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Can Smart Phones be “Smart Enough” to Replace RNs in Call Centers?

Can Smart Phones be “Smart Enough” to Replace RNs in Call Centers?. Barry W. Wolcott Associate Professor Military and Emergency Medicine Uniformed Services University, Bethesda, MD and Chief Medical Officer, Expert-24 LTD barry@expert-24.com. A common d ilemma. WHAT TO DO. SICK.

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Can Smart Phones be “Smart Enough” to Replace RNs in Call Centers?

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  1. Can Smart Phones be “Smart Enough” to Replace RNs in Call Centers? Barry W. Wolcott Associate Professor Military and Emergency Medicine Uniformed Services University, Bethesda, MD and Chief Medical Officer, Expert-24 LTD barry@expert-24.com

  2. A common dilemma WHAT TO DO SICK

  3. Conventional options Play the odds Seek help

  4. You could … Call, and … … Ask A Nurse • Actually Answer Your Question: What to Do • Convenient • Proven safe • No Out-of-Pocket Cost

  5. … but, that is so “90’s”

  6. You have on-line options …

  7. ... but, at best, you get … A list of possible causes:

  8. … and lots of stuff to read …

  9. … but, no real guidance!

  10. An on-line tool must … • Be web and mobile device enabled; • Utilize robust branch-chained decision support tools mimicking the complexity of tools used by RNs in Call Centers; • Provide a recommendation as to the medically most appropriate “next step.”

  11. …while being simultaneously … Deep Broad

  12. … and considering causes … Common Rare

  13. … ultimately, giving real guidance Evaluation now Watchful waiting

  14. Low Back Pain Questions:

  15. Current sources In US: In UK: Primary driver currently is to reduce call center overhead while retaining acceptable ring-to-answer time … that driver is morphing into a perceived need to be “mobile accessible.”

  16. Can Smart Phones be “Smart Enough” to Replace RNs in Call Centers? Yes, about 35% of the time!

  17. QUESTIONS

  18. Telephone-Based Nurse Triage Call Centers in the US • Began in late 1980’s … now ubiquitous; • Provide millions of caller each year with advice as to “what to do next” … from “Call 911” to “Self Care and Watchful Waiting;” • Operated/Contracted for by Plans, Payers, Employers to reduce: • Medically unproductive ED/Acute care visits; • Absenteeism; • Out-of-pocket employee costs; • Very popular and accepted.

  19. Early Concerns Easily Overcome • Advice Quality: Advice mirrors that of equally informed physicians • User Acceptance: 90% subsequently report they followed the advice provided; • Liability: No liability verdicts for properly operated systems; • Cost Effectiveness: Consistently > 3:1 ROI

  20. How Is It Done • RNs telephone interview and subsequent recommendations guided by decision support software that considers: • What conditions could cause that symptoms? • How frequently is each of those conditions among callers of this age and gender (pre-test probability)? • Are there RN-gatherable Q-A pairs that combine to lower the pre-test probability sufficiently to “clinically exclude” each condition? • What would be the best advice for each condition, if it were present? • How great are the effects of a delay in diagnostic evaluation? • What is the “worse” condition that cannot be “clinically excluded?”

  21. Between Scylla and Charybdis • Call Center Costs: Primarily determined by a contractual requirement to meet a client-determined “ring-to-answer-time” 95% of the time; • Effectiveness: Lengthening the R-T-A time results in: • More hang-ups and follow-on ED/Urgent care visits; • Caller ill-will • Increased likelihood that evaluation of a serious condition will be delayed.

  22. Reality Check • The shorter the ring-to-answer-time, the larger the number of nurses that must be on duty at any moment … however, much of the available nurse time will be required only for high call volume periods of the shift; • The cost-per-call answered rises with each reduction in ring-to-answer time … and rises dramatically with incremental lowering below 2 minutes; • Achieving ring-to-answer-times of 30 seconds (a common desired performance level) produces costs-per-call in the range of $30-$45; • Substituting a mobile application that succeeds in mimicking Call Center RN performance would have a dramatic effect on costs … even if only used 30% of users.

  23. Can Symptom Assessment Be Done Safely “On-Line?” • Yes, but … Not using the “symptom checkers” currently available on major medical information web-sites … these are “toys, not tools;” • On-Line Success Stories: • In The US: • Mayo Clinic • McKesson • In the UK: • http://www.nhsdirect.nhs.uk/en/CheckSymptoms • http://health.expert-24.com/demo/symptomAssessment.aspx?m=TlNbYw5ov8Y%3d&d=M9Wg9MgbQOldqA5aQ0Gx8Q%3d%3d&a=gawL1tadiEk%3d&t=PzsQSJzNED3widopoejbS8GQY1h1Ne%2fbVQtZ%2f6CAeDFk9cRUTpN0wQ%3d%3d&g=autEvoqQy5E%3d

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