Appendix 3. Suggested Elements for Public Health Information and Decision Support Hotlines: The Health Emergency Line for the Public (HELP) Model

Contents

Introduction
Goals and Lessons Learned
Elements of a Telephone Information and Decision Support System
   Call Handling Requirements and Support Services
   Service Levels
   Service Users
   Multipurpose/Multifunction Support Services
   Use of Recordings and Other Information Resources
   Use of Call Center Technology
   Information Topics and Content
   Staff Training and Quality Control
   Data Collection and Reporting
   Adaptability and Utility

Appendixes
Appendix 3-A. Sample FAQ from West Nile Virus Library
Appendix 3-B. Sample Report Items and Data Graphs

Introduction

The Rocky Mountain Regional Health Emergency Line for the Public (HELP) program provides a model for disseminating and collecting information in health emergencies. In our experience, the basic call center infrastructure and elements of HELP are needed to support the tools described in this report. This appendix describes those HELP elements so that similar capabilities can be developed within existing community health call centers to support outpatient health care and monitoring during public health emergencies. A more complete discussion of the requirements for call center infrastructure (people, processes, and technology) can be found in the Health Emergency Assistance Line and Triage Hub (HEALTH) model report on the Agency for Healthcare Research and Quality Web site (http://www.ahrq.gov/research/health/).

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Goals and Lessons Learned

The HELP program objectives, which we developed with our public health partners include:

• Developing a standardized and prepared response to public health events.
• Providing consistent, accurate information.
• Collecting and maintaining structured data to better characterize events and responses.
• Developing capability and capacity to adapt to other public health emergencies.

Essential components for a standardized and prepared response include:

• Call handling procedures.
• Call center infrastructure/technology.
• Toll-free lines with up-to-date recordings.
• Integrated Web site.
• Trained information providers.
• Defined referral procedures.
• Consistent, accurate information delivery.
• Structured data collection and reporting.

In our experience with operating health/medical call centers and responding to health emergency events, we learned a number of valuable lessons:

• Structured upfront planning is essential.
• All call center staff should have a basic understanding of the flow of information.
• Systems need to be flexible to:
  • Meet any challenges or unexpected questions and requests for information.
  • Update/change the information provided as new data becomes available.
  • Adapt to unpredictable and changing call volumes.
  • Provide additional trained staff when call volumes increase.
• A formal and timely communications process must be in place that includes constant reviews and revisions of the information so that only the most current and correct information is provided to callers.

The last lesson relates to quality control mechanisms that will ensure the success and continual improvement of hotline services, as well as provide the call center with the capability to provide specialized information customized to the health event.

In planning for future events, it is clear that data collection must be sensitive so that it can:

• Identify special populations and capture the needs of those populations.
• Be flexible enough to address those needs.

Summary: Call centers are a valuable resource in providing consistent and accurate information not only to the general public but also to health care providers, as well as between health care providers and health departments. The goal is to develop a program that can provide much-needed support for those affected, those with concerns (worried well), and those professionals managing the incident.

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Elements of a Telephone Information and Decision Support System

Call Handling Requirements and Support Services

Authorization and Liability

Call flow processes, scripting, and the prepared responses to frequently asked questions (FAQs) should be approved by the appropriate agency (i.e. public health department) or other client. These must be carefully followed during call delivery. Adding unapproved information or personal opinions creates liability for the persons delivering the service, for the contact center itself, and for the client agency.

If call center personnel (licensed professionals or information providers) have a processrelated concern arising from the scripts or decision trees when speaking to a caller, they are to contact supervisors immediately. If the information specialist or clinician handling a call has any concern or is uncomfortable with how the call resolved, they should report the call identification number, date and time of the call, person handling call, and situation/concerns to a supervisor or to quality assurance personnel.

Security, Confidentiality, and Compliance

All caller information should be treated as confidential and shared only with call center and client agency employees for whom it is appropriate. It should be determined whether it is necessary to comply with any provisions of the Health Insurance Portability and Accountability Act (HIPPA). If the client agency is a public health entity, or if the call center is involved in responding to a community emergency, there may be exemptions from HIPPA (http://www.cdc.gov/od/science/regs/privacy/index.htm).

To safeguard patient health information and confidentiality, do not send E-mails or online reports that contain caller identification information unless the content is encrypted. Also consider collecting non-sensitive information. For example, collecting only a caller's zip code and county reduces the amount of information to collect and thereby shortens call times, while still allowing staff to answer questions, supply information, and report situational awareness information to the state health department (i.e. the top information requests by county). This minimal information approach also reduces any potential barriers for callers who may not feel comfortable providing names, addresses, phone numbers, and other identifying information. However, callers may be comfortable supplying additional identifying information, depending on the situation. If a caller's questions cannot be addressed immediately (for example, the information is not available and a response request must be E-mailed to a State epidemiologist) callers can be given the option to supply contact information so they could be called back with a response. Also, if they were reporting an incident, such as a dead bird during a West Nile Virus outbreak, they might supply location information (at least cross streets) to allow for geo-coding of data.

Summary: It is important to determine what the data needs are for either providing information to or collecting information from the public to allow for adequate disease outbreak management and situational awareness for the specific incident being addressed.

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Service Levels

A two-level service system was developed to respond to the needs of different clients and incidents. Level 1 involves only basic information collection and dissemination, while Level 2 involves more advanced clinical triage or decision support. We have developed our platform to provide Level 1 service and use information providers only (unlicensed staff). We have the capability to expand to Level 2 service if the client or incident requires by bringing in clinical staff. However, in many incidents there may be a lack of clinical professionals available to handle calls; therefore, we chose to concentrate on Level 1 service that information providers can deliver.

1. Level 1 Service	2. Level 2 Service
Recorded information on current event status Information Providers give approved content through FAQ's Data collection as required by client Reporting and data analysis as required by client	Recorded information on current event status Information Providers give approved content through FAQ's Decision support for public with suspected related symptoms* Decision support for providers treating public*
Delivery Method Telephone Web site Information Providers	Delivery Method Telephone Web site Information Providers Registered Nurses*

* Level 2 that includes clinicians such as nurses providing decision support for the public and providers will require pre-designed protocols/clinical decision trees specific to the event.

Summary: Planners should first determine the type of service level that they intend to provide and then staff appropriately. It is then important to establish the precise services that are needed before developing the support systems and procedures for them to properly function.

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Service Users

It is helpful to determine the expected potential service users and to begin to forecast what their needs may be. Though we intended to provide services to primarily the general public, we found there were many other service users that we had not anticipated, and we had to develop resources in order to meet their needs. The following figure demonstrates the different user groups we have identified from operating the HELP program.

[D] Select for Text Description

Summary: Planning for specific user groups will help in the development of appropriate resources and information; however, planners should be prepared to adapt services to new user groups as situations require.

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