? Regardless of the inference and based on life experience, the word can carry an emotive element. There are uncertainties in risk, which may be associated with hobbies, tasks, or employment. 

Calculated risk is an action taken after careful consideration and estimation of the probable outcome. Healthcare organizations employ risk managers to identify and evaluate risks to reduce injury to patients, staff, and visitors within the organization. 

The five basic steps of risk management include: 

  1. Establish the context.
  2. Identify risks.
  3. Analyze risks.
  4. Evaluate risks.
  5. Treat/manage risks.

Risks exist in a medical call center too. There are employee risks and patient risks. These can include risks from the physical environment, clinical management, and technology. What can organizations do to help mitigate these risks? They can strive to be calculative, carefully considering and estimating probable outcomes. Even doing so, however, will not eliminate all risk.

A medical call center’s number-one asset is its staff. Click To Tweet

Risk Resource

An excellent resource that covers information on risk is The Art and Science of Telephone Triage: How to Practice Nursing over the Phone. It is a book written by two industry leaders in the field of telehealth nursing practice, Carol Rutenberg, RN-BC, C-TNP, MNSc, and M. Elizabeth Greenberg, RN-BC, C-TNP, PhD. The book also documents the history of telephone triage and its subsequent evolution, provides real-case scenarios, and contains chapters onFAQs, best practices, and other topics. 

Minimizing risk is essential in the medical call center environment. Consider your potential for risk. Then analyze, evaluate, and manage it. Also essential is focusing on ways the medical call center can support the organization’s risk avoidance. Of utmost importance to every organization is supporting the Institute for Healthcare Improvement’s Triple Aim initiative and optimizing health system performance of better outcomes, lower costs, and improved patient experience. 

Hospitals throughout the country are aggressively tackling performance improvement within their own organizations, and evidence shows their efforts are helping to reduce risk. The recent addition of a fourth aim emphasizes the importance of improving the experiences of those in the workforce who provide healthcare. The Quadruple Aim focuses not only on better outcomes, lower costs, and improved patient experience, but also on improved clinician experience. 

A medical call center’s number-one asset is its staff. Employees need to feel recognized for the work they do. Their working environment should encourage respect and foster a sense of belonging and purpose. They should have the ability to influence their work, as well as be given opportunities for professional growth.

Medical Call Center Risks

Let’s drill down a little further on potential risks in a medical call center. Please note, this is not an all-inclusive list and not listed in order of importance. However, it is valuable information to consider. 

Clinical Management

  • Clinical oversight (such as the medical director): approval of clinical content, decision support tools, educational material, medications, and orders.
  • Job descriptions: title, clear description of work duties, purpose, special skills, and qualifications for the position
  • Scope of service: what type and for whom 
  • State Board of Nursing Nurse Practice Act: follow standards of practice
  • Licensure: state license, Nurse Licensure Compact 
  • Orientation/training/preceptor: defined program with monitoring, feedback, and evaluation
  • Policies and procedures: associated with call handling and call scenarios
  • Performance monitoring/evaluations: formal approach using call records and/or call recording
  • Continuous quality improvement: process to identify issues, implement/monitor corrective action, and evaluate the effectiveness

Technology 

  • Electronic Health Record (EHR): access and by whom
  • Computers: hardware/software, latest recommendations, updates, backup, and archiving
  • Database: decision-support tools and functionality for a standard method of documenting the encounter, optimizing the intake of information, and supporting a consistent approach to provision of information and directions for care; reporting of outcomes
  • Telephone system: supports call handling that may include auto-attendant, call routing, tracking average speed of answer, time in queue, abandonment; real-time monitoring, reports, and recording of calls
  • Chat/email/texts/photos: accept and save as part of EHR
  • HIPAA-compliant: protecting health information

Physical Environment

  • Outdoor surveillance monitoring
  • Lighting: internal measurement, general, task, emergency, external
  • Security locks: after-hours or 24/7
  • Parking: on-site, off-site, monitored, lighting
  • Security personnel: on-site, off-site
  • Sound: acoustics, masking, privacy 
  • Workstation ergonomics: standing/sitting, monitor height/distance, keyboard/mouse position, adjustable chair with height/arm and height/back support, headset, and so forth. 
  • Repetitive stress injuries: most commonly affects injuries to the upper extremities (wrists, elbows, and hands) due to repetitive keyboard activities

Patients and Families

  • Medical call center access: 24/7, after-hours, business hours, community service, or provider/payer service
  • Reason for call: emergent, urgent, semi-urgent, and nonurgent
  • Language and culture: linguistically and culturally appropriate and using an individual’s primary language
  • Age-specific or all age groups
  • Social determinants of health: influences an individual’s quality of health
  • Past medical history: health status prior to encounter and effect on the reason for call/disposition
  • Chronic conditions: type, number, effect on the reason for call/disposition
  • Medications: routine, PRN, effect on the reason for call/disposition
  • Preventive health: effect on overall health
  • Disabilities: type, effect on reason for call/disposition
  • Disposition: collaborative decision, access for care as needed

Addressing risk potential in medical call centers will benefit all stakeholders and improve healthcare outcomes.

Traci Haynes, MSN, RN, BA, CEN, CCCTM, is the director of clinical services at LVM.

How Telephone Triage Call Centers Can Help Reduce Physician Burnout



By Shannon Bays-Crockett

When studying worrisome symptoms among physicians and mental health workers in the 1970s, Herbert Freudenberger, a German-American psychologist, coined the term burnout. HHS described professional burnout in 2017 as an occupational hazard that could lead to high-quality healthcare professionals leaving the practice of medicine. By 2017, physicians reporting frequent or constant feelings of burnout totaled 51 percent—up from 40 percent in 2013.

The Center for Treatment of Anxiety and Mood Disorders reports that physician burnout is growing in the United States. One in three physicians experience physician burnout at some point in time. Compared to other professions, physicians are fifteen times more likely to experience burnout. About 45 percent of physicians report that they would quit the profession if it weren’t for the money. Approximately 400 physicians commit suicide each year. Those numbers emphasize the need to quickly address the burnout issue.

Physician burnout symptoms seem to mirror indications of other stress disorders, but there are also distinct differences. Dr. Dike Drummond, author of the blog The Happy MD, talks about physician burnout in his article “Physician Burnout and the Four Phases of Compassion Fatigue” (blog post #297) when he says, “Losing the ability to feel empathy, sympathy, and compassion for your patients is a constant risk for all of us.” 

Nurse triage call centers help physicians achieve work/life balance by reducing or eliminating after-hours and on-call requirements. Click To Tweet

Physician burnout symptoms might include:

  • Physical and emotional exhaustion that leaves physicians worn out and unable to recover during downtime
  • The development of a cynical and negative attitude regarding work and patients
  • A reduced sense of purpose along with a feeling that what they’re doing has little to no meaning or value

Ashley Altus, a writer for The DO, the online publication of the American Osteopathic Association (AOA), reported on Dr. Octavia Cannon’s talk to the January 25, 2018, AOA LEAD (Leadership, Education, Advocacy & Development) Conference in Austin, Texas. Dr. Cannon challenged physicians to instruct students and residents about the importance of life outside of medicine. “Encourage them to take time for themselves,” Dr. Cannon said. 

Dr. Cannon continued to discuss how stress for young physicians is at its peak during training in medical school and residency, citing Medscape’s 2018 National Physician Burnout and Depression Report in which data suggested that 42 percent of physicians reported symptoms of burnout. 

Addressing Physician Burnout 

Imagine the pediatrician attending a daughter’s dance recital or a son’s football game when the phone rings. The caller is the worried parent of a child who is spiking a fever. The physician is torn away from the family activity to advise the child’s parent. The doctor becomes frustrated by missing his own child’s big moment in the spotlight and can’t get that back. Somebody loses out, and the choice between duty, frustration, and guilt is not an easy decision. 

Healthcare Call Centers

One popular solution—after-hours telephone triage—works well to both address physician concerns and serve the needs of anxious patients. Nurse triage call centers help physicians achieve work/life balance by reducing or eliminating after-hours and on-call requirements by offering patients telephone access to advice that is based on guidelines established according to preferences of each provider’s practice. All patient calls are triaged using evidence-based guidelines and are directed to the appropriate level of care. All call records are forwarded directly to the patient’s care provider so they are available the next business day.

By partnering with accredited health call centers for after-hours telephone triage, providers can enjoy their professional as well as their private lives. Other benefits of after-hours nurse triage are reflected in improved physician recruitment and retention and a more satisfying patient/physician encounter when the physician is rested and refreshed. 

Shannon Bays-Crockett is a strategic communications specialist with AccessNurse.

Cyber Security and HIPAA in a Medical Contact Center


Startel, Professional Teledata, Alston Tascom

By Bobby Bennett

Regardless of size, medical contact centers must take steps to protect against cyberattacks and ensure HIPAA compliance. These two issues warrant intentional and proactive attention.

Ways to Prevent Cyberattacks

With cyberattacks on the rise, what steps should a contact center take to prevent falling victim? The first is to recognize that it could happen to anyone. Do not equate small with safe. According to a 2017 Trend Micro online survey, 45 percent of small business owners believe they will never be targeted. The cyber security firm 4iQ states in its 2019 Identity Breach Report that cybercriminals targeted small businesses with cyberattacks at an inordinate rate in 2018—up 425 percent over the previous year. Here are some ways to prevent such an attack: 

  • Install, use, and regularly update antivirus and anti-spyware software on every computer used in your business.
  • Use a firewall for your internet connection.
  • Download and install software updates for your operating systems and applications as they become available.
  • Make backup copies of important business data and information.
  • Control physical access to your computers and network components.
  • Secure your Wi-Fi network and make sure it is hidden.
  • Require individual user accounts for each employee.
  • Limit employee access to data and information. Also limit authority to install the software.
  • Regularly change passwords.
  • Consider two-factor authentication such as a password and a PIN.

The Federal Communications Commission provides a Small Biz Cyber Security Planner on their website. 

A business associate is also liable and subject to civil and criminal penalties for making uses and disclosures of PHI not authorized by its contract or required by law. Click To Tweet

HIPAA and Protected Health Information

Another factor to be mindful of as a call center that takes calls for healthcare providers and clinics is that you are a business associate of the covered entity. A HIPAA business associate is a contractor or vendor to a HIPAA-covered entity that creates, maintains, or transmits protected health information in performing a function or service to the covered entity.

If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the [HIPAA] Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are liable for compliance with certain provisions of the HIPAA Rules. (HHS.Gov)

A business associate contract serves to clarify and limit, as appropriate, the permissible uses and disclosures of protected health information (PHI) by the business associate. They may use or disclose PHI only as permitted or required by its business associate contract or as required by law. 

A business associate is also liable and subject to civil and criminal penalties for making uses and disclosures of PHI not authorized by its contract or required by law. It is important that employees are trained and understand the HIPAA rules required of a business associate. You can find sample Business Associate Agreement Provisions and training resources on the HHS.gov website.

Text messaging (SMS) has become the preferred method of message delivery for both the contact center and healthcare providers. With this growing trend comes the risk associated with the transmission of PHI. 

Standard forms of SMS could mean that text messages may remain on a device for an extended time. If the device is recycled, lost, or left accessible to unauthorized persons, HIPAA violations may occur. You must provide safeguards to reduce your exposure to these risks. 

Secure messaging is a HIPAA-compliant way to safely exchange sensitive information via text. Most contact center system vendors have developed secure messaging applications for use with their systems. However, quite often it is difficult for a contact center to convince a large medical group to make changes and convert from their current secure messaging provider to one offered by the contact center. 

Conclusion

Don’t ignore the risks of cyberattacks and HIPAA-noncompliance in your medical contact center. Take essential steps today to reduce bigger problems tomorrow. 

Startel

Bobby Bennett is the western regional sales manager for Startel, Professional Teledata, and Alston Tascom, leading providers of best-in-class contact center solutions for healthcare and medical telephone answering service call centers. Startel’s Alston Tascom Division has created a stand-alone, vendor-agnostic secure messaging gateway that has integrations with some of the most popular secure messaging providers. Contact Bobby at bobby.bennett@startel.com or 800-782-7835. 

Balancing Patient Care with Data Security and Privacy



The stakes have never been higher for healthcare providers to deliver a positive patient experience. According to a recent study by Prophet, 81 percent of consumers are unsatisfied with their healthcare experience, while only 40 percent believe providers are best meeting their needs. At the same time, data breaches in the healthcare sector are at an all-time high, occurring at a rate of more than one per day in the United States.

These security incidents not only jeopardize patients’ privacy but also put both patient trust and brand reputation at risk.

All the while, medical practitioners, hospitals, and insurers are pressed to keep up with the ever-evolving regulatory compliance landscape. This not only includes the Health Insurance Portability and Accountability Act (HIPAA) but also the Payment Card Industry Data Security Standard (PCI DSS), the EU General Data Protection Regulation (GDPR), and a long list of individual state regulations and data breach notification laws.

With HIPAA violations alone incurring fines as high as 50,000 dollars (for each violation or exposed record), healthcare organizations are finding themselves wedged between conflicting objectives: How do you protect patient data and maintain compliance without losing sight of providing the best possible patient experience? 

Contact Center Security

While you can’t please every patient, you can strike a balance between care and data security. The first place to address this is the contact center.

Patients have full control over inputting their information and can enjoy peace of mind that their data is protected. Click To Tweet

Although online interaction tools and patient portals are gaining in popularity, you can’t underestimate the value of the voice channel. Research by PatientPop shows that 58.5 percent of patients still prefer to schedule an appointment via phone.

As such, your contact center is often the go-to point of interaction for your patients and can set the tone for their entire experience. But this also means that your contact center intrinsically holds, processes, and stores copious amounts of personally identifiable information (PII), from medical records to payment card data. This makes the contact center an alluring target for fraudsters and hackers.

However, it’s not only devious cybercriminals who threaten your patients’ data. Company insiders, such as rogue call center service representatives or contact center agents, pose a massive threat, especially if they have access to patient data given over the phone or stored in desktop applications. In fact, 58 percent of all healthcare data breaches and security incidents are the result of insiders, according to Verizon’s Protected Health Information Data Breach Report.

Security Best Practices

With inside and outside threats, as well as vulnerable legacy systems serving as entry points for enterprise-wide breach incidents, contact centers are undoubtedly a weak link in your security chain. But protecting PII, maintaining compliance, and providing a positive patient experience first involve a hearty dose of security best practices:

  • Treat all data as potentially toxic. The more information that is available in the event of a breach, the easier it will be for a malicious insider or cybercriminal to steal a patient’s identity or access their private medical records.
  • Train all employees and always perform thorough background checks. Go beyond basic employee vetting and background checks, especially when hiring for your contact center environments. Educate staff and agents on data security best practices and on how to spot social engineering and phishing tactics.
  • Prepare your response management policy. Have an incident response management policy and process in place, preferably as part of an information security management system. Prepare for a worst-case scenario and assess your incident response plan at least annually.
  • Tokenize data. Replace PII with a meaningless equivalent, so even if a breach is successful, the hacked data will be of no value to the cybercriminal. This approach can also assist in the event of a social engineering attack, which can put even the most trustworthy employee at risk for exposing PII.
  • Enforce the principle of least privilege. Give employees the minimum level of access required to perform their job function at the appropriate time. Introduce exception procedures for when emergency access is needed.
  • Authenticate the user to authenticate the service agent. Prevent agents from accessing patient data until they have received the right data from the user. This means that until the caller has been successfully identified using the appropriate secure authentication approach, access to detailed PII will be denied.

Descoping Technologies

With these tactics creating a foundation for security in your contact center, you can introduce descoping technologies. Such technologies not only strengthen data security and compliance by removing sensitive data from your infrastructure, but they also garner a positive patient experience and journey.

For the voice channel dual-tone multifrequency (DTMF), masking solutions hold great promise, allowing patients to discretely enter numerical PHI—such as payment card, insurance, or account numbers—using their phone’s keypad. The keypad tones, however, are masked with flat tones, so they are not exposed to anyone but the patient. The data collected is encrypted and sent to a compliant third party, bypassing the contact center’s environment completely.

While this process may invoke notions of automated interactive voice response (IVR) systems, it is not the same. Here, agents can remain on the line in full voice communication with the patient, guiding them through the transaction, answering questions, and even handling wrap-up tasks. There are no challenges with misheard or mis-keyed data, which can lead to premature hang-ups and abandoned calls. In addition, patients have full control over inputting their information and can enjoy peace of mind that their data is protected. This makes for a better overall customer experience.

Conclusion

Data security and privacy are key to providing positive interactions with your customers and patients, and there is no longer any need to compromise in either area. A combination of security best practices, strategies, and emerging descoping technologies are ideal solutions to achieve both. No matter which route you take, the less PII you hold and handle, the better off you’ll be. Remember, no one can hack the data you don’t have.

This article is provided by Semafone, a leading provider of data security and compliance solutions for call and contact centers. Learn more at Semafone or contact Rebecca.Rowe@semafone.com.