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Automatic
Telephone Reporting of INR Results - Introduction |
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The
Basildon Experience in Uptake and Costs |
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How
does it work |
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Is
it complicated to use? |
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Why
not supply clinics with their own hardware/software? |
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Some
examples of what a patient would hear |
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What
about the hard of hearing? |
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How
are the bills calculated? |
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A
few more advantages |
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What
about Patient Confidentiality? |
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Patient
Opinion Survey |
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Thrombus
Article |
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Features |
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AUTOMATIC
TELEPHONE REPORTING OF INR RESULTS |
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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 |
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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 ? |
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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.
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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 ? |
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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? |
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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.
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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 ?
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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.
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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 ? |
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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.
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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.
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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 |
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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.
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SCORE (MAX=10) |
RESPONDENTS |
PHONED |
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CONVENIENCE |
9.5 |
69 |
RELIABILITY |
9.4 |
69 |
EASE OF USE |
9.1 |
68 |
SPEED |
9.7 |
69 |
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POSTAL |
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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 ? |
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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 |
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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.
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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 ? |
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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 ? |
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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 |
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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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