Electronic health records have been a game-changer for the healthcare industry, drastically changing the work environment for clinicians (physicians and nurses). Of course, that means big changes for IT help desks as well, including different types of issues to address and a broader range of people to support.
CareTech Solutions is at the epicenter of this change. As part of our role as a source of healthcare IT services, we provide help desk support to more than thirty hospitals throughout the United States. Fighting alongside our clinicians, we’re on the front lines in the battle to keep up with the pace of emerging technology while doing the important work of caring for patients. With our hands-on experience, CareTech is in an ideal position to ask an important question: Is it time for a clinical help desk? The answer: Absolutely.
The Birth of a New Model
Several years ago, a large healthcare provider came to us with a problem: its help desk was doing an excellent job of supporting staff with desktop and IT problems, but clinicians were reluctant to call.
A CareTech team studied the situation and found that 80 percent of the clinicians’ issues weren’t desktop problems. Rather, they had “how-to” questions about the new systems they were using in their work. In response, we sent help desk agents out to learn the new systems and then brought them back to provide support. First-call resolution rates jumped to about 90 percent, and the help desk began to be accepted by the clinical community.
Based on that experience, we developed a new support model, one built on “towers of expertise.” Our analysts develop strong, deep knowledge in specific clinical systems—Allscripts, Cerner, Epic, McKesson, Meditech, etc.—and when a hospital switches clinical systems, we simply shift those calls to the appropriate tower.
How the Clinical Help Desk Works
Our service desk is staffed 24×7×365 by more than 100 clinically-trained analysts who respond to more than 65,000 calls per month from physicians, nurses, and administrators. Under the clinical help desk model, hospitals are given a single number to call for all IT problems and requests, including the clinical “how-to” issues. Analysts are trained in both the IT and clinical systems, and they have access to a proprietary IT infrastructure knowledge base that supports all major hospital clinical applications. This means that when clinicians call, their issues don’t have be escalated to higher levels; the first-level analysts can simply take over clinicians’ machines and guide them through their issues.
We use proactive monitoring to identify potential issues, often before clinicians are aware, and our call management and incident management systems enable us to collect an advanced set of performance metrics that provide great detail about the types of calls we receive. Clients can access this information in real-time via online dashboards, or on demand using our interactive reporting tool. Every month, each client receives a recap with recommendations for continuous improvement, including a list of frequent callers who may need more training.
The clinical help desk model emphasizes the need for high levels of first call resolution. In fact, we believe first call resolution is the most critical metric for a clinical help desk. It’s the key to reducing costs, improving quality, and getting callers back to work quickly. With tools like remote access, CareTech consistently achieves first call resolution rates of 95 percent.
But this is only possible because we have well-trained analysts. When we bring new analysts on board, they undergo six weeks of intensive training to learn how the hospital works and become proficient in each module in the client’s clinical system. On an ongoing basis, they receive an additional eight hours of training (average) every two months, and we encourage them to develop and improve their skills by pursuing industry certifications.
Although we hold up first call resolution as the highest goal, we also believe that no CIO or IT director should come into a morning meeting and find out a system went down. When there’s a problem, there should be a well-defined escalation process for notifying key stakeholders about high-severity issues. At CareTech, high-severity issues are escalated to an incident manager, who then engages technicians with the appropriate skills and abilities to handle those issues. The manager sends out an escalation notice that provides information about the issue: the problem, the impact, and the owner. He or she then issues ongoing communications and status updates.
While critically important, first call resolution should be just one metric in a robust system of metrics. You should also be tracking average speed to answer, time to acknowledge or resolve clinical problems, reopened or unresolved issues, and call abandonment. If you’re not taking this approach, you may be caught unawares by unintended consequences like poor system adoption, which devalues your IT investment, breeds inefficiencies, and leads to potential regulatory compliance issues and unmet quality and patient care objectives. This also contributes to low user satisfaction, poor customer experience, and increased workarounds. And what happens when a clinician reaches out to a subject matter expert instead of calling the help desk? Total cost of ownership goes up.
When someone tells me a clinical help desk would just be an added cost to the enterprise, I tell them they probably already have a high TCO. It’s expensive when calls go to people whose time is far more costly than the interaction with the help desk. The cost savings, efficiencies, process improvements, and customer satisfaction a support organization can gain from implementing a clinical help desk can be substantial. To provide some context, consider the following case studies.
Cancer Treatment Centers of America
With facilities in Chicago, Atlanta, Philadelphia, Tulsa, and Phoenix, the Cancer Treatment Centers of America (CTCA) are destination hospitals: 90 percent of patients are self-referred, and 70 percent are from out of state, traveling an average of 500 miles or more to receive treatment.
Growth drove CTCA to explore an alternative to its traditional internal help desk. “As we expanded, we began to realize that we were outgrowing our initial system. It was no longer cost-efficient, and it wasn’t satisfying our stakeholders,” says Christopher Downs, director and vice president of Information Services.
The organization first sought help desk support from a global provider that served multiple industries. “Within a year-and-a-half, we saw that our physicians needed better support,” Downs says. “We didn’t have a clinical partner, there was minimal reporting and tracking, and we weren’t seeing a clear return on our investment.”
CTCA made it a strategic priority to find a partner that synced with their culture and specialized in healthcare. “One of our values is a mother’s standard of care. That’s what we provide to our patients, and it’s what we expect our vendors and partners to provide to us,” Downs says. “We treat our patients like we would treat our mothers or our fathers. That’s a critical success factor for us. We wanted skilled analysts who understood our clinical environment, fit with our service culture, and brought to us some of the most advanced toolsets and best practices in the industry.”
Other selection criteria included:
- Will it improve patient care, quality, safety, and satisfaction?
- Will it deliver a brand-standard, enterprise-wide platform solution?
- Will it provide an adaptable, industry-leading commercial package solution?
- Will it provide users with simple, easy-to-use, and reliable tools?
- Will it support and enhance a reliable, 100-percent available, scalable, secure, and cost-effective infrastructure?
- Will it leverage previous investments and existing brand standards?
- Will it leverage our current IT skill sets and our planned technical architecture and standards?
- Will it help us achieve our growth and margin commitments, achieve financial justification, increase patient acquisition, and add new sites and services?
“We wanted a partner who was innovative and willing to work with us,” Downs says. “We wanted calls to be answered by a live person within thirty seconds. That was a demand from our chairman, and it’s something we’ve been able to accomplish. We also wanted an organization that would be able to provide answers and take corrective actions while on the phone and not always escalate to the next level.”
To implement the clinical help desk, CTCA partnered with CareTech Solutions and appointed an on-site client liaison relationship manager to lead the process. Weekly meetings were held to check metrics and evaluate trends, and monthly management meetings with executives addressed strategic direction and tactical issues.
CTCA’s target was a satisfaction rate of 85 percent. The clinical help desk exceeded expectations, achieving monthly satisfaction ratings between 93 and 97 percent. “We changed our culture,” Downs says. “But it didn’t happen overnight. It was one satisfied user at a time.”
“The word-of-mouth feedback is outstanding, too,” according to Downs. ”Not only does this make the Information Services organization look good, but in the eyes of senior management, it shows that we’ve really moved in the right direction and can support the continued growth of CTCA”.
“Having a partner with depth is a major advantage,” he adds. “It allows us to scale up to handle peak call volumes. The clinical help desk has been a very cost-justifiable solution for us.”
Detroit Medical Center
Part of Tenet Healthcare, the Detroit Medical Center (DMC) has nine hospitals and more than 2,000 licensed beds, 3,000 physicians, 1,300 medical students, 1,000 residents and fellows, and 15,000 employees.
“We rolled out electronic medical records system-wide in 2007, and since then we’ve become very aware of the kind of support model required to keep clinicians working in a complex IT environment,” said Paula Tank, director of Clinical Systems.
DMC placed a critical priority on implementing an advanced clinical help desk. “Our physicians and nurses need to count on high-end service 24×7×365,” Tank said. “They need to know that the people they’re calling understand their environment and understand DMC’s holistic view of service delivery.”
DMC’s environment is complex, with nearly 200 active business and clinical applications. Adding to the complexity are the mobile users who move from hospital to hospital within the system. Tank says that remote access has been the key to customer satisfaction. “I can’t overemphasize how important that tool has been for IT troubleshooting,” she says. “People have different ways of describing things, and unless you can see it yourself, you can’t be sure you fully understand the situation.”
DMC measures customer satisfaction by tracking positive responses to the following questions:
- Was the support team professional and courteous?
- Did they provide clear information on the nature of the problem?
- Did they respond in a timely manner?
- Did the support team resolve the problem in a timely manner?
Their goal was 90 percent, but monthly scores have consistently averaged above 95 percent. “With a quarter-million calls a year, this is excellent performance,” says Tank.
What are the keys to DMC’s success? “We gained commitment from senior leadership to invest in advanced IT support,” Tank says. “We then worked with CareTech Solutions to make sure that best practices and tools were in place to support all of our clinical and business applications. Some of the other critical factors have been the skilled analysts who understand our clinical environment, ongoing training, clearly defined service level agreements, and open lines of communication.”
When Is It the Right Time for a Clinical Help Desk?
When you step back and take a look at the big picture, it’s no surprise that healthcare needed a new support model. There are more systems in use today, and the regulatory environment is more complex and demanding, including the Meaningful Use rules. On top of that, the number of devices is growing quickly, both in number and type. Clinicians and patients are bringing in their own devices, and they expect quality support.
So, how do you know when it’s time to consider a clinical help desk? If callers are waiting too long in the queue and they aren’t being greeted by a live person, it’s time. If first call resolution rates, satisfaction levels, and overall service quality are down, it’s time. If calls are being unnecessarily delayed and staff are being misallocated, it’s time. If costs are rising but business objectives aren’t being met, it’s time. Above all, if you’re tired of the status quo, it’s time.
Karl Graham is the senior director of the service desk at CareTech Solutions, where he is responsible for the business and operational management of CareTech’s 24×7×365 IT help desk operation. In 2013, CareTech’s service desk was recognized by KLAS as “Best in KLAS” for IT outsourcing (partial and extensive). Karl is frequently invited to share CareTech’s unique approach to supporting hospitals at conferences and in industry publications.