�I�ve fallen, and I can�t get up.�
Yes, this old, verbally acerbic jab at the
elderly in the past passed as humor. Not only is the joke insipid, but
to those directly afflicted with the phrase�s principle it is an all-too
serious angst often expressed.
When a patient calls McKesson Health
Solutions CareEnhance Nurse Triage (provider of healthcare supply,
information and care management products and services), the situation
may be urgent. Granted, most times patients usually need advice about
seeking appropriate medical care, but occasional cases present the
caller in a life-or-death situation. When this happens, the McKesson
registered nurse who receives the call must summon multiple resources in
real time: notify a supervisor of the critical call situation,
collaborate with team members to manage urgent medical needs and contact
local emergency medical services to possibly dispatch an ambulance. This
must all be done without interrupting the patient call.
That such critical service requirements can
be managed is impressive, but it is dramatically more so when you
realize that the nurses, supervisors and other team members may be
working from home�separated by miles or perhaps time zones�real-time
connected via a secure
instant messaging system.
This virtual call center solution not only
meets the critical care needs of patients, it also provides significant
business benefits that can be measured in both dollars and in lives
saved (dollars/saved lives to be prioritized in interchangeable order,
having worked in a family practice, myself).
Beyond the obvious concerns of
compliance and information security, McKesson�s Medical Management Group
found itself directly confronted by an immediate tactical issue in its
CareEnhance business operation: how to continue to attract and retain
high caliber nursing talent in a tight labor market.
The CareEnhance program provides health plan
members with telephone access to qualified clinical nurses. Plan members
call with questions about health concerns, and McKesson nurses call
patients to provide information concerning chronic disease conditions
(asthma, diabetes and heart failure). McKesson�s direct clients for this
service include insurance companies and HMOs, state Medicaid programs,
the federal government and other large employers. The principal value
delivered by the call center-based CareEnhance program can be classified
into three areas:
Patients are screened to
identify urgent vs. non-urgent needs (i.e., peanut butter drying out
the roof of mouth vs. impending death) and receive a recommendation
to seek care at the appropriate level and time, eliminating
unnecessary visits for some (peanut butter) and encouraging quicker
service delivery for others (death).
Patients. Clinics, hospitals
and doctors are not able to spend as much time with each patient due
to increasing demands, rising costs and limited resources. The
CareEnhance service provides an additional avenue to patients
seeking information relative to their chronic condition or needed
Shortages. By bringing
together a staff of highly qualified nurses in a series of regional
call centers, McKesson is able to serve customers throughout the
country without requiring local staff. This allows McKesson to
reduce total staff numbers and to significantly expand customer
coverage at lower cost.
The current core vehicle of the CareEnhance
service is the call center, but this also presents a business challenge
for McKesson: how to maximize coverage to varying and shifting call
arrival patterns, manage costs, and ensure the highest level of clinical
services for every customer. McKesson determined that the answer to its
challenge was to establish a �work from home� solution for call center
nurses, eliminating the need for nurses to travel to and from a concrete
work facility. To make this solution a reality, McKesson identified a
series of governing requirements:
Resource Connections. A basic
benefit for nurses working in a call center is direct access to
resources for support and escalation. Moving nurses to their homes
could introduce an element of isolation unless nurses are able to
maintain direct, real-time access to their colleagues and
and Reliability. The services
provided (by McKesson nurses) are directly governed by the
requirements of HIPAA for patient record security. They are also
highly sensitive in nature: some customer cases are truly
�life-or-death.� Systems must be able to meet stringent security
requirements and ensure the highest possible level of uptime
Costs. In addition to
improving recruitment and retention of talented nurses, reducing
overhead expenses is a prime motivation for moving the nurses out of
a call center. Therefore, the solution must directly reduce costs
and not require significant technical support or infrastructure.
Excessive and unnecessary equipment must be eliminated, as well (Why
is there a life-sized Mr. T in your office, doctor?).
To combat these hindrances, McKesson claims
to have the answer. To achieve its objective of creating a �work from
home� solution for the CareEnhance program, McKesson implemented Jabber
XCP (not to be confused with Jibber Jabber MrT) as its enterprise
instant messaging solution, integrated with its existing
alert) infrastructure. Jabber XCP is what holds the system
together, allowing nurses to work at home while still maintaining direct
real-time connections with all required resources.
Once McKesson determined its business
objective and specific project requirements, the project team began
evaluating possible solutions. McKesson chose Jabber XCP as its EIM
solution for four reasons:
McKesson deployed a central Citrix server
farm as its solution architecture to make enterprise applications
available to remote nurses via a secure connection. Using a single
sign-on Citrix gateway, nurses have secure access to all in-house
applications. For additional security, all Jabber XCP and enterprise
application data transmissions are encrypted beyond HIPAA requirements
and validated through a central active directory to determine access
The Jabber XCP server is hosted in a secure
alert) to isolate instant messaging traffic from other application
resources, while the Citrix
alert) thin-client is remotely installed on user
machines during an initial connection. All Jabber XCP application
updates and maintenance are managed from the data center and are
transparently delivered to users.
The three primary business benefits and
outcomes are meant to be:
On Investment. Direct cost
savings from this program that add up to millions of dollars per
year have been identified (by McKesson), including reduced overhead
costs for physical facilities, lower labor costs due to more
flexible staff scheduling, as well as potential savings on equipment
and IT infrastructure.
Service Quality Improvement.
Staff are able to further enhance the
quality of service they provide to customers because teams are tied
together via Jabber XCP with a real-time connection that can be used
to escalate urgent calls, tie-in multiple resources for crisis
situations and provide real-time coaching for nurses without
interrupting the patient telephone call.
Staff retention and enrichment.
Clinical nurses have an opportunity
to work from home, which provides significant quality-of-life
benefits that complement the direct business benefits related to
real-time access to shared resources. Because nurses enjoy the �work
from home� experience (who wouldn�t enjoy a job in which one needn�t
dress up and can work from home over the phone?), offering this
opportunity assists the company in attracting and retaining the
highest caliber of nurses.
Jabber XCP enables McKesson to reduce costs,
enhance service delivery and retain employees without re-engineering the
core process that makes CareEnhance a success to begin with.
All of this could come in handy when grandma
is lying on the kitchen floor because you didn�t put the bread basket on
the uppermost shelf as she had asked you to the last time you visited
her (which isn�t often enough, by the way), cordless phone in reach,
unable �to get up.�
David R. Butcher is the assistant editor for
Customer Inter@ction Solutions
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