Interactive phone systems enhance prenatal care
Voice technology monitors risk, cuts costs
If you’ve ever punched phone buttons to switch money from your savings to checking account, you know how an interactive voice response (IVR) system works. Applied to women’s health care, it can collect routine data and cut costs while giving you more quality time with your patients.
Here are examples of the health care and maintenance tasks that professionals are sharing with IVR:
• High-risk pregnancy. Patients receive automatically timed calls collecting data about headaches, medication compliance, baby’s movement, or signs of problems.
• Patient education and comprehension. At Loma Linda (CA) University Medical Center, mothers-to-be can access topics from preparing for a hospital stay to proper use of seat belts. If a nurse asks a patient to learn about toxemia, she also can ask the IVR to print results of the patient’s post-test and assess her understanding of the information.
• Chronic illness updates. Conditions such as diabetes can be monitored through regular patient input of blood sugars, foot care, and dietary intake.
• Data collection. St. Vincent Family Life Center in Indianapolis uses IVR to assess patient satisfaction with inpatient labor and delivery. Melody Reeves, RN, follow-up program manager, is studying breast-feeding patterns of mothers who, before they give birth, indicate plans to nurse.
• Medication compliance. For patients who are using drugs requiring close monitoring, such as Coumadin, IVR check-ins eliminate the vagaries of "telephone tag" between them and providers.
• Family planning. Educational IVR protocols are available for couples interested in either fertility information or contraception. The systems give feedback about methods and risk/benefit ratios.
Much like a sophisticated voice mail system, IVR communicates with patients through digitally recorded questions. At the Loma Linda (CA) University Medical Center, it collects comprehensive prenatal histories, including risk factor questions regarding domestic violence and HIV exposure. Other applications include collecting monitoring data on chronic conditions like diabetes or congestive heart failure. The IVR technology also automatically places calls to new mothers to collect information about infant development and the mother’s postpartum recovery. (For more information on using an interactive voice system as a multilingual patient data gathering and education tool, see story, p. 155.)
When a maternity patient calls for her first appointment, the receptionist directs her to call the IVR and complete the 30- to 45-minute intake history, explains H. Frank Andersen, MD, associate professor of obstetrics and gynecology at Loma Linda. The patient presses buttons to indicate yes or no answers to queries regarding previous pregnancies and family history.
Some patients complain that they have to talk to a computer before they can see a doctor; however, Andersen says that none of them refuse when they are told it’s required.
Survey better at catching risk factors
Andersen likes IVR’s capacity to explore risk factors. "We doctors and nurses sometimes do a bad job of asking about a patient’s drug use or HIV risks," he says. For example, among 22 patients whose histories were collected by both physicians and IVR, physician-collected histories identified four women with exposure to drug use, domestic violence, and HIV risk, but the IVR identified 10.
"The first time we sit down with the patient," Andersen says, "we have a neat computer printout of her history and risk factor ratings in our hands." It previously took doctors and nurses 30 minutes to do paper-and-pencil intakes, but the IVR cuts intakes to 10 minutes for adding details such as the type of surgery a patient might have had, he says.
With the pressure to increase service volume, IVR is a critical tool. "We used to have an hour on the first visit, but now we’re squeezed into 30 minutes, Andersen says. The IVR history gives us more time to spend discussing the patients’ questions and problems."
Anderson points out one especially user-friendly feature of IVR: It can be programmed to speak languages typical of the patient base. "Here in southern California, we have an incredible number of non-English speakers," he says. Spanish, Japanese, Korean, and Vietnamese are not uncommon. By pushing the appropriate buttons, patients hear the questions in their preferred language.
The IVR drew enthusiastic response from physician groups who contract with HMO Health Net in Woodland Hills, CA.
"We asked our medical groups whether they could use it to monitor high-risk maternity patients," says Katherine Davidson, director of utilization management. They liked the idea, she says.
Two of Health Net’s physician groups are now testing the system.
"High-risk patients are invited [not required] to use the interactive system," Davidson says. "We tell them they will have their own nurse to contact if they have questions or problems."
The testing has not reached a point where patient satisfaction is measurable, she says.
Some of Loma Linda’s patients readily take to the IVR before their first appointment, says Andersen. "But we have the interesting challenge of convincing others upfront that all this time on the phone is going to reward them in any way," he says.
"In retrospect, when they see that the payoff for their phone time is an extra 20 minutes to talk with the doctor or nurse about what’s really bothering them, they get excited about it."
How to budget for IVR
Three vendors who spoke with Women’s Health Center Management offer markedly different fee structures.
HomeVue Health Systems in Mission Viejo, CA, sells components from which buyers choose. Gary Mounts, MBA, president of HomeVue, explains that most health care settings have the phone lines and computers required for an IVR.
HomeVue’s average software customization fee is $2,500. That fee covers connections to HomeVue’s central server, which works like an Internet access connection. The fee also includes programming the system to customer specifications. Among the options, for example, are personalized health promotion letters sent at critical points in pregnancy. Added to the customization fee is a per-patient flat rate of $5 to $50.
"It depends on how much function is built into the system," Mounts explains. Some centers install networks that feed periodic monitoring results on each patient to a nurse clinician and case manager.
TeleHealth Systems in Greenwood, IN, offers a "turnkey" package for a price tag covering everything necessary to "go live." President G.H. Roesener quotes a one-time fee $34,500 for a comprehensive package including the computer, customized software, staff training, technical support, and a one-year license to use the company’s copyrighted system. The package comes with one application, such as a postpartum follow-up questionnaire. Additional applications such as questionnaire programs for diabetic mothers-to-be cost $1,500. (For more details on applying interactive phone systems in general prenatal risk factor assessment and pregnancy care, see story, p. 155.) A third IVR vendor, Iameter in San Mateo, CA, specializes in collecting patient recovery follow-up data on such procedures as hysterectomies and processing them for women’s health centers.
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