Efficiency on the Line

Telephony Produces Effective Patient Communication

By Susanna Donato
Susanna Donato is a writer for Physicians Practice

Your phone system is a common, but often overlooked, tool that can improve your staff’s use of time and also help satisfy patients. With current technology, practices can easily automate tasks through phone technology, or "telephony" as it is commonly called.

Elizabeth Woodcock, director of knowledge management for Physicians Practice, estimated that less than 10 percent of solo practices use sophisticated telephone products. But once practices grow larger, Woodcock, said many turn to telephony to streamline calls and automate work processes. For the most part, practices use the technology for appointment reminders or to report lab results, although there are many other uses for telephony.

Press one to confirm
Automated appointment reminders can turn arduous hours of phone calls into just a few minutes of work each day. Many patients already are familiar with automated-reminder technology. Best of all, now reminders call patients with a familiar, human voice. Patients can respond during the call by confirming an appointment, canceling it or leaving a message for the practice.

"The setup might include five minutes a day, just sending the next day's schedule from one PC to another," reported Lorraine Laurio, medical receptionist for Springhill Dermatology Clinic in Mobile, Ala. Laurio has managed the practice's TeleVox system since the early 1990s for appointment reminders, lab results and health reminder calls.

Springhill's system strings together appointment reminder messages from a series of prerecorded items: name, date and time. The computer automatically produces the messages from appointment information in the office’s practice management system. "Everything is in a first-name library, so once 'Paul,' for instance, is recorded, it's in there forever," said Laurio.

The main function of automated reminders is the same as manual phone calls: to reduce appointment no-shows. Automated reminders work because the computer has time to call every day. Calls aren't pushed aside if the flu wipes out the reception staff; and unlike reminder letters, calls can be placed even to patients who recently made or changed their appointments.

"Not too long ago, we had implemented a mailed appointment reminder that had a significant impact on our no-show rate, but an appointment had to be booked 10 days in advance for patients to receive the letter," explained Laura Klepper, manager of health information services for a series of clinics affiliated with Vanderbilt University Medical Center in Nashville.

Klepper noted, however, that Vanderbilt's system "isn't going to completely eliminate people. We get the report in the morning and have to work through those reports and call people who want to reschedule their appointments." At Vanderbilt clinics, where appointments are difficult to get, the staff sometimes goes a step beyond their system's cancellation option. "Some staff call the patients who cancel appointments, to make certain that the appointment wasn't canceled accidentally," Klepper said.

Lab results on the line
In addition to appointment reminders, some practices, like Springhill Dermatology, make lab results available to patients via the telephone. These systems usually let patients dial in with an identification code to retrieve results of a test.

"I like a system that records results and comments in a human voice instead of a computer voice — or, best of all, recorded by the physician," said Woodcock. "And look for the ability to offer different languages as determined by your patient base."

Springhill utilizes a human voice for its recording. After the dermatologist, B. Fred Bodie, M.D., enters benign lab reports into the computer, patients can call 24 hours a day to get their information, reported in Laurio's voice.

"We never have had a negative response about the labs. A few patients who want a more in-depth answer call to ask what [their test result] was. But it eases their mind just to know a test was benign," said Laurio.

Dollars-and-cents of dialing
Appointment reminder services cost from a few hundred dollars into the thousands. Turnkey software lets you customize a program run on a server within an office. To slice costs, most programs also offer a hosted or application service provider (ASP) version that runs on the Internet. Turnkey versions typically cost about $5,000, while hosted versions range from $500 to more than $2,500, depending on the complexity of the system. For instance, lab-reporting software is pricier than appointment reminder services. In addition, services charge either a monthly flat fee or a per-call rate to cover telephone expenses. These rates typically hover around 25 cents per appointment reminder and 75 cents per lab result.

"Before we started, we did a return-on-investment [projection] that showed a 5 percent reduction in our no-show rate would definitely pay for the system, and we have exceeded that," said Klepper. "We saved money by reducing the number of appointment reminder letters. That alone more than paid for the system."

Most small to medium practices can use their existing phone lines, as calls are typically made in the evenings, when phones aren't being used anyway. Very large practices might need specialized equipment. Vanderbilt, for instance, installed a T1 line, which Klepper explained has the capacity equivalent to 24 phone lines, to confirm about 1,900 appointments per day.

Choosing a system
Like any technology, telephony is only worth its cost if it pays for itself. "Weigh the expense versus what you’re spending now," Woodcock cautioned. "It totally depends on the cost and your spending now, but I have seen practices that end up spending more on telephony systems than doing it manually. And, your return on investment (ROI) will be higher if the system is completely automated," Woodcock added. Otherwise, you'll just trade time on the phone for time entering information into the telephone system.

To find out if patients like the system, Woodcock encourages practices to do a pre- and post-implementation patient satisfaction form. "Interview staff, too, if it affects them," she suggested. "If you remove appointment reminders from the front desk, what has it done for the practice?"

This last point is crucial to success. "Before you even look at telephony, look at your underlying processes," Woodcock said. "Telephony doesn't solve the problem — you still have to answer calls and get information to patients. Telephony is just a way to batch or organize work in a better way. It shouldn’t be a substitute for good processes."