Cost Friendly savings notification More timely (paper, despite - PowerPoint PPT Presentation

� Tiered system of DNA (did not attend) calls and letters reminding patients when they are late for a scheduled INR test. � Prior to 2011, all reminders sent by mail � Implemented Televox reminder calls in 2011 � In 2014 we explored impact of this new technology from 2 perspectives: � patient compliance � cost-savings

Response rate better People like to with phone listen messages reminders rather than open mail Cost Friendly savings notification More timely (paper, despite delivery of geographical postage, reminder location or labor) notices travel

DNA Procedures DNA lists managed by Nurses involved at DNA 3, Administrative Team 4 and Final Discharge � Reminders created on � DNA 1 call on second patient record for RN to business day after scheduled follow-up: INR date � Investigate if INR available � Bulk reschedule to one week � Call patient from previous date (2 weeks � Inform physician and request if notice mailed) support, danger of potential discharge � Daily Televox report � Documents status in Dawn managed by Office Manager and hospital record � RN makes final decision for discharge

Lists of patients meeting criteria for DNA 1 and DNA 2 are queried each weekday. The rescheduling of patients calls up the “outbound Televox DNA House Call” procedure and documents the message on the Letters tab

The DNA reschedule event and non-attendance count on the patient record determines the choice of routines for creating outbound messages Text file messages are created and exported to the individual DNA 1 and DNA 2 folders on the server (i.e., H:\DAWN INTERFACE\Outbound\Televox\DNA(X) •A batch file merges all DNA 1 and DNA 2 messages into a single file •The Partners file transfer protocol (FTP) process outputs the files to Televox •An enterprise transaction manager schedules and monitors the entire process

Retrieves files from their secure FTP site daily and makes automated calls at a designated time

The Televox System Used By MGH AMS � Uses a recorded human voice, sounds crisp and professional. Messages are not personalized (staying compliant with HIPAA regulations) � The missed INR reminder made via TeleVox on 2 nd business day following a scheduled INR date Hi, this is a message for a member of your family. The Anticoagulation Management Service at the Massachusetts General Hospital has not received your INR. If you have not had your INR done, please do so by _ reschedule date _. If you have had your INR please call 617-726-3919 and leave your first and last name and medical record number or date of birth. Include the name of the lab and the date you went for your INR. If you have any questions and wish to speak to someone in your native language, please call the interpreter services at 617-726-6966 and ask that an interpreter call our clinic. Thank you.

Phone too Answered - Called - No busy Hung Up Answer Answered - No Invalid phone Out of Order Response number Answered - Answering Repeated Machine message

• During comprehensive educational session, patients receive explanation of our ‘reminder’ system, emphasizing safety • Reminder calls translated into 8 different languages - serves our culturally diverse population

5065 600 5065 500 400 300 200 121 100 37 27 25 25 23 7 4 0 English Arabic Cambodian Chinese - Chinese - Italian Portuguese Russian Spanish Cantonese Mandarin (Time period = 3 months, N=5334)

DNA 1 Calls DNA 2 Calls 6000 250 350 35 300 30 5000 200 250 25 4000 150 DNA1 English 200 20 3000 DNA2 English DNA1 Non- DNA2 Non-English 100 150 15 English 2000 100 10 50 1000 50 5 0 0 0 0 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 Key: 5 – Out of Order 1 – No Answer 6 – Invalid Phone 2 – Phone Busy 7 – Repeated Message 3 – Hung Up 8 – Answer Machine 4 – No Response 9 - Total

� Identified a patient cohort with a scheduled INR date for a 1 month period of time, began 9/11/2014 and ended10/10/2014 � Followed this patient cohort over time to ‘march’ through all DNA levels. Observation ended 11/7/2014 � Determined patients’ responses to DNA 1& 2 TeleVox reminders and written notices (eg. Went for INR as requested) � Data collected allowed: � 1) precise patient response to DNA calls and notices � 2) cost analysis of pre and post use of Televox

(data reflects details of a I week period) 2500 120% INRs scheduled, 2272 Patients/INRs scheduled over 7-day period 100% 99.2% 2000 98.9% 91.2% 80% Percent Response 74.9% 1500 60% 1000 40% 500 20% 356 92 3 or .8% 34 4 0 0% Patients Reminder Level Response to Reminders

** Televox Cost Mail Costs* Total Costs $14,965 $14,965 73% Savings $3,997 $2,581 $1,416 $0 Pre Televox Post Televox *Includes stationary & envelope costs, excludes labor costs ** Benefit from Partners pricing (economy of scale)

� Patients respond positively to Televox reminder calls � Phone calls are timely and prevent further progression to DNA 3 and 4 levels (thus improves patient monitoring and safety) � Significant cost savings

This advanced technology enables our patients to receive DNA reminders on time and re-engage to avoid discharge from AMS “…..For me, the phone messages have been far more effective. I do just about everything online and over the phone now. Most of the stuff I get in the mail these days tends to be junk so I don’t pay attention to it. I usually see the date of my next test in the emails, but tend to forget about it until I get the phone call to remind me.” Justin G.

•Provide options and enhance communications with patients •Adapt and utilize new technologies