Can You Hear Patients Now?
Written by KENYA MCCULLUM
TELEHEALTH SERVICES ENHANCE TREATMENT PATIENTS RECEIVE.
Just as technology has helped improve complex military operations, it has also made military medicine more efficient. Through the use of telephones and computers, trained professionals have been able to supplement the care patients normally receive in a clinical setting and make certain treatments available in the privacy of patients’ homes.
TELEPHONE NURSING
Since March 2005, the Fort Reilly Army base in Kansas has provided telephone triage services to its resident families through the Nurse Advice Line, which has two registered nurses available for consultation. From 7:30 a.m. to 7:30 p.m. on Mondays through Fridays and 9 to 5 on weekends and holidays, servicemembers at the base and their beneficiaries are able to call the hotline to discuss medical concerns— which in some cases actually saves them a trip to the clinic or emergency room.
When patients call, the help line nurses use a care enhanced call center (CECC) program manufactured by McKesson—a San Francisco-based health care services company—in order to determine the appropriate course of action. First, a nurse on the hotline will use the CECC program to intake a patient’s symptoms by asking a series of questions. As each answer is entered into the program, more questions will be asked based on the answers patients have given, and a solution to the problem is provided based on preprogrammed criteria and triage guidelines. As a result of the information given by the patient, a course of action—which may be completed at home, or may require that the patient consult a physician in person—is provided.
This type of service is helpful for patients, as it gives them the opportunity to get the medical advice they need from a trained professional without stepping foot out of their homes.
“What we see a lot of times is maybe there are young mothers, or first-time mothers, in our community here. They’re here by themselves, their husbands are deployed and they have questions about their children, or themselves, and they actually get to speak with someone,” said Diana Johnson, Fort Reilly disease management nurse. “If they need an appointment, of course an appointment is made. At least they can ask somebody and we can actually give advice. I think it’s a great benefit to our community.”
In addition, the nurse help line frees up providers so that they can handle only cases that cannot be solved by the triage system alone. This is particularly important because the medical clinics on military bases tend to be understaffed. However, this problem is not entirely alleviated at Fort Reilly because the hotline does not currently operate 24 hours a day. Right now, when patients call after hours, they receive an answering machine message that instructs them to call the emergency room if they feel it’s necessary. However, this is not an ideal recourse because emergency rooms are not designed to dispense any medical advice via telephone— causing the patient to make a visit that could have been handled through telephone triage.
To remedy this problem, Fort Reilly is in the process of looking for qualified contract nurses, with extensive backgrounds in telehealth services, who will use the same CECC program and follow the same procedures as the nurses in house—allowing the line to extend its hours seamlessly.
“It’ll be transparent to our patients. These people will be located off site, but they’ll be using our same system, so that the advice—no matter what time day or night that they call—the advice will be the same no matter who is talking to them.” said Johnson. “We feel it’s going to be an enhanced benefit to our patients if they have that 24 hour service in place.”
OUTSOURCING TELEHEALTH SERVICES
Fort Reilly is not the only military health care outfit extending its hours of operation through the use of outsourcing: There are several call centers that handle the flow of these calls during an office’s down time, or when providers are too busy to handle the phones themselves.
Contrary to the old model of patients simply calling an answering service and leaving a message for a physician, the services these companies provide have evolved: The employees at these call centers are trained professionals who use more interactive tools that give them more specific information on what each patient who calls in needs.
Call 4 Health, which provides telehealth services to both military and civilian clients, was founded because of the old model of answering services that are not equipped to deal with the complexity and emotion involved when patients need medical help. Ten years ago, Call 4 Health’s CEO and founder Joseph Pores was caring for his mother, who had terminal cancer, and was flabbergasted by the unprofessional and uncaring treatment that he received when he tried to reach her doctor.
“It was a horrible experience and it amazed me that for such a specific need, and in such a fragile situation that I was in as a caregiver, that these [doctors’] offices didn’t take into consideration who was representing them after hours,” he said.
After his mother passed away, Pores made it his mission to make a difference in the industry, and provide care that is 180 degrees removed from the experience that he had when he was caring for his ailing mother.
“Everybody that works for us, answers the telephone as if it were a family member—they take a personal interest in the phone calls, they’re compassionate, they’re empathetic, they’re precise, and they never lose track of what I went through when I was dealing with it,” said Pores. “We want to be the compassionate call center. We want to make sure that the patients are put first. I’m a firm believer that health care needs to be consumer driven, and the entire industry needs to take heed to what the patients’ needs are and to put their cares first.”
Part of what allows Call 4 Health, and similar companies, to provide this level of service is the technology they use. Through the use of software that is commonly utilized in the call center industry, a company can provide services to the military health care facilities that are effective and efficient. For ease of use, each client is assigned a unique telephone number—known in the call center industry as a direct inward dial, or DID—which they will forward their phones to when personnel will be out of the office for the day or for any other breaks from the telephone.
After calls have been forwarded, when a patient calls, call center employees use call management software that instructs them to ask a series of questions based on the parameters determined by the company’s clients. The questions advance on the screen based on the answers given by the patient, and when the nature of the problem has been entered into the program, it gives the employee a solution—from paging a doctor to advising a patient to make an appointment or go to the emergency room.
Call centers like these that can serve the military’s patients are extremely beneficial, as they frees up military personnel to handle less routine problems and more emergency care—and the time can also translate into lives of soldiers in the theater being saved as well.
“If you’ve got a C-130 aircraft that wants to launch at Charleston to take supplies to Iraq and the pilot says, ‘I’m feeling dizzy, I’m not sure it’s safe for me to go,’ and those supplies are expected on the ground, they have people waiting for them, and that stuff just can’t sit around and wait,” said Michael Leibowitz, president of Call Experts, a South Carolina-based call center with military clientele that includes Air Force and Navy bases. “If you’re the oncall duty officer, you’ve got a lot on your plate. A lot of things are expected of a duty officer and if you’re constantly answering the phone it may be something that doesn’t require the attention of a duty officer who is supposed to be logging incoming traffic or making sure field supplies are sent out. It takes attention away from stuff that’s probably better handled by them than the stuff that can be easily handled by a third party”.
And of course, another important benefit the military enjoys from using companies like Call 4 Health and Call Experts is the cost effectiveness of outsourcing these telephone triage services.
“If a military base was to contract somebody to answer their appointment calls and they do 2,000 appointment calls a month, just to handle the phone calls they would need three people, at a minimum of $25,000 per year. You’re looking $75,000 per year there, where the same amount of appointments can be done by a call center at a dollar per appointment,” said Pores. “Where would you rather have your highly trained people? Does it make sense to take one of the nurses from the clinic and have them dealing with the calls when they’re making the higher end of the pay scale? And more importantly, if they’re on the phone, they’re not able to help patients.”
TAKING TRIAGE TO A NEW LEVEL
In addition to call centers, military health care professionals are also making use of telehealth monitors, such as those manufactured by Viterion TeleHealthcare, which can keep patients in constant contact with their providers without requiring them to go into the office. Through these products, doctors can monitor their patients’ progress and give them feedback, while only asking them to actually come into the office when necessary.
Some of Viterion’s products that are used by military and VA doctors include the Viterion Link, which can be hooked up to instruments that measure vital signs, which is sent to a database. As a result, the patient’s nurse and physician can log into a Website to check information—such as the patient’s blood sugar level, blood pressure and weight. The Viterion 100 TeleHealth Monitor picks up where the Viterion Link leaves off, and adds the ability for clinicians to send patients questions that allow them to determine whether the patient is at any risk or needs a change in treatment options. In addition, the company also manufacturers the Viterion 500 TeleHealth Monitor, which combines the technology of the Viterion Link and the Viterion 100, and adds a videophone component so that the health care practitioner can speak with the patient live.
These kinds of products are helpful and convenient for doctors, because it allows them access to their patient’s progress on a daily basis and helps them treat them accordingly without a visit to the office.
“This works extremely well because in our health care system—especially when you have a chronic disease like diabetes— patients generally see their physicians at the most, five or six times a year,” said Sunil Hazaray, Viterion’s president and CEO. “But these products allow almost for daily monitoring, and you really have the ability with our system to catch if something is going off the track at that right moment. That way it prevents more serious illnesses, or it prevents hospitalization.”
In addition, oftentimes veterans in the VA system have to travel long distances to reach their nearest VA hospital for treatment. The use of telehealth monitoring makes it easier for patients to receive care, while reducing travel time.
“Most veterans have to go to a VA site to receive care, and unlike a general citizen, they don’t have nearby access to a physician, since they might have to travel a distance to get to a VA hospital. Using this remote patient doctor or remote patient nurse is a great way to give them care,” Hazaray said. “If a patient in the VA system lives 300 miles away from the nearest VA hospital, it is probably impossible for him to make the monthly visits that the doctor wants him to. This is a good supplement, so that they can now see the doctor once in three months instead of once a month. And the doctor is quite satisfied, because he knows—since the patient is sending the data everyday—that if something happens he can immediately intervene or take the necessary steps.”
Telehealth services have come a long way and only are continuing to evolve in such a way to free up the time of medical personnel, so that they can handle emergency cases. For example, Pores of Call 4 Health would like to see all non-medical phone calls outsourced in the future.
“My personal mission is that call centers will be able to take any and all nonclinical phone calls away from the industry—meaning to get them back on track in dealing what they have to deal with, and that’s patient care,” he said. “Every appointment, every registration, and every prescription refill can be directed elsewhere.” ♦