The message began, “Hello, this is Mrs. John Andrews and I’m calling for Dr. Nicholas.” The message continues, “I was in the shower when my cat came in to the bathroom”. As an answering service owner, you know by now that nothing good could possibly come from this call. “When the cat jumped on the sink and with her tail, she knocked my prescription off the sink and some fell into the toilet and other pills fell all over the floor. And I’m going out of town on Thursday.”
All this time you’re likely thinking, this poor woman has fallen and can’t get up, or worse. Thankfully, she only needed a prescription refill. However, for most of the duration of this call, the patient’s desire, that of asking for a refill, was in question.
Understanding patient intent is the distinction between routing this message correctly or not. Is this urgent so go get the doctor or is this something a nurse can handle in the morning. However, there is another element here, that of practice protocol. Time was when the gatekeeper at the practice was the person who answered the phone – no more. Phone calls comprise the vast majority of patient communications, but with the adoption of web based patient to provider communication as a result of stage 2 of HITECH, we are about to see a rapid adoption at the practice level migrating over to the web.
It is this change that will break the gatekeeper model within the office once and for all. The person answering the phone at the desk will answer even fewer calls, just as auto attendant and voice mail at every extension have reduced the effect of the gatekeeper already to some extent.
There is however, still the element of practice protocol, and this is where the gatekeeper shines. When the parent of a child calls the pediatrician’s office to request an appointment after an asthma attack, the auto attendant gets you to an appointment request voice mail box, but the gatekeeper knows that practice protocol is to escalate this call to a high level. The doctor considers this of a high priority and the gatekeeper knows this, the auto attendant doesn’t.
Some messaging systems can route messages based on message types (appointments here, billing questions there), but there are few systems that have key word priority that can identify and manage an appointment request as a result of an asthma attack from a routine appointment request. This intelligent message routing is coming. Understanding how to integrate this important tool can improve practice quality and effectiveness.
