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Health Emergency Assistance Line and Triage Hub (HEALTH) Model

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Appendix P. Multi-Channel Contact Center System Concept

Contents

Management Summary
     Current State Review
     Summary of Recommendations
     Timeline Considerations
     Proposed Elements of "HEALTH" Multi-Channel Contact Center
"HEALTH" Concept Specifications
     Proposed Option 1: Development of Multi-Channel Contact Center
     Proposed Option 2: Outsourcing of Multi-Channel Contact Center Components
     Proposed Option 3: Combination Development of Multi-Channel Contact Center and Outsourcing
Component Pricing Estimates and Assumptions
     RFI Submittal
     Vendor List
     Pricing Estimates
          Proposed Option 1
          Proposed Option 2
          Proposed Option 3
Key Performance Metrics
     Best-in-Class Comparisons/Components
     Introduction to Best-in-Class Components
Appendix I: Best-in-Class Categories
Appendix II: Best-in-Class Categories Calculations/Descriptions

Management Summary

Wood Associates' consultant conducted a best-in-class assessment at the offices of Rocky Mountain Poison and Drug Center (RMPDC) in April 2003 in conjunction with the Agency for Healthcare Research and Quality (AHRQ) Health Emergency Assistance Line and Triage Hub (HEALTH) Grant and System Concept Specification data gathering for the proposed Multi-Channel Contact Center. It is part of RMPDC's vision to become a multimedia call center, and the threat of a major bioterrorism event provides significant impetus to put the strategy and planning into place.

Wood Associates reviewed operations from a people, process, and technology standpoint. The high-level readout from the assessment document can be found herein under the section "Best-in-Class Comparisons/Components."

This document is laid out in five sections: Management Summary, "HEALTH" Concept Specifications, Component Pricing Estimates and Assumptions, Key Performance Metrics, and Appendixes. It is not the intent of this engagement to be a full contact center assessment of operations at RMPDC; rather, the results were kept at a high level due to minimum access and review of current call center processes. The purpose of the engagement, and the following document, is to provide a roadmap for developing a multi-channel contact center from a system concept and planning perspective. Technology should enable contact center personnel to deliver a high-quality of service to clients, meeting and exceeding client expectations on a regular basis.

Current State Review

Three call centers are in operation at RMPDC today—Poison Center, Drug Center, and NurseLine. The focus of the review was on people and process, and how technology might better enable the workflow at each of the centers. Overall, the professionalism of the staff, both from a knowledge and caring approach for the client, is exhibited. The documentation required in each organization for each contact varies and, depending on the case, can be quite extensive. Processes in the NurseLine seem to flow better with the use of LVM e-Centaurus; however, there are several paper processes that could be streamlined. The screening of callers when all of the nurses are on calls is placed in the Centaurus system; however, the call does not flow to the nurse once the caller is transferred. A new case has to be opened, and the transfer is a verbal "across the room" announcing the caller. This process should be streamlined in that the Centaurus case is opened by the screener, and then passed through call/case transfer to the nurse that is available in the queue. This would be automated, both from a telephony and process perspective, reducing at least two steps and client hold time.

The Poison Center was quite impressive from the amount of calls and the amount of work (case documentation) that was accomplished, while balancing multiple callers at the same time (up to three). The downside to this was that the individual health care professionals (HCPs) (general information specialists in poison information [SPI], and certified specialists in poison information [CSPI]) had to choose how to balance the incoming calls. This led to multiple "hold" times for the callers and extended wrap-up time documenting the case in CasePro. It was observed that several callers hung-up while the HCP had them on hold, and with continued queuing of calls without the chance to properly "wrap-up" the call, the case notes became confusing when updating at a later point. It is strongly recommended that callers be queued into a single line appearance, and a "one and done" strategy should be incorporated that includes after call work (ACW) as a tool to wrap-up the case notes.

Within the Drug Center, the main client Pfizer dictates the call flow, form requirements, and quality control. It is understood that a request has been made to several vendors to provide a contact management tool that will streamline the use of forms and attaching required information to the contact. It would benefit RMPDC if this effort could be expanded to include all of their call centers with a focus on consolidated reporting efforts and a common data repository.

In all of the call centers, current call center statistics available from the Avaya™ Call Management System (CMS) were only in moderate use. There is a wealth of information on calling statistics; a review of current call flows would be in order. It is unclear from this short visit how management was utilizing the call center data to make decisions and for future planning based on call trends and queues.

Process documentation in each of the call centers needs to be matured. Starting with each caller type, a process flow should be documented, and then reviewed for efficiency. Quite frequently, significant improvement efforts can be gleaned from mapping just one of the caller types.

Summary of Recommendations

Recommendation Benefits
Document current processes
  • Record of process current state.
  • Documentation for training efforts.
  • Record of process for identifying improvement opportunities.
Organization development—leadership and management training to promote change
  • Manager to coach/mentor.
  • Empowerment of workforce.
  • Decisionmaking closer to the client.
Condense line appearances to one in Poison Center, utilize ziptone to announce caller
  • Callers answered in order of queue.
  • Promote "one and done" strategy:
    • Accurate call statistics for workforce planning.
    • Confusion avoidance for documenting case information.
    • Associate satisfaction in focusing on single case and wrap-up.
Centaurus case populated for hand-off
  • Streamlined call flow.
  • Efficient use of resources.
  • Verbal hand-off not required.
Case notes/contact information database
  • Uniform across call centers.
  • Access to information by all designated HCPs.
  • Streamlined contact flow.

The current technology in use at RMPDC, especially from a telephony standpoint, is state of the art with current releases. A well-trained, process oriented information technology (IT) staff supports this infrastructure, and there is little system unavailability. The processes in place with RMPDC's vendors are well documented, as are disaster recovery plans. It would be good to have a test of the disaster recovery plans on a regular basis, such as a "fire drill" or other simulated event, to test system back-ups and failure planning. It is of high importance that the call centers continue to formalize their staffing plans in a disaster recovery scenario.

Visio documentation is kept current, and an example of the telephony infrastructure (Figure 1) was provided to the consultant on the first day of the engagement. The infrastructure is capable of handling more calls/transactions than are currently being used, and is well-positioned to migrate to a multi-channel contact center with best-in-class considerations. Although the current infrastructure (telephony) is not taxed, its robust qualities are not being fully used (i.e., CMS reporting).

Figure 1. Telephony Infrastructure Example

Diagram representing a telecommunications network configuration. Go to Text Description [D] for details.

[D] Select for Text Description.

In conclusion, RMPDC is positioned for the future with a well-trained, professional workforce enabled by state of the art telephony. While process documentation is weak, there is opportunity to remove non-value added work by changing some of those processes and more fully utilizing the technology currently in place.

The biggest challenge will be championing change management within the call centers and utilizing change agents with supportive leadership. Without this crucial step in organizational development, any new technologies may be perceived to fail without being given a full chance to enable the workforce with next generation multi-channel contact center tools.

Timeline Considerations

The timeline below depicts both planned enhancements to the call center and recommendations on a schedule to move to a full multi-channel contact center. Although full integration of technology components can happen within 60 to 120 days, it is Wood Associates' view that a conservative timeline be placed on the migration with an emphasis on cultural transformation for the personnel leading, managing, and staffing the call centers.

Timeline 1. Schedule for Planned Enhancements to Call Center

Timeline depicts the schedule for enhancements planned to the call center. Go to Text Description [D] for details.

[D] Select for Text Description.

Proposed Elements of "HEALTH" Multi-Channel Contact Center

It is estimated that in the event of a bioterrorism threat or incident, the six million resident population of Region VIII may correlate to 1000 plus contacts per hour from those seeking information from State public health departments.

Chart 1. Established System Sources of Client Stress

Bar chart illustrating the types of clients who would seek information in the event of a bioterrorism threat or incident.  Go to Text Description [D] for details.

[D] Select for Text Description.

Chart 1 shows that of the total population, those "Worried Well" are the largest group of clients and would put the most stress on established systems, including those health organizations locally staffed. The Health Care Providers are the second largest group followed by those symptomatic or believed symptomatic, which could greatly increase based on the level and location of exposure.

For a health call center today, the resulting traditional voice traffic would overwhelm facilities and staffed personnel. By proposing to offer multiple, non-traditional access points to information, the population will be able to access succinct information regarding the event through Interactive Voice Response (IVR), the Internet (E-mail, Web chat, and Web content) and automated fax-back. In Chart 2A, estimates of which client segment would use the various channels are displayed.

Those "worried well" of the general population will be able to access information from the Web (i.e., http://www.rmpdc.org/) or through a self-service application on an IVR that will provide the latest information regarding the event. Frequently Asked Questions (FAQs) can be posted for use by the public either on the Web or through the IVR and updated as additional statistics and information are gathered from those reporting on the event.

Chart 2A. Client Mode of Accessing Information

Bar chart depicting clients' modes of  accessing information. Go to Text Description [D] for details.

[D] Select for Text Description.

It is estimated that up to 40 percent of the general public would be satisfied with FAQs and IVR. FAQs and IVR provides a way of deflecting traditional voice calls, which could overwhelm contact center resources.

Health care providers could also use these self-service options; this would cause a 50 percent reduction of usage by the general population.

A small percentage of those symptomatic, or perhaps self-determined, could be satisfied with these self-service options.

During the initial week of a bioterrorism event, contact volumes could exceed 1,000 per hour. Although current telephony systems in place at RMPDC could handle the traffic, blockage would begin to occur immediately due to staffing (headcount) constrictions. In Chart 2B, we have plotted how contact volumes might be segmented by channel of choice and by client segments requiring information regarding the event. As shown in Chart 2A and 2B, there will still be a significant request for information via the traditional voice channel; however, the IVR augmenting of the voice channel will help to deflect part of the traditional voice-channel volume.

Chart 2B. Contact Volumes by Channel of Choice and Segment Population

Bar chart depicting contact volumes by channel of choice and by clients requiring information.  Go to Text Description [D] for details.

[D] Select for Text Description.

Overall, the self-service options for the Web and IVR could reduce the need for agents by 53 percent, or 47 full-time equivalents (FTE). The actual need without any alternative channels for contact is 89 FTE—thus, the resulting 42 FTE required is shown in Chart 3. Contact center agents, as depicted in Chart 3, are identified as health care professionals (HCPs). Currently, these are Level 2 personnel that perform a complex set of services. As a bioterrorism event unfolds, it has been identified that most initial contacts will be handled by general information specialists or Level 1 personnel. At a future point, RMPDC will determine who will staff the E-mail and Web-chat channels.

Chart 3. Number of Employees Needed During a Busy Hour

Pie chart shows the number of employees needed for each channel. Go to Text Description [D] for details.

[D] Select for Text Description.

During the high volume periods, primarily at the outbreak and initial 1 to 2 weeks of an event, there will still be significant challenges placed on the resources staffing the HEALTH contact center. As depicted in Chart 3, a requirement of 42 FTE for traditional voice traffic can be expected during a busy hour. Resource planning and augmentation strategies will be essential to managing traditional channels, as well as enhanced channels, in an event. There will be additional challenges, just as crucial, managing the knowledge capital of the content placed on the Web and then activated for delivery through the self-service IVR channel.

Figure 2. Logical Flow of Contacts into Multi-channel Contact Center—HEALTH Model

Flow chart illustrating technologies and processes used to provide information to the public.  Go to Text Description [D] for details.

[D] Select for Text Description.

FAQs, frequently asked questions; IVR, interactive voice response; VAERS, Vaccine Adverse Events Report Surveillance.

"HEALTH" Concept Specifications

In Figure 3, the HEALTH Core Team, through meetings in April and May of 2003, discussed a high-level concept for the infrastructure that would be required in a bioterrorism event.

Figure 3. Required Infrastructure in a Bioterrorism Event

Diagram representing the network's  infrastructure. Go to Text Description [D] for details.

[D] Select for Text Description.

FAQ, frequently asked questions; IP, internet provider; IVR, interactive voice response; PBX, private branch exchange; PDF, portable document format.

The network "cloud" is segmented into two distinct networks—that of traditional voice through either Public Switched Telephone Network (PSTN) or Private Networks (PNs) and that of the Internet Protocol (IP) Network. The team understood that those attempting to get information from the HEALTH Multi-Channel Contact Center would try to gain access through a variety of telecommunication modes.

Further, the infrastructure required to handle multi-channel transactions would be a combination of Web and Interactive Voice Response (IVR) self-help coupled with "live" Web chat, E-mail, fax and perhaps recorded voice (voicemail or IVR capture). All data from these transactions would need to be stored and accessed in real time. The current HCPs and general information specialists at the existing call centers would need to be augmented by adding other health care organizations' (volunteer and direct) personnel and perhaps an outsource provider during high-volume or surge periods.

To satisfy these needs, the HEALTH Core Team identified five components required for the development of the multi-channel contact center. They are identified in Figure 4. These five component requirements were included in the Request for Information (RFI) submitted to the vendors outlined in Section III.

Figure 4. Five Required Components for Multi-channel Contact Center Development

Diagram presenting proposed enhancements to the current telecommunications network configuration of the Denver Health Medical Information Centers. Go to Text Description [D] for details.

[D] Select for Text Description.

Notes:

  • Components are placed on the diagram for illustrative purposes only.
  • Components:
    1. Interactive Voice Response:
      • Capable of Automatic Number Identification (ANI) capture and Computer Telephony Integration (CTI) (capture, store, write to other applications; i.e. LVM Centaurus and CasePro).
      • Capable of interfacing with Web applications.
      • Capable of Natural Speech Recognition.
      • Touchtone or "Speak" input/prompt capture.
    2. Multi-Channel Routing Solution
      • Capable of routing voice, E-mail, Web/chat, and fax work items.
    3. Health Care Professional (HCP = contact center agent) Desktop
      • Ability to have a "screen-pop" of captured information from IVR or other routed channels in local databases/applications (LVM Centaurus and CasePro).
    4. Health Care Professional (call center agent) Desktop REMOTE workstation
      • Business Plan requires HCPs ability to work remotely with fully functional workstations by 12/2003.
    5. Robust Real-time and Historical Reporting System.

Proposed Option 1

Development of Multi-Channel Contact Center

Desktop Specifications

Hardware Component Microsoft® Windows®
Hardware architecture IBM compatible
Central processing unit (CPU) 500 megahertz (MHz) Pentium II
Random-access memory (RAM) 256 MB
Disk Space 400 MB
Recommended monitor resolution 1280 x 1024 (256 colors)
Minimum monitor resolution 1024 x 768 (256 colors)

Hardware and Software Specifications

Count/Number of Seat Licenses Description
90 Avaya Interaction Center 6.0 foundation software
2 Basic supervisors
2 Advanced supervisors
90 Voice channel users
20 E-mail channel users
20 Web chat and collaboration users
1 Interactive voice response (IVR) connector
1 Content analysis for E-mail package
1 Advanced Web tool upgrade

Network and Server Architecture

Hardware Component Hardware Component SUN Solaris
Hardware architecture IBM compatible SUN Sparc (Solaris on Intel is not supported)
Central processing unit (CPU) 1.4 GHz Pentium III 900 MHz UltraSparc III
Rating 648 SPECint_base2000 648 SPECint_base2000
Minimum representative model Dell PowerEdge 1500SC with an Intel Pentium III at 1.4 GHz Sun Fire 280R with an UltraSparc III at 900 MHz
Random-access memory (RAM) 1.5 GB 1.5 GB
Disk space 60 GB 60 GB
Load device CD-ROM CD-ROM

Note: Server identified above is a RMPDC-supplied hardware component, and is not included in pricing estimates.

Figure 5. Telecommunications System Architecture

Diagram depicting the Telecommunications System Architecture. Go to Text Description [D] for details.

[D] Select for Text Description.

ASAI, adjunct switch application interface; CLAN, controlled local area network; CMS, call management system; HCP, health care professional; HEALTH, Health Emergency Assistance Line and Triage Hub; IC, interaction center; IP, internet protocol; LAN, local area network; OA, operational analyst; PSTN, public switched telephone network; WAN, wide area network.

Multi-Channel Reporting Options

Feature Avaya™
Operational Analyst
Genesys
Suite 6 Call Center (CC)
Pulse & Call Center Analyzer
Aspect
Customer Data Mart
Cisco
Intelligent Call Management,
Enterprise Reporting
Real time monitoring across all channels Yes, via Basic Reports Yes, via CC Pulse Yes Yes
Historical reporting across all channels Yes, via Basic Reports and also in Advanced Reports Yes, via CC Analyzer Yes, via Customer Data Mart Yes
Same interface for real time and historical Yes, via Basic Reports No No Yes
Online Analytical analytical Processing processing Yes, via Advanced Reports (Cognos) Yes, via CC Analyzer (Brio) Yes, via Seagate Infoinformation Yes, via Sybase PowerSoft InfoMaker
Tabular Reports Yes Yes Yes Yes
Graphical Reports Yes Yes Yes Yes
3-D Visual visual Reports Yes, via Basic Reports No No No
Web-Based Yes No, for CC Pulse; Yes, for CC Analyzer NR Yes
Multi-site real time reporting Yes No Yes NR
Multi-site historical reporting Yes Yes Yes NR
Custom historical report creation Yes, in Basic via Java Toolkit, in Advanced via GUI Wizard and via IC Report Writer & IC Report Wizard Yes, via CC Analyzer Report Wizard NR Yes, via a Report Writer
Unlimited historical data storage Yes (user configurable) No, about 1 year for CC Analyzer NR NR
Update frequency for historical reporting As soon as transaction completes for Basic Reports; generally nightly for Advanced Reports CC Analyzer updated Nightly As soon as transaction completes for Customer Data Mart NR
Pre-summarized historical data 30 min, daily, weekly, monthly in Basic Reports;
user specifiable and predefined at 5 min, 15 min, 30 min, 60 min, daily, weekly, monthly in Advanced Reports
CC Analyzer provides
5 min, 15 min, 30 min, 60 min, daily, weekly, quarterly, annual
5 min, 15 min, 30 min, 60 min, daily in Customer Data Mart 5 min, 15 min intervals
Multimedia real time DBMS Yes, high performance in-memory DBMS for real time (times ten) Partial, separate real time data/objects, not really an RDBMS Yes, separate real time DBMS No, same database shared with historical, based on SQL Server (this may be performance limited)
Historical multimedia customer interaction repository Yes, normalized logical model Yes Yes, for Customer Data Mart Yes, normalized
Extensible data model Yes Yes Yes NR
Open Interfacesinterfaces Yes, ODBC, & and JDBC Yes Yes, ODBC for Customer Data Mart Yes, ODBC
Ability to take in data from other sources Custom Custom Custom Ability to take in WFM data
Exportable data 6.1 Data Export API to WFM systems, wallboards, word processing applications Stat server real time export interface, open interfaces to the database Contact server real time export interface; Customer Data Mart data exportable to word processing applications NR
Predefined Integration integration to Avaya CMS Yes, complete CMS ECH and 30 min summary interval data, as well as predefined reports across up to 30 CMS systems No No, custom (note they claim to integrate to CMS but this is a custom effort and gets a limited set of CMS data & have no predefined reports) No
Blended CMS and multimedia Reports Yes (cradle to grave CMS and IC report) No No No
Multi-vendor switch reporting Yes, supports same list of switches as IC (e.g., Avaya, Aspect, Nortel, Siemens) Yes, supports same list of switches as Genesys TServer Aspect, Avaya, Nortel NR
Multiple DBMS support Yes, Oracle 8i, SQL Server 2000, DB2 UDB 7.2 (with 6.1) Yes, Oracle, SQL Server, DB2 Yes, Oracle, SQL Server SQL Server only
Multiple platform operating system support Solaris 8, Windows® 2000, AIX 5.1 (w/ 6.1) Solaris, Windows®, AIX NR NR

AIX, IBM operating system product; API, application program interface; CC, call center; CMS, call management system; DBMS, database management software; ECH, external call history; IC, interaction center; JDBC, Java database connectivity; NR, not reported; ODBC, open database connectivity; RDBMS, relational database management software; SQL, structured query language; UDB, universal debugger; WFM, workforce management.

Proposed Option 2

Outsourcing of Multi-Channel Contact Center Components

Desktop Specifications

Client Workstations Minimum Recommended
Processor Pentium II Pentium III
Processor speed 300 MHz 350 MHz
Random-access memory (RAM) 128 MB 128+ MB
Hard disk drive 4 gigs (IDE or SCSI) 4+ gigs (IDE or SCSI)
CD-ROM drive None None
Monitor Color SVGA Color SVGA
Network interface card 1 (10/100 MB) 1 (10/100 MB)
Screen resolution 800 x 600 full screen 1024 x 768 full screen
Operating system Windows® 98, Microsoft® Windows® NT Workstation, Release 4.0, Windows® 2000, Windows® XP Windows® 98, Microsoft® Windows® NT Workstation, Release 4.0, Windows® 2000, Windows® XP
Other Software Minimum Recommended
Installed on clients Microsoft® Internet Explorer 5.0 Microsoft® Internet Explorer 5.5 SP2

IDE, integrated development environment; MB, megabyte; MHz, megahertz; SCSI, small computer system interface; SVGA, super video graphics adapter.

Note: Specifications per Ineto Services, Inc. RFI Response

Hardware and Software Specifications

No changes identified to current infrastructure. See Proposed Option 1, Hardware and Software Specifications.

Network and Server Architecture

Network Round Trip Time Minimum Recommended
Network (trace route) round trip time between agent's workstation and Ineto Sustainable avg. round trip = 500 ms; packet loss of = 5% on any single hop Sustainable avg. round trip = 250 ms; packet loss of = 1% on any single hop
Telecommunications System Architecture

Not provided by vendor.

Multi-Channel Reporting Options
Reporting and Customer Analytics

Gain real-time insights into your service center performance and your customers' needs with our integrated reporting and analytical capabilities. Metrics Autosurvey enables you to automatically generate closed incident surveys in order to gauge customer satisfaction with each service interaction, your service organization, and your company.

Proposed Option 3

Combination Development of Multi-Channel Contact Center and Outsourcing
Desktop Specifications

Refer to—Proposed Option 2, Desktop Specifications.

Hardware and Software Specifications

Refer to—Proposed Option 2, Hardware and Software Specifications.

Network and Server Architecture

Refer to—Proposed Option 2, Network and Server Architecture.

Telecommunications System Architecture

Refer to—Proposed Option 2, Telecommunications System Architecture. Remove Avaya® Interactive Center (AIC) components, keep IVR.

Multi-Channel Reporting Options

Refer to—Proposed Option 2, Multi-Channel Reporting Options.

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