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                    INR RELAY  -  ANOTHER COST EFFECTIVE SOLUTION FROM

PACE HEALTH SYSTEMS LTD -- 

PROVIDED AND SUPPORTED BY THE 

PATHOLOGY DEPARTMENT  AT

  BASILDON AND THURROCK NHS TRUST 

INR Relay - Introduction

Automatic Telephone Reporting of INR Results - Introduction
The Basildon Experience in Uptake and Costs
How does it work
Is it complicated to use?
Why not supply clinics with their own hardware/software?
Some examples of what a patient would hear
What about the hard of hearing?
How are the bills calculated?
A few more advantages
What about Patient Confidentiality?
Patient Opinion Survey
Thrombus Article
Features

AUTOMATIC TELEPHONE REPORTING OF INR RESULTS 

USE THE PHONE 

Provide your patients with a better quicker INR results service,  make your  staff  happier, and save yourself some money     - all at the same time !

The Pathology Department in Basildon & Thurrock NHS Trust has developed a new AUTOMATED TELEPHONE SERVICE available to all UK haematology laboratories that run an anticoagulant service. 

A unique set of highly integrated and dedicated programs, INR RELAY provides you with access to a system which automates your communication tasks and dramatically improves the quality of service to your service users.   The key design features of this new service are high quality, reliability, ease of use, speed, automation, and flexibility to meet your needs - and all this at a lower cost than you are currently incurring in communicating with patients by post.  We will provide you with PC with a modem and some basic software installed and configured to your clinic; then you file transfer your batched daily results to us, and we will do nearly all the rest: - virtually “fire and forget.”  Yes, that’s it, you send us your batched patients’ INR results, doses, and clinic times and we will relay the information to your patients.  We will either phone them, or they can phone us and patients can select for user configured letters according to the preferences allowed by your hospital.  When you are ready, you use your modem to fetch from us fully formatted patient letters - selected for those patients who need them -  configured to your specification.  The best news is that the savings you make in printing and postage costs will pay for the cost of this superior quality service - and you can start straight away.  In most cases, modest start up costs, no extra hardware or software, fully auditable, virtually no staff training, itemized billing, user configurable, regular reports to keep you fully informed of what is happening to your patients.

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THE BASILDON EXPERIENCE IN UPTAKE AND COSTS

In Basildon, there are 2000 active anticoagulant patients in our clinic and in the past we posted 135 letters each working day  (120 patient report letters; and 15 others including “did not attend” (DNA) letters and termination of treatment letters).  We calculate that the cost of transmitting one report by mail is 36p (27p for postage; 4p for paper, ink and printer costs; 5p for staff costs). Assuming 255 working days each year, this amounts to an old total £12,393  per annum.

We have had experience of telephoned results reporting since April, 2000, with over 50,000 results correctly relayed to patients by phone.   Following establishment of the new system, 80% of our patients are contacted by phone, and allowing for the fact that we now choose to send batches of request forms in the post, our letter numbers have been reduced by 72% to an average of 38 per day -  This works out as a saving of 97 letters (£35) per day - and assuming 255 working days each year, this amounts to a real reduction in postal costs of  £8905 per year.   We plan to charge participating hospitals 24p for each telephone contact we make, so assuming a similar uptake to our patients, where we now make 110 calls on average each day (93 patient reports; and 17 DNA messages) this would result in a bill for £6,590 annually for the phone service.  The cost of contacting the residual 28% (20% reports and 8% request forms) by post remains £3470 giving a new total of £10,060.  Compared to the old system, this amounts to an annual saving of £2,333  (19%).   These figures are a real estimate of the savings we made in Basildon, but of course, when calculating your savings, you should take into account the size of your clinic, the phone uptake you expect and the print configuration settings you choose.  The more your patients use the phone system, the more you save.  These savings for your trust are significant, and in addition,  you will be providing your patients with a faster, more reliable and higher quality results service.  For example, in our service, we have found that 80% of patients who use the phone system, have received their result by 7pm the same day, and in addition, we have an acknowledgement that the message was transmitted to its destination. 

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HOW  DOES  IT  WORK  ?

INR RELAY is a centralised computerised service located in Basildon Hospital.   The computers are fully duplicated and backed up, tested and maintained by our trained staff.  The computers act as reservoirs for receiving file transfers from client hospitals.  Once you have completed set up, the transmission of reports to us is easily achieved by automatic file transfer.  We convert these files into voice messages through a customised interface which we will create for each user.  The INR reports are phoned the same day/evening (and the next day if no contact was made) - the preferred route is for us to directly DIAL OUT  to your patients - anywhere in the UK.  You will have the option for us to create customised patient reports (Results letters / DNA letters / Termination letters / request forms) which you then retrieve by automatic file transfer, and print and post locally.  We will bill you according to how many and what type of  reports we send out and we will notify you by return file transfer and autocall of any patients not imported, and after 48 hours of any patients who were not contacted and after 96 hours you will get a final report for that days work.                                           top

If you think about it, in order for this system to work, we need to be provided with the following information for each patient included in your file transfers sent to us every day: 

Your hospital name  - So we can tell who sent the file    essential
Patient information details  - Patient’s name and address - essential
Telephone numbers -  essential
Date of birth - essential
NHS or unique clinic number- essential
Patient Episode details -  Current INR result  - essential
Desired INR range - essential
Name of  anticoagulant - essential
Dose advice essential
Date of Next test - essential
Transport arrangements  desirable
                                          

Most automated systems already have this data or they can be easily added to your database. 

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IS IT COMPLICATED TO USE ?
We have gone to great lengths to make this system easy to use both for the patient and the client clinics.  Our automatic transmissions to patients are so convincing that many patients actually believe that there is a live person making the call.  Why not try it out for yourself right now.  Simply dial 01268 524016, and when asked to enter your 11 digit telephone number, you should type in 00000000000 which will divert you to a random test result, which we change every day.  As for the clinics, once the set up procedure is completed (which should only take a few hours to complete by your clinic administrator), routine transmission and operation by your routine staff is extremely simple - and should involve only the generation of batched reports; then sending us the batched reports (SEND REPORTS icon/program); fetching letters and reports (FETCH LETTERS icon/program); and printing your letters (PRINT LETTERS icon/program).  

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WHY NOT SUPPLY CLINICS WITH THEIR OWN HARDWARE/SOFTWARE?

There are several good reasons to have a single centralised service in preference to multiple local services.  A centralised service means:

1) Local hospitals have virtually no costly hardware to buy or maintain - You will be provided with a PC which will be dedicated for use for this system. The PC will be fully loaded with the INR RELAY client program which will allow you complete access to your patients and configured and ready for you to use.  As the PC is physically separated from your existing network, there is no possibility of access to your existing computer data - and fewer security issues as a result.  Assuming you already have a printer and a phone line, there should be no additional hardware required.   This means that we can create centrally robust call centre hardware, fully duplicated and protected against fire or hardware crashes.  Centrally we can monitor for system failures and recover data automatically with our experienced staff.   It would be prohibitively expensive for each local hospital to set up similarly robust and reliable hardware.                   .                                                                                                                               

2) Local hospitals  purchase no software - You will be provided with a PC which has preinstalled all the software you will need to transmit reports to us, fetch letters from us, print letters and view transmission reports from us.  All the transmission software will be tested before you are supplied with the PC - so setting up could not be easier.  All you need to provide is your input data in an acceptable format.   

3) Your laboratory or clinical staff do not need to spend valuable time training how to use the system.  All they need to do is to send us a file (perhaps several) every working day, containing the batched results of your INR results and dosing advice and clinic times -check the fetched reports and print fetched letters as required.

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SOME  EXAMPLES  OF  WHAT A  PATIENT ACTUALLY HEARS ?  
 

1)“Welcome to the INR RELAY service.  Checking your date of birth:  Your date of birth is twelfth day of June, day twelve of June, nineteen twenty six.  Your INR result from earlier today was as follows: Your INR was four point five repeat four point five - which is a little high for you.  You should do the following: Miss two days, take no anticoagulant for two days then take warfarin tablets, two repeat two milligrams on Tuesdays and Saturdays and three repeat three milligrams on all the other days.  Your next blood test is due in three repeat three weeks on Tuesday fourteenth day of April,  day fourteen of April.  A Nurse or phlebotomist will call to take your next blood sample.  If you would like to hear  a repeat of this message press ONE on your telephone keypad now...    If you would like a confirmatory letter sent to you in the post,  press ONE on your telephone keypad now  -...   If you would like a batch of request forms sent to you in the post, press ONE on your telephone keypad now...   *   Thank you for listening,  please hang up now”.

* Options in italics are offered only at the discretion of the local hospital/clinic.                                                                                    top

2) “Welcome to the INR RELAY service.  Only if your date of birth is correct should you accept the following message:   Your date of birth is Twelfth day of June, day twelve of June nineteen twenty six.

We note that you did not attend for your INR blood test today as we expected.  This automatic telephone call is a polite reminder for you to attend as soon as possible as it is possibly harmful to your health to stay on anticoagulants without blood test monitoring.  If you have just attended for your blood test, you can ignore this message.  Thank you for listening, please hang up now. “

3) Welcome to the INR RELAY service.  Only if your date of birth is correct should you accept the following message:   Your date of birth is Twelfth day of June, day twelve of June nineteen twenty six.  Your INR blood test result from earlier today is quite high indicating that there is too much anticoagulant in your blood at present.  Do not take any further anticoagulant or other medicine which may cause bleeding such as aspirin until further notice.  If you are experiencing any unusual bruising or bleeding problems, you should contact your anticoagulant clinic or doctor straight away,  - because you may need an antidote or you may even have to go to hospital.  We repeat - do not take any further anticoagulant until you have been in contact with your local anticoagulant clinic doctors or nurses.  If you have just already spoken to your local anticoagulant clinic staff, you can ignore this message.   Thank you for listening, please hang up now. “   

 

You can hear some of the messages directly by clicking 

TO HEAR AN INTRODUCTORY MESSAGE CLICK HERE

TO HEAR A TYPICAL REPORT  CLICK  HERE

TO HEAR A HIGH INR MESSAGE  CLICK HERE

 

(Note that you will be asked to install a program called CRESCENDO from LIVEUPDATE.COM so that you can play the MP3 files on your computer).

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WHAT ABOUT THE HARD OF HEARING ?

Clearly there is a subgroup of patients who for various reasons will not be able to use the system.  In our clinic, 80% of patients use the INR RELAY system (the majority over 70 years old).    The other 20% have refused to use it and therefore continue to receive letters in the post.   

Reasons for non-use are as follows:

1) Pulse phones will not work - we require tone phones.                        (Nearly all modern phones are tone enabled).

2) Hard of Hearing.

3) Technology rejection/phobia.                                                            top

We have optimised ease of use for the patients as follows:

a) Latest hardware for superior sound quality

b) System recognises Caller Line Identification (when not suppressed) - In this way, it recognises the home telephone number and therefore the patient.  There is therefore usually no need for the patient to enter a PIN to get access to his result.  This means that all the patient has to do is to answer the phone at home, press one digit on the keypad, and take down three or four items of information over about 60 seconds.

c) Repeat messages offered during call.

d) We now prefer to DIAL OUT to our patients rather than wait for them to DIAL IN.  We DIAL OUT the same evening, and will make three to four attempts before stopping.  This has the advantage of increasing the contact rate, reminds patients actively of the test and result; further simplifies ease of use, as the patient does not even have to remember our number (just answer the phone, press any digit, and take down the result - we cannot think of any way to make it simpler), provides a completely free service to the patient; and contacts non-compliant (non-attending) patients cost effectively. With DIAL OUT patients do not get engaged tones, or have to bear the frustration of being told that their result is not yet available.  Although there are higher call costs to us in dialling out, we have found the quality improvements which DIAL OUT delivers outweigh the cost disadvantages.                              top

e) If all else fails, specific patients can be flagged for conventional postal reporting -  which you or your patient can choose as optional extras.    You can either continue to post your reports to these patients yourself or you can have INR RELAY create the reports for you - which you can download for local printing and posting.  In addition, you can also arrange for specified patients to have copies of results sent by email and/or fax.

While the emphasis of INR RELAY is on encouraging the use of the phone as a rapid and efficient means of transmitting laboratory data and clinical advice,  we recognise that any comprehensive reporting system must be capable of transmitting the information by alternative means (letter, fax and email) to accommodate those (20-30%) of patients who cannot use the phone for perfectly valid reasons.  It is for this reason that we have included a highly configurable system for sending reports by these alternative means into INR RELAY.

 

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PATIENT OPINION SURVEY 

We have conducted a patient opinion survey on the service and the results are summarised in the table below.  Patients were asked to score the service where 10 is excellent and 1 is very poor.

  SCORE (MAX=10) RESPONDENTS
PHONED    
CONVENIENCE 9.5 69
RELIABILITY 9.4 69
EASE OF USE 9.1 68
SPEED 9.7 69
     
POSTAL    
CONVENIENCE 9.4 19
RELIABILITY 8.4 19
EASE OF USE 8.6 18
SPEED 9.6 18

The results speak for themselves.  We were very pleased with the very high praise received from our patients for the phone and for the postal service - especially when one remembers that the majority of patients are over 70 years old.   

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HOW ARE THE BILLS CALCULATED ?

Every time we call a patient, or a patient calls us, or we send the information in the post (or we fax or email a patient),  we keep an automatic record, and we will invoice you quarterly.   The service will  cost you less than you currently pay in postage as long as you allow us to phone your patients in preference to using the post.  For instance, most patients will have a single phone call from us, lasting 90 seconds on average, and we will bill you 24p   (for each telephone contact we make).     Compare this with 27p for a first class stamp.  Of course, you will make further real savings on clerical staff time, printers, stationary and consumables.  See Our Charges for further details.

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A FEW MORE ADVANTAGES

1) You don’t need to worry about postal strikes or postal delays over weekends or holidays.

2) You get an electronic acknowledgement that the patient actually got the message.  With the Royal Mail, there is no way of knowing that the post  has actually arrived when you send a letter - even first class.

3) The patient gets the result at least one day sooner than achievable with the post.  This is important when dose adjustment is needed.

4) You can now transmit results directly to patients who are visually impaired or who have problems with literacy.

5) You can automatically generate patient specific request forms.

6) You can select special contact procedures for a selected patient ie telephone son if patient not answering, fax or email the pharmacist or GP.

7) Special messages can be sent to non-attenders, patients nearing termination of treatment, or patients with very high INR’s.                        top

8) Results are available 24 hours per day, seven days a week.

9) You will be reducing the greenhouse effect by reducing the paper output of your service.

10) You will be supporting the development of pathology modernisation, improving the turnaround time, timeliness and interpretative advice pertaining to the post analytic phase of the laboratory test life cycle.

11) You will be supporting an initiative started in the NHS predominantly for the benefit of the pathology department in Basildon and Thurrock NHS Trust.

12) You will be freeing your staff for more productive or appropriate work.

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WHAT ABOUT PATIENT CONFIDENTIALITY ?
In line with the Caldicott recommendations, we only store the minimal data set necessary, for the minimum time necessary for clinical purposes.  All our staff are full time NHS employees and bound by NHS confidentiality.  Our computers are independent of any other network and by supplying you with a dedicated PC, there is no need to connect to your network.   Access to all our files are password protected and all transmissions are encrypted.  We warn patients in their introductory letter, that it is theoretically possible for their dates of birth or anticoagulant information to be obtained by other persons using our system, but in our experience, no patient has refused to participate in the service citing confidentiality as a concern.  Whilst every effort is made to maintain confidentiality, we have protected the patients from the security features of the service - so ease of use is not compromised.

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WHAT TO DO NEXT ?

Have a look at our INR RELAY -  GETTING SETUP guide.  This will give you details on how easy it is to configure your system, giving ready made setups for commonly used systems such as DAWN 4S and how to transmit your data to us.  It also gives information about  the service contract we offer, limitations of liability and our price structure.

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Summary

INR RELAY - AUTOMATIC TELEPHONE REPORTING OF INR RESULTS  

AUTOMATIC PHONE CALLS

ANYWHERE IN THE UNITED KINGDOM 

EASY FOR YOUR PATIENTS 

EASY FOR YOU 

HIGH QUALITY SERVICE 

RELIABLE 

FAST 

COST EFFECTIVE

SEND FAXES AUTOMATICALLY 

SEND EMAILS AUTOMATICALLY 

NHS TO NHS

 

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INR RELAY
Introduction
Try It Now
The Basildon Experience
How does it work?
Is it complicated to use?
Hardware/software issues
Examples of dialogue
Hard of Hearing Patients
Calculation of Bills
Advantages
Patient Confidentiality
Patient Opinion Survey
Thrombus Article
Features
Getting Set Up
Introduction
Setting Up
Validation
Routine Operation
INR RELAY Client
Screen Shots
Import file description
Trouble Shooting
Additional Information
Contract
Sample Configuration 
Our Charges
Contacts

For printable version of full INR Relay document please click here.