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[July 16, 2004]



Helping Grandma



�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 Jabber XCP (news - alert) enterprise instant messaging system. (news - alert)


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 HIPAA (news - alert) 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:


  • Recommendation. 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).

  • Time With 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 care.

  • Overcome Labor 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:


  • Maintain Team 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 supervisors.

  • Ensure Security 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 performance.

  • Reduce Operating 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 information technology (IT) (news - 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:

  • Security and compliance;

  • Its open standards and open platform;

  • Cost-effectiveness and

  • No configuration by the user required.

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 privileges.


The Jabber XCP server is hosted in a secure VLAN (define - news - alert) to isolate instant messaging traffic from other application resources, while the Citrix (news - 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:

  •  Return 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 [email protected] Solutions Magazine.

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