Farragut Family Practice is an independent, four-physician office including a physician’s assistant and two nurse practitioners. As a division of Summit Medical Group, Farragut Family Practice, used to share on-call duties with four other Summit practice locations. By implementing PerfectServe’s Answering Service solution across the five locations, Summit improved overall patient and provider experience and satisfaction.

Key Results:

• Reduced Communication Cycle Times
• Enabled Seamless Interfacility On-Call Scheduling
• Simplified After-Hours Operations
• Eliminated Routing Errors

Advocate Medical Group (AMG), a Chicago-based medical group with over 1,500 physicians and specialists at more than 200 different practice sites, opened a centralized contact center in February 2014 to provide 24/7/365 coverage for 500 physicians across 40 of their sites. The center is also the main hub for patients to contact their doctors and other clinicians.

Expectations for the center were high. But the center’s technology wasn’t up to the task.

“Our technology didn’t allow messages to be transmitted in a meaningful or secure manner,” says Dr. Jennifer DeBruler, medical director of Advocate Medical Group. “We knew we were using an outdated technology, and we planned to implement something new.”

AMG resolved to find a secure communications technology that was fully automated—eliminating the need to update call schedules, and facilitating real-time calls with secure voice and text messages.

Balancing the need for rapid communication and response without unnecessarily interrupting physicians was another important need for AMG. Because disruptive doctor-to-doctor communications had been a historic problem, the ideal solution required asynchronous communication so care providers could communicate with each other about a patient when it was most convenient. Says DeBruler, “When doctors are busy seeing patients, they don’t want to be interrupted for things that are not urgent, especially during the day.”

Ready. Set. Plan.

The search for a new technology started close to home. AMG knew that 4,000 physicians across 12 Advocate Health Care hospitals were using PerfectServe, which meant AMG physicians were already familiar with it.

PerfectServe ensures secure communication of protected health information among providers and care team members, so AMG didn’t have to worry about HIPAA compliance. By automatically identifying care team members and routing information based on when and how they work, PerfectServe met all their other needs as well.

“PerfectServe was the answer,” says DeBruler.

AMG believed that successful workflow automation required a thorough understanding of the work in order to optimize its flow—starting with the needs and behaviors of the users.

Success also required understanding who needed to talk with whom and when, as well as mapping out the changes needed to enable a process that worked for everyone.

“We brought people together early in the process to discuss what we expected the technology to do and how we wanted to use it,” explains DeBruler.

Working closely with PerfectServe and the contact center, AMG offices carefully set up the rules required for the system. “We had to consistently bring the appropriate operations and physician leaders to the design sessions,” says DeBruler.

Physician engagement up front and throughout the implementation was key. “We continued to listen to the physicians and make tweaks after going live with PerfectServe,” she says.

Gradual adoption proves successful

First impressions are important; a provider’s initial encounter with a new technology tends to leave a lasting impression. Rather than risk unnecessary confusion, frustration or backlash by implementing PerfectServe everywhere at once, AMG set a timeline for gradual adoption. By bringing on doctors a few groups at a time, AMG was able to make frequent performance assessments, fine-tune the configuration for each hospital and ensure that doctors were successfully configuring PerfectServe to their preferences.

Once the implementation of one group was deemed successful, AMG would start the next one. DeBruler reports that 500 providers were brought on board in 2015. “When we started in January, we were at 481 interactions; by December, we were up to 4,600 interactions.”

Feedback was continually sought during each group implementation. “We had huddles with the practices on a regular basis during the week,” says DeBruler. Physicians could call the medical directors at the contact center if they experienced any problems, and AMG quickly addressed any issues that emerged.

AMG also created a committee to review questions about PerfectServe and respond to requests about who could use it and how it might solve additional problems. Through this methodology, the committee was also able to satisfy the need for home health nurses to manage their on-call coverage with PerfectServe—just like the physicians.

Administrators of Balboa Nephrology, a large San Diego-area group practice with more than 20 locations and facilities, were aware that their organization’s clinical communications processes were in need of updating. First, they were concerned about the possibility that staff were sometimes sending text messages with protected health information (PHI) via unsecure personal mobile devices. Ensuring compliance with HITECH and HIPAA regulations and reducing the risk of security breaches were top priorities for the group.

Second, both administrators and care providers wanted to move from using older technology, such as pagers for clinical communications, to using the mobile devices that the providers were already relying on for other communications.

And third, they wanted to make communication a high-reliability process, as the systems used for pagers and answering services occasionally failed to transmit messages correctly or to the right person.

A Comprehensive Solution to Meet Complex Needs

According to Patrick Hoz, Balboa’s Director of Practice Operations, the group’s communication needs were especially complex because their physicians care for patients in a number of different facilities: 17 office practice sites organized into 6 distinct pods, 35 different dialysis units, and 13 separate hospitals. The needs of these facilities varied, including a means of identifying and contacting an on-call physician or a physician rounding for the day; coverage for office staff during lunch breaks; call triaging, call routing, and message collection during holidays, nights, and weekends; and a rapid, accurate process for staff to contact physicians and for physicians to contact one another.

“What kept me up at night was the thought of implementing a new service in a large, complex practice,” said Hoz. He realized that solutions focused solely on the inpatient setting would not function well in an ambulatory care environment, and vice versa. The solution had to take into account the whole care continuum, as the group served patients with kidney conditions across the entire spectrum of care.

Hoz learned about PerfectServe from a physician who rounded at a hospital where the hospitalist group relied on PerfectServe for clinical communication. Balboa’s Medical Informatics Officer, Dr. Terry L. Behrend, had tested a number of different communication systems, but found they offered only partial fixes. He gave PerfectServe the green light, the board approved the choice, and the implementation process officially started.

A Secure, Comprehensive Platform

PerfectServe is a comprehensive and secure communications platform that routes voice, text, and web- and system-generated communications based on clinician workflow and personalized algorithms. This allows physicians, clinical teams, and practice groups to selectively filter and control when and how they’re contacted. PerfectServe’s rules engine filters communication events based on multiple variables unique to each clinician, which can be updated easily via a phone or mobile device.

To contact a physician using PerfectServe, the individual calls a single extension or uses the web-based texting function. By indicating the physician’s name or specialty, the caller is automatically connected to the physician via the mode of communication preferred by the physician at the time. If the physician prefers not to take the call or text at the time, a message is sent. Either way, the contact is tracked and documented. The caller does not need to know the physician’s call schedule or office hours beforehand— PerfectServe stores this information and routes calls and messages accordingly. Data is housed securely in the PerfectServe server rather than on the recipient’s device, ensuring compliance with HIPAA regulations.

PerfectServe removes the variability often present in clinical communications and speeds the cycle time for contact between clinicians, optimizing communication among care providers across the care continuum and supporting improved care coordination. Because PerfectServe is a cloud-based service, no special hardware is needed; staff and clinicians can access the platform via a landline, smartphone, mobile phone, standard pager, or web interface. The rules engine was designed to recognize whether PHI is included in a message; a message with PHI can be sent in its entirety to a secure device. A notification can be sent if the receiving device is not secure.

A Carefully Planned Implementation

The group’s leadership was concerned about implementing a large-scale change all at once given the variable needs and workflows for the different office practice sites, hospitals, and dialysis units. Leaders decided to implement PerfectServe first at a single location with a pilot group of five physicians, including Dr. Behrend.

After working with the physicians to input their contact preferences into the rules engine, the pilot group went live with PerfectServe. An implementation specialist from PerfectServe provided on-site support and training to help the physicians and staff of the pilot group optimize the features of PerfectServe based on their workflows and contact preferences. Dr. Behrend became the project champion, educating other physicians about specific features. The pilot group provided feedback on preferences in regard to features and various configurations to help the PerfectServe implementation team customize features to the specific needs of the group.

A month later, the group implemented PerfectServe at all remaining locations with all physicians.

“We implemented PerfectServe really quickly,” said Hoz. “And we were able to roll out the new technology without significant problems. Initially we were concerned that patients would dislike the lack of live interaction that they had previously with answering services, but I’ve received no complaints.”

A Wide Array of Benefits

With PerfectServe, the group replaced pagers and answering services with a secure, comprehensive platform that enables an efficient and streamlined clinical communication process. One of the benefits recognized immediately by Hoz was ensuring secure communication. “Now I have peace of mind knowing that our staff are HIPAA compliant. I am no longer worried about the possibility of staff sending non-secure SMS texts with patient information to our physicians.”

Hoz appreciates the flexibility of the PerfectServe platform; the practice was able to customize features to match the specific needs of different care team members. For example, a nurse in the hospital dialysis unit often needs to contact the covering physician to let him or her know when a patient concludes a dialysis session. PerfectServe created a customized menu that routes callers to an interactive menu that allows them to key in the time and patient room number; this information is automatically sent as a secure text to the appropriate physician, streamlining a key piece of clinical communications.

Hoz also appreciates the system’s analytic capabilities. Before PerfectServe, he had no efficient way to track the number of calls physicians received or the turnaround time for their responses. Now Hoz receives a daily report via email that shows the number of calls, the originating site, the receiving physician, and the time until response. “It gives the physicians some accountability,” he said. The reports also help Hoz assess staffing and physician coverage needs. Hoz believes that the data on response time has made the group improve in providing timely consultations.

Hoz has been gratified to see several unexpected workflow efficiencies with PerfectServe. The office supervisors can easily access the on-call list for all six pods through a secure portal and, if needed, can change the physician call schedule. Because data is cloud-based, the schedules are immediately updated and subsequent calls are automatically routed to the covering physician. With the ability to create distribution groups, supervisors can easily send a message to all the physicians and staff within a pod at once.

Sue Seberg, one of three clinic managers at the practice, has also seen improved workflow efficiencies with PerfectServe. In the past, messages left with the answering service when the offices were closed for lunch were faxed to each setting. Now, staff log in to PerfectServe to start their day and when returning from lunch, and after retrieving all messages, they can then address or forward as appropriate. They can also copy messages into the electronic medical record if needed.

In addition, according to Seberg, the office receives fewer calls now, freeing up personnel for other tasks: “We continue to receive calls from patients, but not from staff in the hospitals or dialysis units. Our medical assistants have more time for patient care.”

The Results

Balboa Nephrology Medical Group implemented PerfectServe to ensure secure, efficient communication across the continuum of care. With PerfectServe, the physician group has streamlined clinical communication and replaced older technology with a modern, cloud-based communication platform. PerfectServe’s flexible design and comprehensive implementation support has allowed Balboa Nephrology to customize features to best meet the complex needs of the group across both inpatient and ambulatory settings.

Practice
A large hospitalist practice specializing in geriatric patients with ~50 practitioners and 100+ facilities, including primary care clinics, hospitals and medical centers, skilled nursing facilities, long-term care facilities, independent living residences, and short-term rehab centers.

Prior to PerfectServe
Clinicians visited each client facility according to a preset schedule. Whenever a patient needed additional attention, personnel would call in the patient’s situation to a triage center staffed by seven LPNs. The triage nurse would either respond to the issue herself or, when warranted, contact a clinician and relay the information. The nurse or the clinician would then call the facility back and relay the treatment plan.

Challenges
Contact between triage nurses, clinicians, and client facilities was time-consuming and complex, often taking an hour or more to complete the cycle. When a practitioner called the facility back, he or she might not connect with the original caller, who would continue to wait for a callback.

Additionally, relaying this information through a third party increased the potential for miscommunication, and the process meant protected health information (PHI) was not always locked down.

Solution
After assessing the organization’s pain points, PerfectServe recommended their clinical communication solution that would allow staff in all client locations to contact practitioners directly by calling or texting a single number that assured they would always reach the right practitioner in a HIPAA=compliant manner. The new setup would reduce cycle times and miscommunication, and each clinician could decide how to accept his or her own contacts. Emergency calls would be routed through the triage station to make sure they received immediate attention.

Transition
A task force of six clinicians was established to work out a set of usage recommendations that would be given to the rest of the staff when PerfectServe was implemented practice-wide, which guaranteed there were no surprises.

The PerfectServe implementation specialist spent time on site working out a call flowchart that accommodated the organization’s unique workflows.

Staff immediately experienced a major improvement in call cycle times, and call handoffs were virtually eliminated. As a bonus, PerfectServe was also significantly less expensive than the answering service provider the organization used previously.

Results
Cost Savings: Compared to the third-party answering service the organization previously paid for after-hours call support, PerfectServe’s fee for 24-hour coverage is about half as much.

Streamlined Care: Call cycles dropped to just a few minutes—far less time than before PerfectServe.

Process Transparency: PerfectServe provided regular contact reports that included information about day/time, origin, recipient, and duration for all calls. This made it easier to identify areas for improvement.

HIPAA Compliance: Since PerfectServe consolidates all PHI within a single, secure platform that accommodates a variety of communication channels, it supports implementation of effective risk management policies. The platform also makes it easy to audit communication trails from beginning to end, which helps with risk monitoring efforts.

“Before PerfectServe, we had a typical answering service. They were satisfactory— but they weren’t innovating.”

That’s Matt West, Chief Operating Officer of Premier Surgical Associates. Premier is East Tennessee’s largest surgical provider, and its 28 physicians perform more than 15,000 general, vascular, bariatric, and oncology surgical procedures a year and see upwards of 1,000 patients in office visits each week.

“We perform surgeries at almost every major hospital in the area,” says West. “When our physicians are on call, they may be covering for more than one hospital. Or they may be on call for both general and vascular patients. And each doctor wants to decide how he is reached and how calls are handled. At the same time, we need our communications to be efficient, secure, and compliant.”

Issues

West notes that few physicians look forward to their time spent on call, yet all recognize the vital need for rapid and clear communications between doctors and patients after normal hours. They weren’t happy with the old system, and they were letting West know.

“As our complexity grew, so did dissatisfaction with the status quo answering service,” recalls West. “The wrong messages were often delivered to the wrong doctor—and not necessarily by the most HIPAA-compliant method. Then the doctor who received the message would have to track down the doctor on call to forward it. And I’d hear from a frustrated doctor the next day: ‘Why am I getting these messages?’”

The information provided about the calls was also seriously limited. West describes a typical morning at Premier: “The answering service would send us a fax or email listing calls from the night before, but without any detail on what transpired. The staff would have to scramble to find the doctor and confirm what had happened: ‘What did you do with that patient? Was there a consult? Do we need to follow up?’”

Even more urgent was the need to ensure compliance with HIPAA regulations and reduce Premier’s risk of a security breach. “I’m also the privacy officer,” notes West. “First and foremost, we wanted to address that risk.”

When West began evaluating vendors, he knew it wouldn’t be easy. Premier’s unique workflow couldn’t be forced into a one-size-fits-all offering: “There are a lot of idiosyncrasies to our organization. A generic solution wouldn’t have worked.”

A Solution Up to the Challenge

One of the office locations in Premier’s practice group was already using PerfectServe on a limited basis, and the facility’s office manager encouraged West to take a look. After seeing what PerfectServe had done with its algorithms and how well the company understood the requirements of Premier’s IT systems, West was convinced he’d found the right partner for the whole organization. “We didn’t see this kind of customization from any other company,” he notes.

West says his confidence proved well-founded: “[PerfectServe has] given us a system complex enough behind the scenes to meet all our needs, but with tremendous simplicity and usability. Not 8,000 different menu options, just six or seven different key functions that allow users to do what they need to.”

More Than an Answering Service

Each doctor can choose or change how he or she wants to be contacted, from any device and in real time. Users can send messages, add attachments, or make calls from within the PerfectServe app, keeping communications secure.

Instead of sending emails, PerfectServe’s streamlined web portal allows the Premier staff to easily send doctors HIPAA-compliant messages. “A lot of doctors don’t read their emails,” West says, “so this notifies physicians on their phones. Just a quick little secure message telling them, ‘You need to see Mrs. So-and-So in room 403,’ or ‘Call the lab about X,’ and the staff can see when the message has been read.”

The real test of any system is how it handles after-hours calls from patients. West notes that any patient calling after hours likely has a medical issue or concern and is anxious to hear back. PerfectServe helps Premier manage the communications workflow to ensure a rapid and effective response.

“After-hours patient calls go directly to a transcription service, and we’ve provided the transcriptionists with customized templates to ensure the proper information is captured,” West explains. “This way, we know the call details going to the physician are succinct yet complete, so the doctor has the right information to decide if it’s something that can wait until tomorrow, or if the patient needs immediate attention.”

Another valuable feature is the centralized scheduling. “It used to be that our physicians were always looking at ten different calendars to see when they were on call,” says West. “Most of our doctors now operate completely from their mobile devices. They use the PerfectServe app to look at their schedules, send and receive messages, forward them to their partners, and so on.”

Finding Answers Together

Implementing the PerfectServe platform across the entire Premier Surgical Associates organization took about four months. PerfectServe and Premier worked together closely to fine-tune the system as it was deployed.

“One of the things we struggled with for the first couple of months was that a patient would call our office after hours, get directed through the auto-attendant and then be asked, ‘Is this a general surgery issue or a vascular surgery issue?’” West says. “Well, the patients don’t know. To them it’s all just surgery. So they were routinely selecting the wrong choice, and getting routed to the wrong physician. It’s the kind of thing you don’t anticipate, but you learn as you go.”

Working collaboratively with PerfectServe, Premier came up with a plan to easily resolve the issue: now patients just select their doctor. If the doctor’s not available, the message is automatically routed to the doctor on call.

“We appreciate that once we defined the things we wanted to do differently, PerfectServe quickly made the changes, sometimes in a couple of hours,” West says. “They’ve shown an ability to adapt on the fly with things that are important to us. We never got an answer like ‘No, we can’t do that.’ They’d say, ‘OK, let’s figure it out and fix it’— and we’d work together to come up with a solution.”

Change Made Easy

Driving adoption of a new system across an organization also presents challenges. Early adopters may embrace a new technology from the start, while others resist leaving the tried and true. West notes that the simplicity and intuitive functionality of the PerfectServe app soon won over even those who were least comfortable with digital technology.

“We started implementing in February and kept working with PerfectServe to tweak the system,” West recalls. “By mid-April, I wasn’t hearing any more complaints and I even got some positive feedback. And for surgeons, that’s unheard of.”

The Results

West reports that physicians and staff especially value the detail and accuracy of information that PerfectServe puts at their fingertips. Because the Premier staff is copied on all physician after-hours messages, when they come in the next morning, they can simply review the messages and quickly decide if they need to follow up with a patient or doctor.

An added bonus has been the organization’s ability to use these detailed messages to help track and improve billing for consults and other physician tasks that the old system didn’t track. West also deeply appreciates not having to worry about HIPAA compliance.

West saves his highest praise for PerfectServe’s flexibility and its ability to customize a solution that precisely met Premier’s unique needs. “They put a lot of resources into making sure that their solution would work perfectly for Premier.”

West’s advice to other practices looking at solutions for secure communications? “You need to look for a vendor that understands that not all practices are the same. PerfectServe’s understanding of this was critical to our implementation and overall success.”

West also expresses confidence that as Premier Surgical Associates continues to grow and evolve, PerfectServe will keep pace. “I’ve been asked by PerfectServe to join strategic discussions and contribute ideas,” West says. “It feels good to know PerfectServe is engaging customers to help build a strategic road map for what kind of products and services they develop, and I appreciate being able to give input on that.”