Tag Archives: Healthcare Call Center Articles

The Ten Critical Steps of Taking a Triage Call

By Marci Lawing

The goal of every triage call is to make patients feel comfortable and heard, while at the same time collect critical information from them and get them to the appropriate level of care based on their symptoms.

Step 1: Introduce Yourself. Use your first name, title, and the practice or physician you represent. It’s imperative for you to clearly identify yourself and state your credentials as a nurse employee of the practice for which you work. When you introduce yourself, you create a relationship.

Step 2: Collect Demographic Information. Before you are ready to hear your patient’s concerns, you will need to know some basic information. Age, gender, and other data will affect your triage protocols, so be sure to collect all the necessary demographic information. This information is needed so it can be put in the appropriate chart and followed up.

Step 3: Gather Medical History. Get a brief medical history so you do not miss any important surgeries, medications, or relevant medical information from the recent months or years. You’ll want to know your patient’s medical history before he or she details the current issue.

Step 4: Let the Patient Talk. Now that you’ve armed yourself with all the necessary information you need to proceed, let the patient speak freely about current concerns. Be an active listener. That means that you don’t just listen; you participate in the conversation by asking any probing questions needed to ascertain a full description of the patient’s complaint.

Step 5: Document the Assessment. Once you’ve listened carefully to the patient, document your assessment carefully with the necessary details.

Step 6: Choose the Right Protocol. With the right triage protocol, this step can be fast and efficient. Be sure to document the answer to each question and make any additional notes needed.

Step 7: Get the Patient to the Right Level of Care. Now that you’ve followed the protocols and completed the assessment, you’re ready to recommend the level of care your patient needs. Be sure to speak clearly and at a pace the patient can follow while you detail every step he or she needs to take.

Step 8: Give Relevant Care Advice. Provide solutions based on the patient’s symptoms in order to help identify the best path to care.

Step 9: Make Sure Your Patient Knows When to Call Back. Confirm that the patient fully understands your triage advice and knows when and who to follow up with. Triage tip: Make sure your patient is able and willing to follow the plan you discussed. Click To Tweet

Step 10: Offer Reassurance. Make sure your patient is able and willing to follow the plan you discussed. It is important, especially with serious symptoms, that the patient follows your triage advice. If told to go to the ER, verify with the patient that he or she has access to safe transportation.

You can’t underestimate the power of empathy. Over 80 percent of patients who call their physician’s office may not need urgent care, but they all urgently need empathy, someone to listen, and someone to care. That’s the role of the triage nurse. In addition to being a good clinician, a critical thinker, and making sure everyone stays safe, you are also there to provide empathy and care advice to patients.

These ten critical steps will help you stay on track and ensure that patients get the quality care they deserve.

Marci Lawing, RN BSN, is the clinical nurse manager at TriageLogic LLC. TriageLogic’s online learning center is available free of charge to telephone triage nurses and teams as an educational resource and practical training guide. Along with course videos, coursework includes class notes, related articles, and learning materials. You will receive a TriageLogic Telephone Nurse Triage Certification for each completed course. Managers can also set up teams and check their individual nurses’ progress in the course.

The Patient Experience Contact Center

By Richard D. Stier

Patient experience failure, the incentivized reduction of avoidable readmissions, increasing rates of physician burnout, and the escalating priority of revenue cycle management, have all combined to incubate an unexpected solution: Exit the call center; discontinue generic transactions.

Instead the patient experience contact center is born. Enter the era of thoughtfully deployed patient experiences, beginning with the first point of contact. In contrast to yesterday’s call centers, which processed physician referrals and class enrollments, today’s patient experience contact centers are a health network’s communications nerve center. They deliver intentionally memorable experiences that strengthen preferences, mitigate risk, reduce unnecessary readmissions, serve as physician practice extenders, and solidify patient loyalty.

Patient Experience Failure: Currently healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report that they received the “Best Possible Care.”

In what universe is a 29 percent failure rate acceptable? Could we miss revenue projections by 29 percent? Be over budget by 29 percent? Would it ever be acceptable to miss quality standards by 29 percent? “We only dropped 29 percent of newborns, so we met the standard.” Seriously?

“Best Possible Care” experiences begin before a patient receives care and continues after the patient returns home. Healthcare contact centers are uniquely positioned. They serve as the virtual front door for personalized support and referrals before using a clinical service and for individualized follow-up and coaching after discharge.

With the launch of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program by CMS in 2006, hospitals have dedicated significant time and resources to improving the results of CAHPS surveys. The shift from a transaction-focused call center to an experience-driven contact center is an investment to improve the experience of care—beginning with the first touchpoint when someone new to the community calls to request a referral to a primary care physician (PCP) and continuing after discharge when a contact center navigator calls to confirm a follow-up visit with that PCP.

That first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference. Whether on the phone or online, healthcare contact centers can intentionally deliver a transformative first patient experience.

Incentivized Reduction of Avoidable Readmissions: One-half of all hospitals in the United States (2,597) will be penalized by the Centers for Medicare & Medicaid Services (CMS) for unnecessary readmissions in FY 2017. Those penalties will total $528 million, over $100 million more than in FY 2016. During 2016 forty-nine hospitals received the maximum penalty of 3 percent withholding from Medicare funding. A total of 1,621 hospitals have been fined over each of the five years (source: HealthStream SUMMIT 2016).

Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Health Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion annually, $17 billion of which is considered avoidable (source: Provider Advisor 2016 Volume 2, Issue 2, p. 4).

It’s about to get even harder. For FY 2017, CMS is adding open-heart surgery—a more complex, longer-stay procedure—to the list of clinical conditions monitored for avoidable readmissions.

Increasing Physician Burnout: Nine out of ten physicians discourage others from joining the profession. Currently about 300 physicians commit suicide every year (source: Daniela Drake, The Daily Beast, 2014).

As many as one in three physicians is suffering from burnout, which is linked to a list of pervasively negative consequences, including lower patient satisfaction and care quality, higher medical error rates, greater malpractice risk, higher physician turnover, physician alcohol and drug abuse and addiction, and physician suicide (source: Dike Drummond, MD, Stop Physician Burnout).

Physicians face increasing burdens, including the complexities of ICD-10 coding; new billing models; responding to new government regulations; dealing with a changing landscape of health plans; sharing information across the network; inefficiencies of credentialing, provider enrollment, and onboarding; documenting quality; cybersecurity; loss of autonomy; threats from alternative providers; and the “retailization” of primary care.

And, here comes the value-based reimbursement plan for physicians: MACRA (Medicare Access and CHIP Reauthorization Act). Beginning in 2019 physicians will be reimbursed on various performance metrics such as quality, advancing care quality, resource use, and clinical practice improvement. According to Deloitte, “Providers are in for a notable awakening when the law takes place in 2017.”

On top of this avalanche of stressors, physicians must keep up-to-date clinically, build practice volume, and improve their patients’ experiences. Are you exhausted yet?

Growing Focus on Revenue Cycle Management: The Affordable Care Act (ACA) and Medicaid expansion has created an influx of previously uninsured patients that has left healthcare organizations scrambling to accommodate increased demand while simultaneously experiencing lower margins. Because consumers are assuming greater financial responsibility for their own healthcare, healthcare delivery networks must shift from a wholesale to a retail environment where they interact directly with patients on issues such as pricing, billing, and payment. Unfortunately, hospitals and health networks are experiencing a strong correlation between the use of high-deductible plans and the amount of bad debt they are incurring (source: HealthCare Finance, 2016).

Concurrently, few healthcare organizations have taken the steps necessary to integrate the many information systems that support revenue cycle management. Systems are incompatible across service lines, locations, and functionality. Different software solutions are frequently employed to support disparate functions such as registration, clinical documentation, and billing.

Even worse, some of these functions may be done manually or are only partially automated, making data analysis incomplete or impossible. As the industry migrates toward value-based care, healthcare organizations are entering new collaborations, taking on risk contracts, exploring alternative sources of revenue, and being pressured to document outcomes. Patient experience contact centers address a myriad of healthcare industry pressures. Click To Tweet

Summary: Patient experience contact centers are a timely response to a myriad of industry pressures. Redeploying a legacy transaction-focused call center as a patient experience contact center can strengthen preference for your organization, mitigate risk, reduce unnecessary readmissions, serve as a physician practice extender, and solidify patient loyalty.

Richard D. Stier, MBA, is vice president of marketing for Echo, a HealthStream Company. He is a passionate and results-proven proponent of delivering transformative patient experiences.

Moving from “Sick Care” to “Health Care”

By Mark Dwyer

In 2012 our government enacted legislature that mandated U.S. hospitals to reduce readmissions by emergency departments (ED) admits for the first thirty days post-discharge. To force this change in behavior rather than wait for hospitals to choose to proactively address the overall health of their communities, the government began penalizing hospitals who had higher than average readmission rates through a deduction in their reimbursed Medicare payments.

This was a radical change in American healthcare; it put the onus of keeping patients well on the hospitals and providers who treated them. No longer could hospitals simply wait for individuals to require hospital care; instead it became their responsibility to proactively manage ED-admitted patients for at least the first thirty days post-discharge. If they were unsuccessful in providing the patient with the tools and help needed to keep them from readmitting, they bore the weight of a financial penalty.

Initially, the penalty amounted to 1 percent of the hospital’s total annual Medicare reimbursement. It was tied to three specific DRGs (diagnosis related groups): acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Each hospital was scored against its neighboring hospitals to determine which ones had readmission rates in the highest twenty-fifth percentile of the surrounding hospitals. If a patient who had been admitted via the ED due to one of these three DRGs required readmission within thirty days post-discharge, and the hospital’s readmission rate was in the highest twenty-fifth percentile of hospitals in the area, the hospital’s overall annual Medicare reimbursement was reduced by 1 percent. Although 1 percent may not seem like a lot, when applied against the hospital’s entire Medicare reimbursement dollars, it was significant—especially for hospitals operating with only 2 to 3 percent profit margins.

But the government didn’t stop there. In year two of the program, the percentage of Medicare reduction was increased to 2 percent of the hospital’s total annual Medicare reimbursement amount. In year three, not only was the percentage again increased to 3 percent of the hospital’s overall Medicare reimbursement, but three additional DRGs were added: elective knee replacement, elective hip replacement, and chronic obstructive pulmonary disease (COPD). Healthcare software vendors have programs to educate and manage patients post-discharge. Click To Tweet

At this point many hospitals began paying attention, especially when over 2,200 U.S. hospitals were penalized for failing to reduce their readmission rates. To address this ever-increasing reimbursement reduction, hospitals had to implement programs to manage Medicare patients post-discharge for at least the first thirty days. To do so, many homegrown programs were introduced with varying success.

A number of healthcare software vendors began developing and marketing programs to help educate and manage the patients post-discharge. Some of these programs involved on-site care management visits, phone calls, reminder texts, and emails. Some also involved extensive motivational programs designed to not only assist patients in remaining proactive about their care but also the patient’s caregiver. Too often the Medicare patient’s primary caregiver is an elderly spouse who is also battling a litany of health issues. Assisting them and other familial caregivers was determined to play a critical role in the process.

But what about the many patients who suffer from more than one chronic disease? Some vendors realized that many Medicare patients suffer from comorbidities. It is not unlikely for an individual with diabetes to also be obese, or someone with HF to have been admitted with an AMI DRG. Initially, since these various disease states were defined as separate care plans, patients suffering from comorbidities experienced multiple interactions post-discharge in order to manage all conditions that could possibly result in a costly readmission.

To motivate patients and their caregivers to follow post-discharge instructions regarding medications, to make and attend post-discharge provider appointments, and to integrate with the hospital’s care management or medical call centers, vendors have begun collaborating with leading content developers. By adding patient educational and motivational training content to their software programs, post-discharge programs can enable nurses or care coordinators conducting follow-up calls to select the specific information needed to address each patient’s multiple issues. This comorbidity program approach eliminates the need for redundant calls to address each of the patient’s healthcare issues. Instead it enables the nurse or care coordinator to select the content, surveys, motivational scripts, and other resources needed to meet all of the patient’s unique needs across a wide array of health conditions.

Future-thinking hospitals and providers who see the need for follow-up beyond the initial thirty days post-discharge are beginning to take a stand for long-term health management by using customizable comorbidity programs. This is a real step in the direction of healthcare management. Imagine a future where healthcare generates greater revenues from having empty beds, keeping area residents healthy and at home.

Mark Dwyer is the COO of LVM Systems, Inc. For more information about LVM’s Comorbidity Care Management Program (CCMP), contact LVM Systems sales at 480-633-8200 x223 or info@lvmsystems.com.

Interoperability in the Healthcare Call Center


By Matt Everly

The call center in a healthcare organization preforms a variety of important functions. One is serving as a virtual lobby when processing internal and external calls. It may be the initial touchpoint a patient has with the organization, so the experience must be positive. As the saying goes, “You only have one opportunity to make a first impression.” The call center also serves as the nerve center for ongoing communications.

Modern healthcare call centers need to handle all types of calls quickly and efficiently. To ensure that the virtual lobby experience is positive, the call center agents need immediate access to accurate data. To accomplish this, information systems need to share, pass, and store usable data from system to system. Interoperability is a term used in healthcare to describe the idea of different technologies and systems communicating to share data.

To handle calls effectively, the call center system needs to use data that may reside in external databases on other systems. As an example, if a caller wants to talk to an admitted patient, the agent needs to know which room to send the call to. Most patient admission, discharge, and transfer (ADT) information resides in a database that is external to the call center system.

Without interoperability, the agent would have to bring up a second screen to view the ADT information, go back to the call center system screen, manually enter the room extension, and transfer the call. With interoperability, the call center system can automatically download the ADT information from the external database and present it to the agent on the call center screen, thus eliminating several steps and decreasing the chance of error. Interoperability works behind the scenes to automate data exchanges and sharing.

Making sure the hospital call center is interoperable with other systems is the safe way to make sure call center agents communicate with callers in a timely and effective manner. A few of the important IT systems and technologies that should be interoperable within the healthcare call center system include:

  • Electronic health records (EHR)
  • Messaging applications (paging and secure messaging apps)
  • Alarms and monitoring systems
  • Nurse call systems
  • Scheduling systems

Many healthcare call centers routinely use outdated technology. Binders with paper call schedules, non-PC-based PBX consoles, fax machines, data access terminals, and sticky notes are used by agents to access the information they need to handle calls. These makeshift solutions lead to inefficiency and mistakes. Using interoperability, data can be combined to form a master record for a particular patient. Click To Tweet

Interoperability Works Both Ways: Hospital call center systems store information as administrators and agents input data or create schedules. This information may be valuable to other departments or used to augment an external document.

As an example, when an agent takes a message from a patient for a clinician, that message can be automatically sent to the EHR system and be posted to that patient’s individual electronic health record. By using interoperability, information from numerous databases can be combined in one area to form a master record for a particular patient.

Not All Systems Allow Interoperability: Legacy systems and technologies were not designed with data exchange in mind. There are several ways to connect IT systems to the healthcare organization’s larger digital ecosystem, but these can be costly and potentially unreliable.

Health Level Seven (HL7) is a set of standards used to transfer clinical and administrative data between software applications. Many present-day IT developers design products with HL7 in mind, helping organizations move toward interoperability throughout the enterprise. The healthcare call center can use HL7 to populate patient, clinician, and employee directories for agents. HL7 also can be used as a way to post information from the call center system to a patient’s EHR.

Reducing Costs: Interoperability will make your call center agents more efficient, eliminate mistakes, and reduce costs by automating processes that are currently handled manually. As healthcare providers look to reduce expenses, interoperability in the call center is a natural solution.

Matt Everly is the marketing director for Amtelco’s 1Call healthcare division. Matt has worked at Amtelco for over twenty years and has held numerous positions, including southeast regional sales manager, executive suite market development, and marketing manager.


Medical Call Centers Rise to Meet Healthcare’s Pressing Needs

By Gina Tabone

Medical call centers have finally gained recognition and credibility in the healthcare marketplace. Centralized medical call centers are rapidly emerging as the backbone of health systems because they are integral in achieving better patient outcomes. They offer a proven solution for reaching the three goals of the triple aim: improving the patient experience of care, improving population health, and reducing the per capita cost of healthcare.

Improving patient experience requires open access so patients receive the most appropriate level of care needed, in a time best determined by specially trained nurses guided by evidence-based tools. The patient learns to expect reliable advice, taking into account their current health state and consistently available day or night. Gaps in care are eliminated and delays are avoided, leading to favorable patient outcomes and higher reimbursements in a fee-for-value model. When patients’ well-being is enhanced, everyone gains, especially the patients. Medical call centers can stake a claim for making that happen.

Labor costs consume up to 70 percent of many call centers’ operating budgets. Outside partners can assume the responsibilities with greater efficiency and better outcomes for a lower cost. The choice to retain, outsource, or develop a hybrid pursuit is a multifaceted decision that organizations must thoroughly evaluate to determine which solution best aligns with their mission, future vision, and strategic plans.

Medical call centers are taking on a variety of responsibilities that are well suited to be conducted remotely and reliant on state-of-the-art technology and a dedicated workforce. Appointment scheduling is the most common task in many medical call centers and often happens in tandem with the strategy of centralization. Electronic medical records (EMR) products now have customized templates embedded with providers’ schedules used for office visits, imaging, or procedural appointments. Outbound calling campaigns are often conducted in conjunction with scheduling for appointment reminders.

Additionally, centralizing medication refill requests is emerging as a successful addition to many medical call centers. Call center technology such as CRM (customer relationship management) allows requests to be tracked, acted upon, and measured to ensure that established targets are met in a timely manner. Patients expect a standard process for their medication needs and a defined time for responses or resolution. Medication management and compliance is critical for optimal outcomes, so implementing a process that fosters this is a good idea. Patients stratified as high risk garner the most advantages, which contribute to maximum reimbursements for medical treatments.

Medical call centers have taken on the significant task of not only caring for the acute needs of primary care patients but also the chronic needs of vulnerable, high-risk patients as well. Successful coordinating and transitioning care is central to every health system’s strategy. Nurses are the clinicians assigned to figure out how to morph from case management to transitional care coordinators.

Training nurses in the fundamentals of remote patient care is imperative and is based on the standards of care used by telephone triage nurses. The practice of triaging acute symptoms will serve as the starting point for nurses involved in coordinating care. We must proclaim the unlimited value of a medical call center to the healthcare industry. Click To Tweet

We must continue to proclaim the unlimited value of a medical call center to the healthcare industry. In many healthcare organizations, more than 10 percent of employees spend the majority of their day doing their job on the telephone. The benefits of centralizing and consolidating the work they do are undeniable.

The task at hand is capturing the limited attention of decision-makers and educating them on the role medical call centers play in a fee-for-value system and the distinct results that are possible. The political future of healthcare may be uncertain, but there remains a need for products, services, and expertise that bring the call center to the forefront of patient care.

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

Finding the Right Medical Call Center Consultant

By Gina Tabone, MSN, RNC-TNP

In terms of delivering high quality, cost-effective healthcare, most people would agree that this year is going to be very complicated, and many organizations are going to rely on consultants to help them be successful. Every day dozens of potential solutions are offered for overcoming healthcare delivery challenges, and one solution repeatedly suggested is that of a medical call center. Many organizations do not possess the internal expertise to effectively implement and operate this type of access to care.

A successfully operated medical call center can meet the need to provide access, continuity of care, optimal resource utilization, and better outcomes for more patients. Many healthcare organizations have already established their own call centers, others outsource to nationally recognized organizations, and some are still exploring the best options for their patients and organizations. Often the expertise of a medical call center consultant is engaged to define the best goals to work toward and to map out strategies for achieving those goals.

If you’re considering working with a medical call center consultant, you should be happy that your organization acknowledges the value of a medical call center and is willing to seek out and pay for industry expertise. As a responsible leader, you want to select a call center consultant who can meet your needs, direct your efforts, and ensure success for your call center, your organization, and yourself. Remember, your reputation is on the line.

Your best interests are served by selecting a consulting group with established roots in providing telehealth. When you’re looking for advice about a specific subject, there’s an inherent intelligence that only comes with someone who has experience in that subject. Hands-on medical call center expertise is invaluable when you’re hiring a consultant for help with a start-up or making your existing operation more efficient.

Empathy is the icing on the cake. Look for a consultant who can identify with you and understand the emotional roller coaster that a leader of a 24/7 call center faces. An empathetic consultant understands what motivates you and what keeps you up at night and can see the current situation from your perspective. Consultants with a history of successful call center leadership can focus on experiences similar to yours, respect the uniqueness of your organization, and customize proven strategies to ensure that your call center meets and overcomes the challenges that healthcare may face in the months ahead.

Gina Tabone, MSN, RNC-TNP, is director of clinical solutions at TeamHealth Medical Call Center. Prior to joining TeamHealth, she served as the administrator of Cleveland Clinic’s NURSE on CALL 24/7 nurse triage program. Under her direction, ED utilization declined, continuous care coordination improved, performance metric targets dropped from 33 percent ABD to less than 5 percent, URAC accreditation was achieved, and the call center grew from covering 350 physicians to the integration of more than 1,500 employed and affiliated providers.

[From Connection MagazineMarch/April 2016]

5 Tips for Successful Patient Triage

By Ravi K. Raheja, MD

Triaging patients over the phone is challenging because nurses have limited information available to them. Because they are not able to use touch and visual cues, nurses have to use their years of training, education, and instincts to help them make the right decision every time.

This article covers five common challenges and issues faced by triage nurses. Here’s how to avoid some of the most common of these issues and how to ensure positive triage outcomes.

1) Avoid Stereotypes: As a triage nurse, be careful to be objective no matter what the circumstances. It can be easy to mistake a caller’s sex or age by listening to his or her voice. To avoid stereotyping the caller, always confirm the age, gender, and medical history before triaging a patient.

2) Listen First: It is easy to jump straight into triaging the first symptom mentioned by the patient. Instead listen carefully to the caller’s history and symptoms, then explore all possibilities. For example, abdominal pain in an older female may signal a urinary tract infection, while pregnancy may need to be considered in a younger female. Asking for a brief history and exploring the callers’ concerns in more detail will prevent overlooking a serious symptom and triaging to the wrong disposition.

3) Assess the Situation: Remember to use your own professional judgment to assess the situation. It is important to listen to the patient to understand his or her concerns and get a good history. However, patients sometimes have their own diagnosis and accepting the caller’s diagnoses can lead to a bad outcome. For example, a parent may call and say her child has chicken pox. It is the nurses’ role to understand that the caller is concerned about chicken pox. However the nurse cannot assume the parent is correct. The nurse must do a full assessment of the child’s airway, breathing, and circulation, as well as assess the rash and any other symptoms to make the correct triage decision.

4) Address the Callers’ Emotional State: Listen to the caller’s concern, voice, and anxiety levels. While the triage nurse is the trained professional, callers who are anxious have to be taken seriously and get an extra-thorough assessment for two reasons: first to ensure there is nothing really serious going on, and second to reassure the caller that you are taking them seriously and they will be okay.

5) Use Nurse Triage Protocols Properly: Triage protocols are carefully and thoroughly designed, but they can still be misused. Nurses can omit using a protocol, use the wrong protocol, or use a protocol improperly during triage. For instance, many new nurses tend to over-use fever protocols. When misuse occurs, it puts the patient at risk. It is critical for triage organizations to provide detailed and comprehensive continuing nurse triage education and good quality assurance programs to ensure high-quality patient care.

Further, nurses need to be trained to use their professional knowledge in addition to protocols. Critical thinking skills are essential for any triage nurse to adequately and safely make assessments and decisions. Triage nurses must have balance between good judgment and proper protocol practice.

Ravi K. Raheja, MD, is the COO and medical director of TriageLogic. Founded in 2005, TriageLogic is a URAC accredited, provider of quality triage solutions, serving over 3,000 physicians and covering 6.5 million lives. TriageLogic provides both software and after-hours nurse triage services. Whether you need nurse triage software for your call center or your office, an outsourced nurse triage service, or a combination of the two, TriageLogic has a customized, cost-effective product to meet your needs. TriageLogic also has an online learning center with educational blogs and videos for telephone triage professionals. For more information visit www.triagelogic.com.

[From Connection MagazineMarch/April 2016]

How to Evaluate a Nurse Triage Call Center Platform

By Ravi K. Raheja, MD

You probably already know that nurse triage technology is evolving quickly. In just a few years, we’ve moved from monitoring fax machines, distributing calls, and being available in person to helping patients remotely via the Internet, integrated electronic medical records, and iPads.

Given this continually evolving environment, how do you assess whether your call center is using the most appropriate technology and thus maximizing its potential? Before you start evaluating your existing software or new platforms, the first step is to make a list of what functions your call center currently performs and what functions you would like to offer in the future.

With your management team, begin by discussing a five-year plan for the call center, considering your organization’s vision and needs. Make sure to get input on your plan from staff members at every level, including non-clinical operators, nurses, and IT staff. You may get valuable insight about your strengths, weaknesses, and the direction to move forward. You’ll want to develop the following lists:

A Services List:

  • Services you offer now
  • Services you want to keep
  • Services you want to add
  • Services you want to discontinue

A Features List: For every service you offer, use the input of the staff members who use each service to make a list of features:

  • Features that are helpful and you want to make sure you continue offering
  • Functionality you can add that would make the process better
  • Features you would like to add

As you consider this list, keep in mind the flexibility and capability of your vendor in terms of understanding your needs and adding functionality as you and the technology evolves.

An IT List:

  • What is the current uptime of your system and what would be ideal?
  • What is an appropriate disaster plan for your system?
  • How much IT support does the vendor provide?
  • How much IT support does your organization require?
  • Would you benefit from a hosted solution or an on-premise solution?

A Support List: Your platform is only as good as the team that builds and supports it, so consider:

  • The vendor’s IT expertise
  • The vendor’s call center expertise
  • The vendor’s medical resources

A Finance List:

  • What does your current budget look like?
  • How can you increase revenue or justify spending?
  • What is the cost to replace or upgrade your platform?
  • What is the cost to maintain your platform, including both vendor and internal costs?

With all this information, you will be in a good position to evaluate software and platform possibilities for your call center. Here are some key questions to help ensure that a new or existing platform is a good fit:

  • Does the platform have all the modules and functionality you need now and for the next five years?
  • Does the platform have additional features that are available to add?
  • Has the vendor continued to develop new functionality to keep up with technology trends?
  • Does it integrate well with other EMR- or Web-based systems?
  • Does it allow for a hosted or on-premise solution?
  • Does the vendor have a team of experts in the call center space to support you?
  • Does the vendor provide reliable, 24/7 urgent support?
  • Does the platform allow your call center to communicate effectively with the providers?
  • What is the true cost of your system? Include vendor fees, internal IT costs, and efficiency savings (areas where you could save time by automating tasks or increasing efficiency).

As you proceed, keep in mind four main considerations: your organization’s vision and needs at all levels, the features you already have and those you want, the customizability of the new or existing software, and the IT requirements to support your nurse triage platform. You now will be in an excellent position to evaluate and make decisions on expanding or customizing your existing platform or venturing into incorporating new software into your system.

Ravi K. Raheja, MD, is the COO and medical director of TriageLogic. Founded in 2005, TriageLogic is a URAC accredited, provider of quality triage solutions, serving over 3,000 physicians and covering 6.5 million lives. TriageLogic provides both software and after-hours nurse triage services. Whether you need nurse triage software for your call center or your office, an outsourced nurse triage service, or a combination of the two, TriageLogic has a customized, cost-effective product to meet your needs. TriageLogic also has an online learning center with educational blogs and videos for telephone triage professionals. For more information visit www.triagelogic.com.

[From Connection MagazineMarch/April 2016]

Can Telehealth Save Medicare?

By Charu Raheja, PhD

Currently Medicare is waning under the pressure of much of America’s population living longer than the system can support. With this in mind, the healthcare system is desperately in need of innovative ways to improve healthcare and reduce costs. One possible solution to the problem is the proposed Medicare Telehealth Parity Act of 2015, H.R.2948, sponsored by Rep. Mike Thompson and introduced July 7, 2015. The bill is the beginning of a revamp of Medicare’s approach to treatment and care that could improve American health and lower healthcare costs as a whole. Telehealth allows patients to contact a nurse or physician directly via their cell phone or computer to discuss symptoms and receive care without leaving the comfort of their homes.

Though telehealth as a whole includes many moving parts, one essential component for the success of telehealth is telephone nurse triage. Telephone nurse triage is a system by which registered nurses are available to take patient phone calls and determine the proper amount of care needed in the proper time frame. Nurses use standardized symptom-based protocol guidelines to ensure high quality of care with every phone call.

With convenient access to nurses 24/7, patients are empowered to make the right decisions about their health and what the next steps for their symptoms should be. Patients who better understand their conditions and have a method of self-management, such as access to a registered nurse, are more able to decipher the appropriate level of care, thus avoiding costly ER visits and improving overall patient satisfaction.

An important aspect for the successful use of nurses in telehealth is for the nurses to have direct contact with physicians. In many systems triage nurses communicate patient call information with providers, allowing for better patient relationships with their provider and continuity of care. Nurse triage facilitates the best use of the healthcare workforce by alleviating doctor workload pressure and allowing them to reach the most urgent cases first.

By utilizing telephone nurse triage as an affordable telehealth option, everyone benefits; providers can be assured that their patients are receiving the best care possible. Patients are satisfied with their care and confident in decisions made regarding symptoms they were once unsure of. And the cost of healthcare in America will be driven down by the efficiency and convenience of patient access to healthcare professionals at reduced costs.

Currently most Americans think of telehealth as an option for those living in remote areas where it may be difficult to visit a doctor’s office, but there is infinite value in the use of telemedicine in urban city centers where the emergency room census can be extremely high. Telehealth provides a positive alternative to unnecessary urgent care and emergency room visits, lowers hospital re-admissions—and with the healthcare costs saved—could in fact save Medicare.

Charu Raheja, PhD, is the CEO, chair, and co-founder of TriageLogic. Founded in 2005, TriageLogic is a URAC-accredited, physician-led provider of high-quality telephone nurse triage services, triage education, and software for telephone medicine. The TriageLogic Group serves over 7,000 physicians and covers over 10 million lives nationwide. Charu also serves on the board of Community Health Charities. For more information visit www.triagelogic.com. (This piece was inspired by Michael Hodin’s post “Saving Medicare” in Huffington Post, October 26, 2015.)

[From Connection MagazineMarch/April 2016]

Creating a Citizen Experience Turnaround

By Abby Herriman

The year 2014 was a tough one for federal government customer service. With the issue-plagued rollout of Healthcare.gov, accusations of poor service at Veterans Affairs, and customer satisfaction ratings for the public sector reaching the lowest point in sixteen years, it’s clear that something needs to change in the way our government interacts with citizens.

While these cases are recent, citizen experience has been a recognized problem for a while. A 2011 executive order declared that federal executive departments should provide services “in a manner that seeks to meet the customer service standard established…equal to the best in business.” In conjunction with this mandate, the Office of Management and Budget (OMB) elevated customer service to the status of a Cross Agency Priority (CAP) goal, bringing together a cross section of senior officials to devise common strategies and best practices.

A democratic government relies on its ability to engage with citizens effectively, but meeting the expectations of citizens requires changes on many levels. While the use of technology is critical, there are three areas federal entities should incorporate into their service plans:

  • Improve accountability through effective performance management
  • Integrate channels of communication within and across agencies
  • Build public trust through engagement

With federal customer service ranking second to last in a list of forty industries in the American Customer Satisfaction Index poll, these three focus areas can help ensure that changes implemented in the contact centers and in technology tools will have the desired outcome: building trust and confidence that the federal government will and can serve its people.

Improving Accountability Through Effective Performance Management: Across the private sector, customer service organizations closely monitor dozens of metrics within contact centers to better understand their performance against historical trends. These measures – such as “order defect rate” and “negative feedback rate” – are not as widely or consistently tracked in government. While the Government Performance Results and Modernization Act (GPRAMA) requires agencies to set and track metrics, a 2014 report looking at six agencies found that none of them received a passing score in terms of compliance.

It is critical that agencies begin to see the power in tracking metrics, not just for compliance but also for improving service. While close metric tracking takes an investment in technology, it also needs buy-in that it will have the same outcomes in a “citizen-service” environment as it does in a customer-service environment.

The Veterans Benefits Administration (VBA) has faced tough scrutiny in its inability to effectively process claims from veterans. As part of its effort to improve service, agency leaders set performance management targets, such as “increase compensation claims processing quality to 89 percent accuracy.” They also aimed to increase the number of disability claims files online from a baseline of 2 percent in 2013 to 20 percent in 2015. Every process and technology implemented is now evaluated and measured against these (and other) goals to ensure that overall service is improving.

Integrate Channels of Communication Within and Across Agencies: The federal government has a gap to close in terms of online service when compared to the private sector. In a report, “Uncle Sam at Your Service,” one-third of respondents said that the information they received was not consistent across the multiple channels they used to resolve their issue. With 77 percent of consumers expecting to use multiple channels of communication while interacting with a service provider, it is not enough to simply make those channels available (which many agencies are now doing), but to ensure that the same information is provided whether the citizen visits the website, sends an email, or calls a contact center.

This consistency is more difficult in the federal environment because of the complexity of the issues. Take, for example, students seeking get federal aid for college. They will have to interface with people and use data from Department of Education, the IRS, and possibly even Social Security and other agencies to get that aid. One of the most important steps the federal government has taken to achieve consistency, not just within agencies but also between agencies, is the OMB’s establishment of the Customer Service Community of Practice (CoP). This organization is tasked with driving inter-agency collaboration on best practices and common metrics to benchmark cross-agency performance.

Building Public Trust Through Engagement: Citizen service in a democratic society is more than just providing answers; it is allowing the people to have a voice in the process. Agencies need to implement feedback tools such as customer surveys or comment mechanisms. The CoP has proposed implementing a cross-agency feedback tool and is currently soliciting feedback for pilot testing.

There is proof of the impact of these tools. The VBA instituted a customer satisfaction survey in 2010 and with that feedback has identified ninety-seven process improvements, of which fifty-five have been implemented. Across the government, agencies are using crowdsourcing and challenge competitions (such as Challenge.gov) to encourage citizens to participate in solving the country’s more difficult social and technological challenges. A growing use of social media by agencies is also enabling more real-time engagement of citizens and on-the-spot problem solving.

These three focus areas need to drive the implementation of technology, policy, and process within the federal government to help the public sector meet mandates and, most importantly, citizen expectations.

Abby Herriman is the SVP of delivery and innovation at HighPoint Global.

[From Connection Magazine – May/June 2015]