Health Emergency Assistance Line and Triage Hub (HEALTH) Model

Appendix O. Requirements Document

Contents

Background
Specifications/Requirements
     Functional Requirements
     HEALTH Telephony Solution
     HEALTH Triage Solution
Appendix I—CasePro
     Client Environment
Appendix II—LVM Systems' e-Centaurus
     http://www.lvm-systems.com/
     Client Environment
Appendix III—Current Infrastructure
Appendix IV—Proposed Changes to Infrastructure (Components)

Background

In August 2002, the Denver Health Medical Information Centers (DHMIC—the Rocky Mountain Poison & Drug Center and the Denver Health NurseLine) submitted a proposal to the Agency for Healthcare Research and Quality (AHRQ) to provide a Health Emergency Assistance Line & Triage Hub (HEALTH) model. The goal of the proposal was to determine the requirements, specifications and resources needed for developing the HEALTH model, a public health emergency contact center. The purpose of the model is to examine the effects of the regional care models and their impact on resources allocation and capacity in the event of a potential bioterrorist event. DHMIC was awarded the grant in September 2002.

The cornerstone of the grant request is the model development of a business process and computer application systems to identify:

• Requirements for surge capacity: facilities, equipment, and personnel.
• Lessons learned for bioterrorism preparedness from other regional models of care (for example, cardiac or trauma care).
• Linkage with local public health and emergency preparedness infrastructures.

The objective of this model is to address the public health emergency information needs of Colorado and Hawaii as a starting point for a regionally exportable model. This contact center may include E-mail, fax, phone, or Web chat as an interface to the public. The model must be scalable to provide exportability to six states of Region VIII and the states of Idaho, Nevada, and Hawaii.

Specifications/Requirements

Functional Requirements

The following functional requirements have been identified for the HEALTH model. The requirements will be directed toward telephony interaction with the customer, but is not limited to telephony as a means to communicate with the customer.

HEALTH Telephony Solution

Integration of Telephony Solution

• The HEALTH Telephony solution must be capable of integrating with the existing Avaya Telephone Switch. (see Appendixes III)
• The HEALTH Telephony solution should be capable of integrating with multiple switch platforms such as Cisco, Alcatel, or Nortel in order to be exportable to other states.
• The HEALTH Telephony solution must provide reporting and data transfer in a manner that can be exported to State and Federal agencies.
• The HEALTH Telephony solution must be consistent with the DHMIC long-term vision of becoming a Multi-Media Contact Center (see Appendix IV). This vision includes the ability to accept and respond using multiple communication methods in addition to the telephone. This includes faxes, E-mails, and Web chats.

Telephony Functionality

• The HEALTH Telephony solution must provide Interactive Voice Response (IVR) with the customer contact.
• The HEALTH Telephony solution must be able to replicate the existing functionality of the current telephony systems, including Automated Call Distribution (ACD) and the use of Expert Agent Skills (EAS).
• The HEALTH Telephony solution must provide call-tracking metrics.
• The HEALTH Telephony solution should be capable of sending multiple types of data formats including, but not limited to, Microsoft® Access and Excel.

Telephony Management Functionality

• The HEALTH Telephony shall be able to be managed remotely.
• The HEALTH Telephony solution must be able to replicate the existing management functionality of the current telephony systems.
• The HEALTH Telephony solution must support remote agents.

Telephony Performance

• The HEALTH Telephony solution must be initially able to receive 1,000 calls per hour.
• The HEALTH Telephony solution must be available 24 hours per day, 7 days per week. The amount of availability should be no less than 99.99 percent.

Telephony Scalability

• Initially DHMIC envisions low call volumes for the center, but the number of calls could rise quickly in a bioterrorism event.
• The HEALTH Telephony solution must support simultaneous 75 to 100 agents.

Telephony Ease of Use

• The HEALTH Telephony solution must have a Graphical User Interface (GUI) look and feel.

Telephony Security

• The HEALTH Telephony solution must comply with Denver Health's security policies for Telephony systems.

Telephony Manageability

• This system must have an "ease of administration" sense to it; hence, DHMIC staff should not have to complete extensive training on the usage and manageability of the system prior to its installation.
• DHMIC needs to have the ability to perform remote administrative duties on the HEALTH Telephony solution.
• DHMIC uses both Microsoft® Windows NT and 2000; therefore, both platform based interfaces are required.

HEALTH Triage Solution

Integration of HEALTH Triage Solution

• The HEALTH Triage solution must have the ability to process multiple methods of incoming work using a single user interface for the agent to document work including the contact and protocols used during the contact.
• The HEALTH Triage solution must be capable of providing a single user interface to existing telephone triage software or DHMIC software such as LVM Systems' e-Centaurus application (see Appendix II) and CasePro software (see Appendix I).
• The HEALTH Triage solution must be capable of integration with the HEALTH Telephony solution to allow information collected in the telephony solution to be used in the Triage solution.
• The HEALTH Triage solution must provide reporting and data transfer in a manner that can be exported to State and Federal agencies.

HEALTH Triage Functionality

• The HEALTH Triage solution must be able to replicate the existing functionality of the current triage systems.
• The HEALTH Triage solution must be able to support 20 remote agents.
• The HEALTH Triage solution must provide contact-tracking metrics.
• The HEALTH Triage solution should be capable of sending multiple types of data formats including, but not limited, to Microsoft® Access and Excel.

Triage Management Functionality

• The HEALTH Triage solution must provide IVR with the customer contact.
• The HEALTH Triage solution must be able to replicate the existing functionality of the current telephony systems.
• The HEALTH Triage solution must provide call-tracking metrics.

Triage Solution Performance

• The HEALTH Triage solution must be initially able to handle the same amount of users, records, and data interfaces as existing systems such as CasePro and LVM Systems' e-Centaurus.
• The HEALTH Triage solution must be compatible with current Local Area Network (LAN) infrastructure and not erode current performance levels.

Triage Solution Scalability

• The Triage solution must be able to support 90 customer contacts at any one time.
• The Triage solution must be able to support 20 remote agents.
• The Triage solution must be able to support 90 agents at anytime.

Triage Solution Ease of Use

• The Triage solution must have the look and feel of existing user interfaces such as CasePro and LVM Systems' e-Centaurus.

Triage Solution Security

• The Triage solution must comply with Denver Health system security policies.
• The Triage solution must be HIPAA (the Health Insurance Portability and Accountability Act of 1996) compliant.

Triage Solution Manageability

• This system must have an "ease of administration" sense to it; hence, DHMIC staff should not have to complete extensive training on the usage and manageability of the system prior to its installation.
• DHMIC would like to have the ability to perform remote administrative duties on the solution.
• DHMIC would like to use a Microsoft® Windows® 2000 based solution so the Information Technology department can best manage the system.

Appendix I—CasePro

CasePro is an online patient record used by the Rocky Mountain Poison Center (RMPC) for data collection, case management, tracking, and reporting. Its current functionality includes the following:

• Call center application to record and track incoming calls to the RMPC.
• Toxic Exposure Substance Surveillance (TESS) compliant. The American Association of Poison Control Centers uses TESS for data collection and reporting. Any poison center system must be TESS compliant.
• FIFRA (Federal Insecticide, Fungicide, and Rodenticide Act) compliant. The RMPC has clients that are required to submit reports to the U.S. Environmental Protection Agency (EPA).
• Public and industry reporting. The RMPC has other public and industry clients with client specific reporting requirements.
• Quality assurance. CasePro is used to review cases for completeness, quality, and accuracy.
• Case entry/storage and retrieval.
• Fast.
• Durable.
• Decision support. There is logic built in to decrease data entry errors and help assure accurate reporting.

Client Environment

HW Requirements (with Failover). RMPDC is currently using Dell™ PowerEdge 4300 with 1 gigabyte Random Access Memory (RAM) and a 455 megabyte processor dedicated to CasePro. They run two instances, one for backup and one for restore.

Maintenance Support. Most changes can be planned in advance. Currently, there are few emergencies that require immediate attention. Major events (i.e., an anthrax outbreak) would require immediate changes to the application. There is generally a 1 to 2 month lead time for changes.

Users. There is an average of 6 users, 15 during peak periods and 2 during low periods.

Appendix II—LVM Systems' e-Centaurus

http://www.lvm-systems.com/

LVM e-Centaurus Nurse Telephone Triage software is an online patient record used by the Denver Health NurseLine (DHNL) for data collection, case management, tracking, and reporting. LVM e-Centaurus software offers three sets of standardized nurse guidelines: Schmitt Pediatric guidelines, Thompson Adult guidelines, and the American Institute for Preventive Medicine guidelines. With the software product, "Nurse Guidelines for Telephone Triage," you can cost-effectively use standardized guidelines to triage and track each call.

Easy to use, straight forward system:

• Ability to track questions asked, caller's responses, advice given, appointments made, and follow-up information.
• Standardized guidelines to ensure each call is handled in an appropriate manner.
• Ability to modify guidelines to fit your needs as well as your clients' needs.
• Each guideline is supplemented with Nurse Additional Information.
• Manageable guideline topics such as chest pain, fever and chicken pox.

Client Environment

HW Requirements (with Failover). DHNL is currently using Dell PowerEdge 4300 with two gigabytes random-access memory (RAM) and 455 megabyte processor dedicated to LVM e-Centaurus. The server houses the FoxPro Database; application/component drivers reside at the desktop.

Maintenance Support. Most changes can be planned in advance. Currently there are few emergencies that require immediate attention. There is generally a 1 to 2 month lead time for changes/enhancements which are negotiated directly with LVM e-Centaurus System Support.

Users. There is an average of 7 concurrent users, 10 during peak periods and 4 during low periods.

Appendix III—Current Infrastructure

[D] This diagram represents the current telecommunications network configuration of the Denver Health Medical Information Centers (Rocky Mountain Poison and Drug Center [RMPDC] and Denver Health Nurse Line) at the time of this report. It outlines from where the telephone lines into the center terminate at the demarcation point (DMARC) before entering two telephone switches (Nortel® and Avaya®). The telephone switches are then connected to various voice handling equipment to provide the functionality of voicemail (Avaya Intuity AUDIX®), call monitoring (Avaya CentreVu CMS®, Telecorp), call accounting (Microcall®), and call recording (Dictaphone Freedom® and Prolog).

CMS = call management system.

Notes:

• In August, 2003 the three call centers moved to a new location in Denver, Colorado.
• In August, 2003 the Avaya™ G3Si was upgraded to an Avaya™ S8700 Media Server.
• In August, 2003 a RightFax server solution was implemented in the new call center.

Appendix IV—Proposed Changes to Infrastructure (Components)

[D] This diagram represents proposed enhancements to the current telecommunications network configuration of the Denver Health Medical Information Centers (DHMIC). It outlines from where the telephone lines into the center terminate at the demarcation point (DMARC) before entering two telephone switches (Nortel® and Avaya®). The telephone switches are then connected to various voice handling equipment to provide the functionality of voicemail (Avaya® Intuity AUDIX®), call monitoring (Avaya CentreVu CMS®, Telecorp), call accounting (Microcall®), and call recording (Dictaphone Freedom® and Prolog). The five proposed enhancements include: 1) Interactive Voice Response to be added prior to the DMARC to provide menu driven options to callers; 2) Multi-Channel Routing for various contact methods; 3) Healthcare Provider (HCP) Desktop for multiple channels; 4) Remote Agent HCP Desktop for multiple channels; and 5) Multi-Channel reporting system.

CMS = call management system.

Notes:

• Components are placed on the diagram for illustrative purposes only.
• Components:
  1. Interactive Voice Response (IVR)
     • Capable of Automatic Number Identification (ANI) capture and Computer Telephony Integration (CTI) (capture, store, write to other applications; i.e., LVM e-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 e-Centaurus and CasePro).
  4. HCP (call center agent) Desktop remote workstation
     • Business plan requires HCP's ability to work remotely with fully functional workstations by December, 2003.
  5. Robust Real-time and Historical Reporting System
     • Ability to consolidate reports to show all activities performed by a contact center representative, including contact center productivity on phone, E-mail, and Web.
     • Ability to export data into popular file formats (i.e., Microsoft® Excel and Access).
     • Ability to access reports via the Web.

Return to Contents
Proceed to Next Section