Health Information Centers

Key to a Healthy Future

Effective personal health management relies on proven medicine, highly specialized technology, and synergistic expertise to improve health and sustain a competitive advantage. All three can be provided efficiently and effectively though a Health Information Center (Medical Call Center).

A Health Information Center is an accessible, cost-effective resource center where trained medical professionals (Registered Nurses or Physicians) take calls from health plan members, patients, employees or citizens who want professional healthcare advice, information and placement in the medical treatment system. After talking together, the medical professional uses his or her judgment and clinical algorithms to evaluate the caller’s needs. The caller is then redirected to the right care resource or information.

With medical professionals on the telephone using specialized software and interactive audio technology, time and again a Health Information Center proves to be the single best strategy to deliver the right care at the right time in the right setting with the right resources. Programs anchored in a Health Information Center are measurable, manageable and actionable. Both processes and results become increasingly accountable.

Functions of a Health Information Center

Healthcare leaders use Health Information Centers for a remarkable variety of clinical, administrative and marketing functions, including:

• 24 Hour health advice and triage
• Public health surveys and alerts
• Utilization reviews
• After-hours triage
• Open enrollment marketing
• Physician-to-physician referral
• Emergency department authorization
• Pediatric Hotline
• Patient follow-up
• Compliance monitoring and counseling
• Primary care physician (PCP) assignment
• Complaint follow-up
• Health information inquiries
• Meeting or class registrations
• Outcomes evaluation
• Direct contract management
• Market research and surveys
• Membership programs
• Benefit information
• Physician referrals
• Program or product launches

Triage Call Processing

FONEMED’s FoneMedic advice begins when a call comes into the Health Information Center telephone switch. The caller first hears a disclaimer advising him/her to call the local emergency number in the case of an emergency, otherwise to remain on the line for the first available FoneMedic. That call is then transferred to an available FoneMedic, who identifies him/herself by name and profession.

The FoneMedic takes the call and looks up the patient’s demographic information and call history. The FoneMedic verifies that the information is still correct, as well as verifying the phone number that the caller is using (in case emergency dispatch is needed during the call itself).

The FoneMedic asks the caller the reason for the call and what the caller’s original intention was, if he/she had not called the service (e.g. “I’d have gone to the E.R.”, “I was thinking of calling my doctor in the morning”, “I can take care of this myself”).  The FoneMedic then asks a number of preliminary assessment questions such as symptom duration, exacerbating and relieving factors, current medications, temperature, allergies and relevant medical history and enters this data into the software.

The FoneMedic selects the most appropriate medical protocol and quickly reviews the preliminary information in that protocol (i.e. the differential diagnoses). The software guides the FoneMedic through a series of triage questions (from most critical to least critical).  The FoneMedic clicks Yes or No to reflect the caller’s response to each question.

The algorithmic software generates a recommended disposition based on the answers to these questions. Possible Final Dispositions are: Immediate (ED); Urgent Care; Self Care/Home Care; and see Physician (in a specific amount of time).  The FoneMedic can accept this as the Final Disposition or override it, but he/she can only override it with a more-urgent disposition, based on his/her medical knowledge and professional impression of the call and caller.

The FoneMedic is able to document his/her clinical impression, as well “cut and paste” information from the Final Disposition and Recommended Action screen into the Notes section of the software, which makes them a permanent part of the call record. 

The FoneMedic then asks the caller to repeat back in his/her own words what the FoneMedic has just recommended that he/she do, and asks whether or not the caller will comply with the recommendation. The caller is reminded that they are the final judge of what is right for them, but that they can call back at any time. The call is then closed and all information entered and patient responses are, at that point, unchangeable. 

If the disposition is to seek immediate Emergency attention, the software automatically prompts a FoneMedic call-back every 15 minutes, to ensure successful referral; in other cases where the FoneMedic feels that follow up is appropriate, the FoneMedic can prompt the software to remind him/her to do a follow up call at any time interval.

Reporting

An Encounter Report that documents the most important aspects of the call is built automatically during every call, and with the client’s permission this report can be faxed to the E.D. or to the caller’s physician of record at the conclusion of the call.

Summary utilization reports are prepared monthly for clients, showing the breakdown of who used the triage service in the last month by day, sex, age, original inclination and final disposition, among other general demographic information. These reports also include patient satisfaction, which is obtained through outbound calls to a random sampling of callers every week.