Lines of Fire

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.

That's possible because Patient Infosystems' reps are prompted by their computers and read from scripts that appear on their screens (screen pops, a CTI feature). The scripted dialogue, which is generated with proprietary software called LOPs (for live operator positions) that the company developed, is hooked into Campaign Manager with a "proprietary interface," which pops it up on the screen of an operator the instant he or she receives the call, according to CIO Kent Tapper. LOPs also enable operators to scroll forward and backward through the screens--which is particularly helpful when multiple operators are involved in the same call or if a patient wishes to back up and repeat a question. At the conclusion of the session, more company-developed proprietary software, called DOX (a loose acronym for demand publishing system), in combination with Microsoft Word, translates and automatically prints out the results of the conversation in a customized report, which is then sent to the patient and the physician.

The reps' dialogue is all scripted, but since it varies according to the patient's response to each question, "there are thousands of paths in there," notes Brunton. In the previously mentioned asthma example, for instance, an operator would make a different suggestion or comment to the patient who was awoken nine times during the past month than to one who was awoken one time. One of the reps' biggest challenges is adhering to the script when patients prefer to veer. Included in the reps' two-week training session are role-playing exercises that prepare them for when a lonely, perhaps elderly patient wants to chat or when a patient asks a pointed medical question such as, "What is this red spot on my arm?" "We want to be friendly but not a buddy system," notes Brunton. "We still need to manage the call." The department appears to be succeeding: in a typical five-hour shift, 10 reps can reach as many as 1,200 patients--averaging an efficient two and a half minutes a call. (Including the automated portion of these calls, a typical patient session lasts from 8 to 15 minutes.)

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