Unlike Gordon Petrie, Don Carlberg didn't need a big-picture view; rather, he needed something that would help him bring his entrepreneurial vision into focus. Casting about for a business model for a new high-tech health-care company, he asked himself this question: "What single piece of technology can be used by virtually anyone, is instantaneous, and is two-way?" He takes pleasure in pointing out that the answer is not the Internet but the telephone, and that's why his company, three-year-old Patient Infosystems, in Rochester, N.Y., revolves around call-center technology--combining such cutting-edge applications as interactive voice response (IVR), computer telephony integration (CTI), preview dialing, on-demand publishing, and artificial intelligence. Notes call-center manager Betty Ann Brunton, "We have a lot of technology for a small company, with a lot of capability. And we are anxious to use it."
Simply put, Patient Infosystems, which has 75 employees, uses the telephone to help patients take better care of themselves. The idea for it sprang from a growing body of scientific research that documents how people are often more comfortable talking about sensitive medical issues to an automated telephone system than they are to a live person. Studies have shown that individuals will divulge more intimate personal details to a computer-generated voice asking questions (IVR) than they will to a real human being on the other end of the line.
Patient Infosystems exploits that preference to tackle a thorny issue bedeviling the health-care community. Despite the fact that doctors and health-care providers have more expertise than ever and that more people are better informed about health, health risks, and unhealthful behavior, between 30% and 60% of patients nonetheless don't comply with their prescribed treatment. That has at least two negative consequences that Patient Infosystems aims to address: patients don't get well, and health-care costs go up.
Patient Infosystems uses its elaborate call center to conduct regularly scheduled interviews with various patient populations--asthmatics, diabetics, those suffering from heart disease, for example--to gather information about how those people are managing their diseases and their treatment plans. The phone system, which is hooked up to the company's patient database (hence the CTI), automatically uses the patient feedback gathered in the "conversation" to generate customized, personal reports (on-demand publishing) that employees of Patient Infosystems then mail or in some instances fax to the patients and their doctors. The patients' health-care providers foot the bill for the service, whose cost varies according to the frequency of calls and the nature of the disease but in general runs from $12 to $16 a session.
Like Famous Smoke Shop and Jacobs' Golf Group, Patient Infosystems has some inbound lines (a nurses' hot line and some survey-response lines, for example) that are managed with an ACD (a Meridien One, from Nortel, 800-4NORTEL, nortel.com, $500 to $700 per seat, or agent). But the bulk of its call-center operation is outbound based and relies on a software program called Campaign Manager (from Genesys Telecommunications Laboratories, 888-GENESYS, www.genesyslab.com, $3,000 to $4,000 a user for 50 users). The Unix-based software (it's also available in Windows NT) works in conjunction with Patient Infosystems' proprietary patient database (which was built in-house and runs on an Oracle server). It begins its job by scanning through the database records and determining who needs to be called on a given day, in a given window of time, based on parameters established during initial patient-enrollment interviews or on information provided by the sponsoring health-care provider.
To avoid alienating patients with its technology, Patient Infosystems always starts its sessions with a live operator before transferring patients into the voice system. Campaign Manager facilitates outbound calling by checking to see which of the company's 20 patient-service representatives is currently available and then, only after ascertaining that a person is ready to make a call, initiates dialing.
Once in the voice system, patients typically respond to a series of questions (such as "In the past month, how many nights did asthma symptoms awaken you?") by saying a number between, for instance, one and nine or, in some instances, answering yes or no. The system is fairly skilled at understanding a variety of accents and intonations (and words like "none"), thanks to voice-recognition and artificial-intelligence components in the software. Based on the patient's response, Campaign Manager will then select another question to ask or a comment to make (for instance, "Ask your doctor for instructions on what you should do when you have an [asthma] episode"). Patients have the option at any time to exit the system and return to a live operator (they do so by saying "stop"), but so far, since the company began running its sessions, last summer, between 75% and 80% of patients have opted to remain in the automated system. If and when patients do switch back to a live rep, IVR technology enables the operator to pick right up where the patient left off in the automated system--regardless of whether the operator is the one who initiated the call.
