Appliances, free software and software-as-a-service offerings all provide feature benefits, as well.
Telephone consultations constitute 10 percent to 20 percent of all primary-care interactions, up to 80 percent of after-hours care, and account for more than one quarter of all medical decisions in some sub-specialties. Though phone interactions are characterized by a greater probability of malpractice lawsuits than face-to-face interactions, providers document fewer than 30 percent of phone interactions and most commonly rely on medically untrained phone operators to screen and relay messages to on-call providers.
For smaller practices, or practices that rely on telephone triage services to manage most after-hours patient care requests, a one-time investment of less than $5,000 in a configurable unified-messaging appliance might be considered. These appliances are feature rich and allow practices to configure a work flow that meets their specific needs. Modern messaging appliances include features allowing users to receive instant notification of messages via e-mail or SMS, return calls from the voice-mail interface, and record live conversations. Since the appliances eliminate the need for a third-party intermediary, patient privacy and HIPAA risk is better managed.
Chad Jensen, IT manager at LaTouche Pediatrics in Anchorage, Alaska, replaced his practice's answering service with a unified messaging appliance that integrates with an existing PBX and has resulted in almost no incremental recurring cost. The investment paid for itself in less than one year. Jensen notes that practices with complex call schedules, specific call-escalation protocols, or other advanced needs should consider options with an enhanced feature set.
Asterisk is one of several freely available open-source telephony-development platforms that turn standard computer hardware into customized voice-application servers. Asterisk is used to power small office PBX systems and large call centers. Asterisk is not an application specifically designed for medical practices, but rather a set of programming tools that can be manipulated to meet specifications.
Using Asterisk, a competent engineer can develop customized applications that perform automated functions, including message capture and transmission to the on-call provider, message escalation of notifications to backup devices and call recording. There are a variety of integration opportunities, including integration with EHRs (drop recordings into a patient's chart) and scheduling systems (automate appointment reminders).
The primary benefits of Asterisk are its flexibility and the potential to control long-term recurring costs. Asterisk has no licensing cost and runs well on barebones computer hardware. Furthermore, an Asterisk application can work with both voice-over-IP and PRI lines, and should produce little or no incremental change in recurring phone charges. The major investment associated with implementing an Asterisk-based solution is labor (a competent programmer with Linux experience is required).
Simple Asterisk systems can be implemented in a matter of days or weeks, while larger projects would consume proportionally larger resources. Customized Asterisk implementations make sense for larger practices looking to make a moderate one-time investment in order to automate several telephony processes and eliminate large monthly answering service bills.
Another alternative for practices are software-as-a-service (SaaS) products that can be configured to answer calls, collect messages and transmit notifications to an on-call provider's device of choice according to a predefined call schedule.
Once configured, practices forward their phones to a number provided by the vendor, and the vendor's servers handle calls according to the agreed-upon protocol. The SaaS option is typically offered at a flat monthly rate; minutes are not counted and superfluous fees are not assessed. Call recordings can be maintained, downloaded over an encrypted connection and placed in an EHR.
Sidney VanNess is president and CEO of On Call Central.
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