Tag Archives: Healthcare Call Center Articles

Telephone Triage

Of all the exciting advances in medicine, one falls outside the traditional scope of new drugs, innovative procedures, or revealing research. This development is in the application of telephone technology to facilitate the provision of healthcare. One of the most exciting developments in telemedicine is telephone or nurse triage. The history of telephone triage dates back three decades.

If you wish to look into this opportunity, here are some resources to consider:

Telephone Triage Literature: As a primer for learning more about telephone triage, you might want to refer to some of the many books available on the subject. Here is a list of some of them (let us know your favorites and we will add them to our list):

  • Pediatric Telephone Advice by Barton D. Schmitt, Raymond C. Baker (Spiral-bound)
  • Pediatric Telephone Protocols: Office Version by American Academy of Pediatrics, Barton D. Schmitt
  • Quick Reference to Triage by Valerie G. A. Grossman, et al.
  • Telephone Health Assessment by Sandra M. Simonsen
  • Telephone Medicine: Triage and Training: A Handbook for Primary Care Health Professionals by Harvey R. Katz, Harvey P. Katz
  • Telephone Triage: Theory, Practice, and Protocol Development by Sheila Q. Wheeler, Judith Windt
  • Telephone Triage for Obstetrics and Gynecology by Vicki E. Long, Patricia C. McMullen
  • Telephone Triage of the Obstetric Patient by Deborah E. Swenson
  • Telephone Triage Protocols for Adult and School Age Populations with Women’s Health and Infant/Child Protocols by Sheila Wheeler, RN, MS
  • Tele-Nurse by Marijo Baird, Sandi Lafferty

Telephone Triage Providers: There are several call centers, which provide telephone triage on, an outsource basis or for a fee to hospitals, clients, individual practices, and medical answering services:

The Beryl Companies
3600 Harwood Road
Bedford, TX 76021
Steve Schaumburg, Director of Marketing
800-833-2000
Steve.Schaumburg@Beryl.Net
www.beryl.net

Fonemed, LLC
2975 Broadmoor Valley Rd, Suite 201
Colorado Springs, CO 80906
Eric Stoen, Sr. VP, Operations
888-366-3633
stoen@fonemed.com
www.fonemed.com

HealthLine Systems, Inc.
17085 Camino San Bernardo
San Diego, CA 92127
Richard D. Stier, Vice President
800-733-8737
RStier@healthlinesystems.com
www.healthlinesystems.com

NotePage, Inc.
PO Box 296
Hanover, MA 02339
S. Housley
781-829-0500
sales@notepage.net
www.notepage.net

Telephone Triage Vendors: The following vendors have integrated telephone triage protocols into call center software:

Epic Systems Corporation
5301 Tokay Blvd.
Madison, WI 53711-1027
608-271-9000

LVM Systems
1818 E Southern Ave, Ste 15A
Mesa, AZ 85204
480-633-8200
info@lvmsystems.com
www.lvmsystems.com

McKesson
CareEnhance Systems
Phoenix, AZ 85012
800-345-3342 x1230
www.epic.com

Fonemed, LLC
2975 Broadmoor Valley Rd, Suite 201
Colorado Springs, CO 80906
Eric Stoen, Sr. VP, Operations
888-366-3633
stoen@fonemed.com
www.fonemed.com

HealthLine Systems, Inc.
17085 Camino San Bernardo
San Diego, CA 92127
Richard D. Stier, Vice President
800-733-8737
RStier@healthlinesystems.com
www.healthlinesystems.com

NotePage, Inc.
PO Box 296
Hanover , MA 02339
S. Housley, Webmaster
781-829-0500
sales@notepage.net

Additional Resources: In addition to information on the websites of the preceding vendors, also refer to:

allnurses.com
Bulletin board for telephone triage nurses
http://allnurses.com

[Submit additional information about telephone triage books, outsourcers, and software to dehaan@connectionsmagazine.com.] 

[From Connection MagazineApril 2004]

Resources for Medical Call Centers

Call Centers that process calls for the healthcare industry have the same needs as other call centers, plus more. These call centers handle a variety of functions such as telephone triage, PBX/console call routing, emergency dispatch, nurse call, on-call scheduling, appointment setting, insurance claims, or physicians’ answering service. (Telephone triage is an especially specialized medical call center function; see “Telephone Triage” for more information.)  While no medical call center would attempt to handle all of these functions, many have more than one specialty, especially hospital-based call centers.

According to Amcom’s Steve Green, “A primary role of the [medical] call center is to help the hospital compete for ‘customers’ – that is, for the physicians who bring in the patients.  The call center must provide services that keep physicians happy – especially paging services, call processing (with accurate transfers/connections and short hold times), messaging, and registry/locator services.” This is true rather it is an internal hospital-based call center or an outsource call center.

Equipment that is applicable for an outsource call center is generally appropriate for the medical call center as well. Many vendors, however, have added features to address the unique needs of the medical call center. Here is a brief overview of what is available for a healthcare related call center:


1Call: A division of Amtelco: To meet the specific needs of the medical community, each healthcare facility can design a custom system by selecting the appropriate modules:

Console Call Answering: Answer and transfer calls quickly and easily.

On-Call Scheduling: Let physicians and staff members enter their own on-call schedules. The schedules are automated, ensuring that the information agents see is always current.

Appointment Taking: Simplify appointment scheduling for physicians and personnel, as well as for rooms and equipment. Appointment reminders can also be sent.

Class Registration: Register callers for classes, with tools such as enrollment sizes and automatic reminders.

Help Desk: Scripts with branching capabilities guide agents through various types of questions, helping them find solutions for callers and staff.

Patient Placement: Enter information about incoming patients, refer patients to other facilities, and verify room availability.

Physician Referral: Search multiple criteria to help refer the appropriate physician to each caller.

R.E.D. Alert: Instantly notify personnel and groups about internal and external emergencies or disasters, including instructions on what they should do.

IVR (Interactive Voice Response): Automates routine phone calls.

eConferenceLink Web Conferencing: Offer on-line classes, seminars, meetings, or training sessions to the community and to employees. Attendees join a conference call for audio and use a Web browser to see the information being presented.

Just Say It Speech Recognition: Provide internal and external callers an easy way to route their calls using speech recognition.

Perfect Answer: Simplify call handling with prerecorded messages in each agent’s voice.

Voice Logger: Automatically record all calls, enabling facilities to ensure accuracy.

For more information, contact 1Call at 800-356-9148 or info@1call.com.


Amcom Software Inc.: Amcom software products unify existing telephone, paging, and computer information systems to create a comprehensive call center solution. Core products include:

Speech Recognition: Amcom Smart Speech applications enable call centers to process a majority of routine phone requests including directory assistance, messaging, and paging independently of an agent and with more ease of use than touchtone.

Paging Management: Comprehensive paging execution, monitoring, and archival documentation. The system’s design provides a transparent front end for agents and users of IVR, speech, and Web-initiated pages to all paging devices (in-house and wide-area pagers, cell phones, and PDA’s).

PC Attendant Console: Workstations automate agent tasks and integrate caller and directory information in one PC-based application. Screen-based interactive functions include automatic screen displays (screen pops) of incoming calls, single button call transfers, conferencing, speed dialing, and other telephony functions. This Windows-based application provides easy access to database information, messaging, and staff tracking options. Features and options include:

  • IVR: Applications include auto attendant, page request, meet-me paging, status change, message storage, wake-up call, and event notification.
  • Event Notification and Response: Initiates, monitors, and manages emergency notifications of all types, automatically delivering the message, collecting the responses, escalating if needed, and logging all activities for reporting and analysis.
  • Web-Based Applications: Employees and other authorized users can do directory searches, view scrolling rosters, update status and availability, view and maintain monthly on-call calendars, and activate pages from the Internet via PCs or wireless devices.

For more information, call 800-852-8935.


LVM Systems: LVM’s components of their e-Centaurus system are designed to position the medical call center as the communication hub. The primary modules include:

  • Physician Referral
  • Physician to Physician Consult
  • Service Referral
  • Class & Screening Registration
  • Health Information
  • Surveys
  • Contact Management
  • Literature / Brochure Fulfillment
  • Answering Service
  • Behavioral Health Intake
  • Membership Registry
  • Complaint / Suggestion Tracking

For telephone triage, LVM has collaborated with Drs. Barton Schmitt and David Thompson, to make available the most tested and clinically proven protocols. Additionally, LVM will customize the software screens and fields to support a center’s unique call process. It includes:

Medication / Dosage Calculator: When over–the-counter medications are recommended within, the nurse can access the software’s dosage calculator – saving time while enhancing accuracy.

Frequently Used Protocols: This feature presents a pick list of the top protocols and can be changed as needed to reflect seasonal variations.

Question or Advice-specific Comments: e-Centaurus allows ad hoc information to be captured at the point in the call where it occurs.

Adjustable Views: LVM provides two ways to view triage questions: one at a time or full screen (showing many questions in sequence) to suit nurse preferences.

Remote Access: Staff for short periods of peak call volumes or tap into more abundant labor pools. LVM supports Citrix or MS Terminal Server and has successfully implemented remote access at several client sites.

For more information, contact LVM at 480-633-8200, info@lvmsystems.com.


Startel: Healthcare organizations use Startel equipment to centralize existing hospital telephone systems into one main call center. Startel’s healthcare clients can make use of the following features in their call center:

OnCall Scheduling: Automatically displays time and date sensitive information when a call is presented to an agent. Clients, departments, or specified individuals can enter and update information. On-call schedules can be accessed through a Web browser for a convenient updating interface. Internet users have their own security log-ins and all activity is tracked in a detailed history file. Information can be categorized by primary on-call and backup(s).

Time Activated Alerts: Users can enter an unlimited number of agent instructions that are automatically displayed to call center staff during specific time intervals. When a call is presented to an agent, all instructions that are applicable to that day and time will be automatically displayed.

Answer-with-a-Smile: Automatically plays client-specific greetings using the actual voice of the agent answering the call. Various greetings can be recorded and played based upon time-of-day and day-of-week, creating versatility and flexibility for supporting all of your departmental or client needs.

Voice Logger: The voice logger will automatically record the phone conversations in an MP3 format, storing them as discreet digital recordings for future playback.

HIPAA Compliance: Startel has added additional system security features as well as privacy and transaction tracking features to assist medical call centers in protecting personal information, as specified by HIPAA (Health Insurance Portability and Accountability Act).

Contact Startel at 800-782-7835.


Telescan: Telescan recognizes the importance of effective call processing in the healthcare market. “The ability to speak to an actual agent is more important in the medical industry. Voice prompt doesn’t work well in a medical emergency,” stated Lee Mueller of Telescan.

Spectrum Messenger is a secured, selective instant messaging system. With Spectrum Messenger, a client can directly contact call center agents through email to update information or advise them of any necessary changes. At anytime of day or night, a doctor may notify the service through text message, PDA or through basic email of schedule changes or patient information.

Spectrum On-Call Scheduler helps track the medical community’s complex schedules. With this program, the call center can manage the on-call schedule for a physician or group, including combined schedules for large groups or a weekend shared schedule.

Spectrum VMail: Telescan is planning to introduce Spectrum VMail, a full function application that brings integrated voice messaging to the Prism platform; Spectrum IVR, interactive voice response, and companion to VMail.

Spectrum Data Manager is also expected to be released this year. It will combine a high-performance database server with a full-range of networking and reporting capabilities.


Xtend Communications Corp: Xtend Communications has provided call-processing systems to various industries, including healthcare, since 1967. Here is a brief overview of the systems and modules they have to offer:

MediCall: Designed specifically for the healthcare industry, MediCall is a Windows-based CTI application that gives agents visual access to advanced telephony capabilities from their computer, delivering information about the call before it is answered. Alphanumeric messages can be delivered through email, pager, fax, or on-screen. All PBX functions such as overhead and radio pages, park and page, and code calls are automated with MediCall.

Paging Gateway is an integrated paging platform that enables staff to generate pages – voice, numeric, or alphanumeric – with or without staff intervention. IVR-type voice prompts and single keystroke execution allows end-users and agents to initiate pages both on and off-premises. This system can handle thousands of pages per hour, automatically log the page request, provide unanswered page notification, and reduce paging errors.

WebXchange provides enterprise-wide on-line, up-to-date directory information services centralized into one easy access format is a necessity. This can be combined with on-call scheduling abilities and radio paging.

STARchive is an on demand system for recording, archiving, and delivering telephone calls and their content from any phone, anywhere. STARchive stores and delivers the content of the call as a .wav file.

Marathon is a digital call recording and logging solution that offers voice recording, retrieval, archival, and call management on an open systems platform.

Flash Alert is a mass notification communication solution that provides a centralized command center for alerting and notifying personnel – simultaneously or within a pre-defined period – of an impending issue.

AnswerPro is a powerful Windows-based CTI application that gives call center agents visual access to advanced telephony capabilities right from their desktop computer.

[From Connection MagazineApril 2004]

How HIPAA Affects You

By James M. Ballard

Call centers that handle protected health information need a strategy for meeting the government security and privacy mandates of HIPAA (the Health Insurance Portability and Accountability Act), which was signed into law in 1996.

HIPAA is an evolving government mandate that sets standards for the security and privacy of protected health information. HIPAA security and privacy rules require covered entities, such as hospitals and health care centers, along with business associates of covered entities, to institute policies and procedures that reasonably safeguard such information, whether it is exchanged verbally or electronically.

To meet the various HIPAA requirements, many health care companies have created their own HIPAA task force. These groups are responsible for keeping up with the ever-changing HIPAA requirements and for determining how their company’s purchases of hardware, software, and outsourced technology solutions are affected by these rules. Companies rely on vendors to provide hardware and software solutions that will comply with the HIPAA rules and to enhance the products and solutions to maintain compatibility with future changes.

It is critical to stay up to date on the changes to HIPAA regulations. Some vendors, such as my company, Startel Corp. of Irvine, Calif., have assembled a strategic team of software engineers and HIPAA attorneys to continue to review HIPAA requirements and implement necessary changes in software platforms. Customers should look to their vendors to provide solutions that will enable them to cost-effectively implement the modificationsto remain HIPAA compliant.

How will HIPAA compliance affect you? If your call center takes and forwards messages that contain protected health information, such as patient messages to health care practitioners, HIPAA requires you to take reasonable steps to avoid the accidental disclosure of these messages. Some steps are simple to implement. For instance, depending on the environment, operators may need to speak softly and limit the amount of personal information they include in patient messages. Other strategies require technical safeguards, and that’s where a vendor’s add-on “HIPAA features” become critical.

One of the most important HIPAA regulations affecting call centers is the safeguarding of protected health information that is electronically stored. One easy way to protect patient information is to require a secured, password-based login, which effectively blocks unauthorized access to such information. The system should be designed to automatically log off unattended workstations after a certain amount of time, and require a password for accessing workstations and central databases. Privacy screens can also be used to darken the screen if there has been no activity for a given amount of time. The operator can reactivate the screen with a mouse click or may be required to re-enter his or her password. The user should be able to determine the timing and the required steps to re-enter the system.

HIPAA regulations also require call centers to restrict unnecessary access to electronically stored patient information. An audit trail of who has accessed this information is critical. This audit trail should show the message number or identifier, the date and time it was accessed, and by whom. The audit information itself should be protected to reduce the risk of sensitive information being revealed. Each time a message is viewed, saved, printed, or sent to a client, that information should be recorded in this log, along with details about when and by whom the action was initiated.  Audit trails help you to comply with access rules by recording how, and by whom, messages and other patient data have been handled.

Information transmitted by most email systems is vulnerable to interception. HIPAA security regulations require call centers to encrypt or otherwise safeguard protected health information that is transmitted over the Internet. HIPAA software helps you to meet this requirement by adding a simple encryption mechanism to your email system. Upon receiving encrypted emails, clients use a standard key for decryption.

Fax transmissions of patient data must also be handled with care. HIPAA software should provide a confidential cover sheet explaining that the fax contains sensitive material. Ideally, the cover sheet should automatically be attached to the fax prior to being sent.

By using Health Level 7 data transfer protocol, the movement of patient information to online directories is controlled by the sender, so that sensitive patient information is protected. The directory used by the operators needs to be flexible enough to restrict viewing of patient information, while enabling operators to provide sufficient information to callers for efficient and effective call processing.

It is critical for companies required to comply with HIPAA to work with vendors that have studied the legal aspects of the regulation and that understand the implementation issues. Many vendors are struggling with HIPAA and only a few have employed legal and engineering experts to safeguard your implementation of HIPAA compliant software. Before purchasing a product that will be governed by HIPAA standards, be sure to review how the vendor arrived at its solutions and whether it meets your company’s HIPAA task force standards. HIPAA regulations will continue to change and your vendor must have the capability and knowledge to change with the rules, so that you and your company can maintain a HIPAA-compliant environment.

James Ballard is director of sales at Startel Corp. For further information on the Startel Corp. HIPAA compliance standards, please email info@startelcorp.com.

[From Connection MagazineMay 2003]

The Trouble with Medical Messaging Service Part 2: Technology Threats and Opportunities

By Joseph Sameh

According to the results of the April 2001 Harris Interactive survey, people are accustomed to using the Internet for customer self-service.

Customers can now track package shipments, pay bills, order books, and do numerous other tasks without the participation of a customer service representative. More than 90 percent of people with Internet access would prefer to communicate with their doctor via email while only 15 percent of doctors would want to do so.

The most significant use of the Internet in the teleservices industry is in the self-management and maintenance of on-call schedules. As a result, many call centers have been reclassified into contact centers.

The threat: A number of organizations are providing email access to doctors. Understanding the threat of this technology is crucial. These new providers will unquestionably grow and this trend has the potential to destroy the medical messaging service industry as we know it.

These companies are well organized and superbly financed; some even have the support of pharmaceutical companies and massive electronic medical records suppliers. One such company, Medem, is endorsed by the American Medical Association. Think back to the introduction of voice mail and remind yourself how that technology changed the commercial telemessaging business. In a similar way, cable TV has hurt the broadcast networks. For those providing medical messaging services, this is an even bigger threat.

The opportunity: Admittedly, these players have the significant advantages of access and money but many don’t fully understand the operational dynamics of the health care call center market, the patients, and the practices. Many companies intend to charge patients to use their service. Why patients would flock to a “pay-for-email” model when they could place a phone call instead is hard to imagine, unless the office hold times are so staggering that any price is worth avoiding the wait. Banks have successfully implemented pay-for-service by providing notoriously poor service to their client base. Now banks charge for everything. In the U.S. we have what many believe is the best health care system in the world, but access can be a challenge. All these players are addressing the aspect of patient access.

Most of these companies rely on the physician as the touch point for the patient. Stated differently, if the patient’s call results in a physician requiring the patient to come in to the office, the doctor ends up asking the patient to call the office to schedule an appointment. The physician becomes the secretary for the secretary. Physicians answering phones at the front desk is not a viable option, yet these companies think doctors will want to answer all email messages.

There are some successful Internet self-service models. Federal Express successfully offered its clients an easy-to-use system. Customers can augment live customer service with Web-based self-service. This process saves millions of dollars annually in reduced labor and the more it is used, the more valuable it becomes. This is known as the “role of network” effect.

Joseph Sameh is the founder of Mediconnect, Phone Screen, and NeedMyDoctor.

See part one, The Trouble with Medical Messaging Service.

[From Connection MagazineApril 2003]

HIPAA Compliance Issues: OCR Offers Guidance

By Mike Wilson J.D.

The January 2002 issue of Connections Magazine gave an overview of the Health Insurance Portability and Accountability Act and explained that call centers would be treated as business associates of health care providers under the law. Recently, the Office of Civil Rights (OCR) issued some additional guidance, though not with as many specifics as call centers might like.

First, the law does not impose rules upon call centers directly because call centers are not subject to regulation by the Department of Health and Human Services (HHS). Instead, health care providers and other covered entities are required under HIPAA and other pertinent regulations to obtain from business associates, such as call centers, contractual assurances that information will be handled in conformity with the law. Thus, a suit by the health care provider for breach of contract is a potential exposure for the call centers. HHS cannot impose civil monetary penalties on call centers for breaching those contractual duties.

Disclosing the minimum necessary: One question frequently asked of OCR is whether doctors may leave messages on patients’ answering machines to remind them of appointments or provide information about prescriptions. OCR says yes, provided that care is taken “to limit the amount of information disclosed.” For example, says OCR, the health care provider “might want to consider leaving only its name and number and other information necessary to confirm an appointment, or ask the individual to call back.” OCR says the”Privacy Rule permits disclosure of limited information to family members, friends, or other persons regarding an individual’s care” but that health care providers should “use professional judgment to assure that such disclosures are in the best interest of the individual and limit the information disclosed.”

This raises a significant question: “How are covered entities expected to determine what is the minimum necessary information that can be used, disclosed, or requested for a particular purpose?” The OCR says that health care providers must “make their own assessment of what protected health information is reasonably necessary for a particular purpose…and implement policies and procedures accordingly.” There is more language regarding reasonableness, but the bottom line is that no safe harbor is given in OCR’s guidance. However, it is clear that the health care provider, rather than the business associate, is responsible, according to HHS, for establishing the minimum necessary policies and procedures.

Next steps for call centers: Since a business associate’s obligations are contractual, rather than regulatory, a call center might ask the health care provider to specify in the contract what information can be released to whom in given situations. A call center might ask for a contract that creates a kind of safe harbor, relieving the call center from breach of contract claims by the health care provider if the specific policies and procedures of the health care provider (as opposed to a general policy) have been followed, whether or not those policies ultimately are found to be in compliance with HIPAA. Getting assistance from legal counsel in forming such contracts is a good idea.

Mike Wilson is an attorney and author. He teaches at Sullivan University in Lexington, Kentucky. This article should not be construed or relied upon as legal advice.

[From Connection MagazineMarch 2003]

The Trouble with Medical Messaging Service

By Joseph Sameh

Nationally, medical telemessaging service has a problem. Typically, when a person purchases a service, there is a perceived notion of value gained through that purchase. Housekeeping, snow removal, tow truck services, and office janitorial services are just a few examples. Physicians’ point of view towards answering service once fell into that category as well. But that was then and this is now.

The Problem: Each evening for more than 60 years, answering services have been providing overnight backup telephone support for physicians. Many of our readers are descendants of these pioneers. Today, messaging services for doctors are considered a necessary evil. When patients call after hours, the physician may be contacted by the answering or messaging service. If so, the physician and the patient discuss the crisis at hand and map out a strategy. For all the commitment, hard work, and effort of the call center staff, the only thing the physician perceives today is an invoice from the call center at the end of the month — that is with the exception of the middle of the night wake up call to treat the patient. How would you feel if you were a purchaser of this service?

Early on, and before, managed care, most patients and their physicians had a one-to-one relationship that lasted throughout their lives. Most physicians were sole proprietors in private practice. When a patient called the doctor after office hours, the doctor naturally had great insight into the patient’s history and medical needs. The two grew old together. The invoice amount paid by the physician to the message service was viewed as part of the overall cost of maintaining good relations with the patient in an era of increasing economic advantage for healthcare providers. A fee for service insurance reimbursement model characterized the era. As such, the patient and the provider were both beneficiaries of the after hours call. The patient received the round the clock care that was expected and the physician knew the patient would be a loyal customer in return.

With the advent of managed care, certain concurrent events changed the landscape of medical practice management. One change that exerted great influence on the patient-provider relationship was managed care itself and the impact of its lists of network providers. No longer was the relationship between patient and provider under the control of the patient and the physician. It was suddenly under the influence and control of the insurers and employers.

Managed Care Organizations (MCOs) began to apply downward financial pressure for reimbursements to physicians. As a result, the patient/provider relationship hit a low point. Patients began to complain that not enough time was spent with them in the office. Sometimes physicians were no longer readily available after hours. Doctors began to complain that they couldn’t treat the individual appropriately due to managed care oversight. Doctors also began to experience income stagnation and even contraction. Consequently, doctors no longer perceived themselves as the beneficiaries of the after-hours transaction. The new beneficiaries became the patient, the answering service, and on occasion the pharmacy.

Your physician however still has to retain 24-hour coverage, and therein lies the problem. Physicians still must pay for messaging services. Along with the emergence of MCOs and due to some of the same pressures, solo practices began to disappear as ever increasing group size became an unpleasant fact. This trend benefited the physician in some quality of life measures. Permitting and supporting a nightly call coverage scenario, one in which physicians began to experience evenings off on a regular basis, is one such benefit. The era of sole proprietorship was largely over. Now we have the day of the physician-employee. This further inflamed the breach in the patient/provider covenant as patients lost control over who would manage both their daytime and after-hours needs.

Development of large, multi-disciplinary groups led to another tension: the successful management of on-call coverage schema by the message center. Due to human error or lack of understanding, often the wrong physician is paged or no one at all is contacted for urgent matters. Indeed, industry experts agree that incorrect message dispatch is the most daunting issue for doctors in medical messaging today.

Adding to this challenge, outside market forces have inevitably affected every provider to the health care field. Answering service is no exception to this reality. In terms of inflation-adjusted dollars, the rates for answering services are significantly lower today than they were 20 years ago. Labor costs are higher as a percentage of overall costs than ever. An abundance of high-tech equipment and a search for lower paid, entry-level employees answering phones for doctors is the result. When one adds the cost to adequately train and retain quality employees there is scant room for error on the employer’s part.

To add insult to injury, regulatory pressures on the health care delivery system have created more paperwork for every medical practice. Consequently office staff has a greater burden than ever before. According to Howard Wolinsky, co-author of Healthcare Online For Dummies and a veteran medical and technology reporter for the Chicago Sun-Times, “If we could get physicians and their patients to communicate via email and avoid voice mail jail, we could save loads of time and even squeeze out more time for docs to spend with their patients face to face. Now that would be a breakthrough.” According to Wolinsky, “with the availability of broadband and new technologies, the pieces already are in place.”

Other sources, including Harris Interactive, according to the results of a survey conducted in April 2002 indicate that 95 percent of patients want to exchange email with their doctors. However, a much smaller percentage of doctors do so. This suggests that many patients hope doctors will take advantage of Internet technology to improve patient outreach efforts, but that doctors themselves may still be ambivalent. We’ll explore doctors’ current attitudes towards technological change in our next article, Technology: Threat and Opportunity, to be published in the next issue.

Joseph Sameh is the founder of Mediconnect, Phone Screen, and NeedMyDoctor.

See part two, The Trouble with Medical Messaging Service,

[From Connection MagazineJan/Feb 2003]

Knowledge of HIPAA Important for Medical Call Centers

By Luanne Sorenson

Call Centers interested in providing contracted services to health care providers will have a competitive advantage if they are familiar with HIPAA requirements.

What is HIPAA? HIPAA stands for “Health Insurance Portability and Accountability Act.” It is a federal law that went into effect on April 14, 2001. Passed in 1996, the law provides new safeguards to protect patient privacy and confidentiality. In the past, some states have had extensive privacy guidelines while others have had very little. In enacting HIPAA, Congress mandated the establishment of comprehensive federal standards for the “privacy of individually identifiable health information.” The Privacy Rule requires that covered entities “reasonably safeguard” protected health information (PHI) – including electronic and oral information.

According to a U.S. Department of Health and Human Services (HHS) fact sheet dated July 6, 2001, most health plans, health care providers, and health care clearinghouses must comply with the new requirements by April 14, 2003. The law gives HHS authority to make appropriate changes to the rule prior to the compliance date. The Office for Civil Rights (OCR) within HHS has been given responsibility to ensure that HIPAA regulations are explained and enforced.

The OCR points out that “health care providers have a strong tradition of safeguarding private health information. But in today’s world, the old system of paper records in locked filing cabinets is not enough. With information broadly held and transmitted electronically, the rule provides clear standards for all parties regarding protection of personal health information.”

Across the country, health care organizations are working hard to ensure that they are HIPAA compliant by the 2003 deadline. Under HIPAA, patients have significant new rights to understand and control how their health information is used. While final interpretations are still being worked on, all covered entities are required to adopt written privacy procedures. According to HHS, the privacy procedures must include who has access to protected information, how it will be used within the entity, and when the information may be disclosed. Covered entities also must educate employees on the new procedures and designate a privacy officer. In addition, covered entities must take steps to ensure that their business associates protect the privacy of health information.

How does this impact call centers? Under the law, independent call centers are considered business associates. As such the Privacy Rule requires providers and health plans to obtain from their call center, satisfactory assurances, typically through contract, that the center will use the information only for clearly defined purposes, safeguard the information from misuse, and help the covered entity meet HIPAA compliance obligations.

The Privacy Rule also is impacting call center operations. For example, some call centers provide outbound services reminding patients of upcoming appointments. Some interpretations of HIPAA maintain, that when such calls are made, the calling agency cannot leave a message that includes the patient’s name and the nature of the appointment. Instead, verbiage such as, “this is to remind you that someone in your household has an appointment at X clinic on X date” must be used. In some cases, this change is causing confusion among patients who have begun to question why the healthcare organization is calling with a reminder when not enough useful information is provided.

In February of 2001, Secretary Tommy Thompson requested public comments on the final rule to help HHS assess the real impact of HIPAA regulations on health care delivery. During the 30-day comment period over 24,000 comments were received. According to the OCR, it continues to review this input “to determine what changes are appropriate to ensure that the rule protects patient privacy as intended without harming consumers’ access to care or the quality of that care.”

Keep yourself informed as new interpretations are released regarding HIPAA. Initial guidance and other information about the new Privacy Rule are available on the Web at www.hhs.gov/hipaa.

Luanne Sorenson is the Director of Customer Relations at Gundersen Lutheran Medical Center In La Crosse, WI.

[From Connection MagazineJan/Feb 2002]