EPISODE TEASER / Summer Penn (guest):

…We wanted to be able to make changes ourselves on the fly without having to escalate to a telecom engineer. So with this program, it’s just web-based and any changes that we make implement essentially right then and there. So we can change your recording and we can create a call tree that we’d like to wait after hours because we don’t know that would happen with the current calls in the hold queue or change hold queue times, change the hold music all on the fly with the tip of our mouse.

Jessica Ortiz (host):

Hello, everyone. I’m Jessica Ortiz with the Center for Care Innovations. Today, we’re talking about one of the exciting projects that West County Health Centers has been working on for the past year. Our hope is that by sharing the highs and lows of this particular digital health solution, safety net organizations can apply the lessons learned here to their own challenges.

Jessica Ortiz:

I’m here with Summer Penn, who is a member of our Tech Hub learning network, which is comprised of 14 tech board, California based community health centers, clinic coalitions, and primary care departments in county health systems that are working to accelerate the adoption of innovative technology. We partner with our Tech Hub members to vet, pilot, evaluate, and spread innovative digital health solutions, targeting Medicaid markets and historically underinvested communities. We are excited to bring you this story today. Summer, do you want to introduce yourself and tell folks a little bit about you?

Summer Penn (guest):

Sure. Hi, everyone. My name is Summer Penn. I’m the IT director at West County Health Centers. I’ve worked for West County Health Centers for about 20 years. My area of expertise is really around the EHR technology and anything that kind of integrates into it, as well as more patient communications.

Jessica Ortiz:

We’re happy to have you, Summer. Tell us about the project you’ve been working on. How did you get started?

Summer Penn:

Happy to be here. Thank you. With the beginning of the pandemic, we realized really quickly that we did not have a phone system that could support the home-office type work style that we had to quickly pivot to. We had implemented a few solutions that were with our current infrastructure and/or required some staff to actually have to be on site, and then the combination of Zoom. We realized really quickly that, that was becoming a big gap in being able to support our users. So we had to quickly pivot to a phone system and we chose Dialpad.

Jessica Ortiz:

And thinking about your solution, could you share with us a little bit more about the platform that you chose?

Summer Penn:

Yeah. Dialpad is a pure VoIP solution. VoIP stands for “voice over IP,” which essentially means that the capabilities of this phone system do not rely on it being plugged into the data ports or a phone line that’s on your wall. It can be used from any internet-based device. So we opted for only a few hardware phones, but for the most part, most of the agency does not actually have hardware phones on our workstations any longer. It is either a desktop application or a phone application that you can install on your smartphone.

We wanted to be able to make changes ourselves on the fly without having to escalate to a telecom engineer. So with this program, it’s just web-based and any changes that we make implement essentially right then and there. So we can change your recording and we can create a call tree that we’d like to wait after hours because we don’t know that would happen with the current calls in the hold queue or change hold queue times, change the hold music all on the fly with the tip of our mouse.

Jessica Ortiz:

Wow. That’s impressive. So you don’t have to wait? There’s no time in between.

Summer Penn:

No time in between.

Jessica Ortiz:

Just make decisions.

Summer Penn:

We got feedback on our “hold” music actually. We got a few complaints, but then also it was on our surveys that we review. I thought it was a funny song. It was basically, I don’t know if you guys heard it, it’s that “I’m On Hold” song. Doesn’t really sound like a song, “I’m On Hold.” You should look it up. There’s a YouTube video. At first, it just sounds like a lovely guitar song. Then the lyrics are just talking about how he’s on hold, waiting for his friend to join. That was apparently offensive to some people. So which I can see in a moment where you’re not feeling good and you’re frustrated, it could not have the intent we were expecting.

Jessica Ortiz:

Yeah. We all don’t share the same love of each genre of music.

Summer Penn:

True. Yeah. So we quickly changed it to a very nice, almost meditating type melody.

Jessica Ortiz:

What was that vetting process like when deciding? At CCI, we have a framework we suggest, which is making sure that’s a mission fit, operational fit, and sustainability of using the platform. How did this play into your decision making?

Summer Penn:

We usually like to take a little bit longer in our vetting process, but because of the limited resources, we only vetted three different phone solutions. That was essentially the VoIP solution to our current phone system, which was AVAYA at the time. That VoIP solution was Top Hat. It did not have the analytics or anything. We would also still have to rely on our whole telecom engineer to do most of the supporting for us as well as another phone system – I’m not recalling off the top of my head – but it was more of a local company, what the name was.

Summer Penn:

The CIO who we were working with at the time, had used Dialpad at his current hospital systems. With the analytics, and then also this feature that essentially it listens to every conversation and transcribes. Then, if there’s a keyword, we can actually build in an assist card to the call center for who’s answering that call. So that call center representative has all the most current information in regard to that topic based on our programming of that assist card.

Summer Penn:

So for example, if “COVID testing” was mentioned by either the call center agent or the patient, an assist card will pop up, giving them hyperlinks to any outsourced websites that we need to refer to like the SoCo (Sonoma County) Emergency website. Or even just a whole list of phone numbers and/or clinic hours, or our own internal information about [COVID] testing that we could give to the patient right there on the phone.

Jessica Ortiz:

Can you share your top highlights of this project so far?

Summer Penn:

The top highlight is actually that assist card. Before then, we had kind of an antiquated Excel spreadsheet that was, or things lost in Team channels that our call center would have to go digging through to find the most up-to-date information. Then things get copied. There’s always version control issues. So this assist card allowed for a real time, basically place updates that we can keep updated, because the information was changing on the fly pretty much weekly. So it was one of the better technologies for us to implement at the time.

Jessica Ortiz:

Can you use the assist card to help with appointment scheduling to ensure that the patient gets the right slot at the right time?

Summer Penn:

In a sense, it doesn’t kind of give the ability to do online scheduling or anything, but it does give because we have very specific, we actually have what’s called kind of a scheduling “bible.” So it has every different tabs of which clinics, which providers are actually taking new patients – that is always referenced – unless you remember everything. But it took place of some of those kind of who is accepting new patients. We haven’t built everything out on the assist cards. We were mainly playing with most of the COVID and any other type of pain points that our agency was going through, but essentially we could create assist cards for all those things.

Jessica Ortiz:

Could it be used to identify a triage opportunity?

Summer Penn:

Absolutely. Yes. So any kind of keyword that you’re able to program, it’s really just one keyword, but you can create as many assist cards as you want, will trigger an assist card to pop up.

Jessica Ortiz:

In implementing this platform, what was the biggest challenge you faced?

Summer Penn:

Training and getting used to a phone system that you did not have a physical phone for. That was a huge challenge for our users and it’s just hard on staff overall to have a big change like that. I think if I were to do it again, I would’ve purchased hardware phones and just kind of made it same as usual in the addition to being able to use it from home. But unfortunately buying all new hardware for 300 workstations, especially phones was pretty expensive.

Summer Penn:

We’re planning on potentially phasing that in future, but at this point we’re almost getting used to it. So there may not need to be as much of a need to purchase the hardware. That, and then Telecom was kind of a newer technology that I was not fully proficient in and porting phone numbers and dealing with Comcast to port phone numbers to this new phone system was a bit harder than I had anticipated.

Summer Penn:

I’m not a telecom expert and definitely learned a lot in this process, but we had an original go-live date of around March 15th, I want to say, off the top of my head. That was dependent on our port request – which is where we list all the phone numbers and the accounts they’re a part of – to Comcast and ask them to release our phone numbers to this new phone system. Well, that request, we don’t find out until 24 hours before the go-live whether or not it was approved. Of course, there’s the balance of wanting to communicate to staff and make staff aware because as soon as that port request goes through, it is not easy to get it to revert back.

Summer Penn:

You want to communicate to staff with the intention that we’re going to go live, assuming that the port request was going to be approved. And it was not approved, and it didn’t get approved the next go live, which was about three weeks later. It didn’t get approved the next time. It wasn’t until May 17th that it finally got approved. That was after trying to understand why a phone number was not part of an account when we thought it was. It was just all these idiosyncrasies with telecom technology that I had no idea about during the time of.

Summer Penn:

It was a pretty big challenge and frustrating to staff, but luckily it only really mainly impacted our call center staff because of the phone numbers coming in. All the rest of the staff were still able to use and learn Dialpad because they were able to use it making calls out. We had the caller IDs that were coming out of Dialpad forward to our mainline. If anybody did call out of Dialpad in that kind of, medium period, the calls would still be, if they just returned the call, would go to the call center with the phone system they were using at the time of.

Summer Penn:

It didn’t allow us to being able to forward internally because those calls were on a whole separate phone system. But once those porting requests… How I actually got over it was we decided to just pare down those lists. We had way too many numbers on that list, and we thought that was part of the problem. Instead of doing all at once, we focused on our main numbers that we know we use as direct lines and focused just on those and then submitted the port requests instead of trying to do every number within my contract.

Jessica Ortiz:

It sounds like you became the telecommunications expert, Summer.

Summer Penn:

Yes, I learned a lot in this process. Could about laugh about it now, but it was hard during the time.

Summer Penn:

Another challenge was not having enough call center staff since the pandemic and essentially in the beginning, a lot of people like to assume that the problem was a new technology – “Dialpad was the issue of why the calls were not being answered.” But in looking at the analytics and seeing how many representatives we’d have available for the call volume we were experiencing, we were able to determine and prove that the issues were not our new phone system, but in fact were the lack of staff and not having enough humans to actually answer the phones.

Summer Penn:

So to mitigate that we actually changed licenses, escalated a lot more licenses internally to be able to answer on behalf of the call center. It’s an elevated license rather than a talk-user. So the larger majority of staff for all of our front office representatives, not just call center representatives. In addition to some of our MA floats had the capability of jumping in during peak hours to help answer when our call volume was the highest.

Jessica Ortiz:

Did the new phone system highlight changes that you needed, but perhaps were not so obvious at first?

Summer Penn:

Yeah, it did actually. So it helped us determine that we needed a whole call tree for other things that we kind of had more calls for, especially with Zoom. Patients are trying to get onto their Zoom line. We were able to quickly create a department called Zoom Assistance, add that to our phone tree so that someone could press “2” for Zoom Assistance.

Summer Penn:

That would actually go to all the MAs, all the medical assistants of that site, including I’ve added all the IT department so that we are available to also answer those calls for those patients. Because usually if they’re calling that line, they need to be able to get answered and helped quickly in order to get to their appointment on time without impacting the rest of clinical care.

Jessica Ortiz:

I know you mentioned this before about COVID-19 and trying to focus some of that effort on this and also the challenges of not being able to really get this program going from a distance when you have folks working in other places. What were any other challenges associated with the pandemic during this transition?

Summer Penn:

Yeah. I think it was not being able to have everybody in a singular place. We had to rely on our videos and making sure that the supervisors were sending those videos and how-to documents to their users. Honestly I think the biggest other challenge is just how much is going on with a pandemic and how much stress that impacts even just the status quo clinic. It just adds in a whole other element. So there’s been a lot of changes and it’s kind of hard for staff to keep up with all the changes.

Summer Penn:

So since we’re not all together, we can’t bring them into a room and make sure they’re full focused. There’s an element to Zoom meetings and I’m sure this is everybody, but there’s definitely some multitasking going on a little bit more than there used to be. So sometimes, your attention span can waiver or wander. So I had a few office managers essentially admit to me that they haven’t really reviewed any of the training material. I think one of my lessons learned would be to engage the office managers in the vetting process all the way through to make sure they were more cheerleaders about this new program that we chose instead of more finding it of a nuisance of learning something new.

Jessica Ortiz:

So how much training and orientation was necessary for existing staff? I know you talked about the challenges with that. I’d like to hear more.

Summer Penn:

Yeah. So we did everyday leading up to the go live, we did everyday lunchtime webinars for anybody who could attend for about two weeks, actually, leading up to our go live date. That was just for the regular talk-user. Then we also held separate webinars for call center folks because it’s a slightly different use case depending on your license. We recorded both of those and we have those trainings and videos embedded in our new LMS system so that every new user gets assigned this course and they get a certificate at the end of the course that’s been completed.

Jessica Ortiz:

What is LMS?

Summer Penn:

Oh, thank you. Learning Management System. So we use Compliatric and that’s where we assign all our courses for the HIPAA, bloodborne pathogens, et cetera, et cetera. With this new system, we actually have the capability of creating our own learning management courses so we can upload and create our own and then assign it to users and actually kind of schedule anytime we want, how often do we want it to be done, annually or every six months. So we have the capability of automating that training if we want them to do it every year, for example.

Jessica Ortiz:

How has this platform impacted sensitive services like behavioral health? Could you use the new system to augment understanding patient needs?

Summer Penn:

So not every line do we have the transcription enabled for. We only have a transcription enabled for calls coming in through the call center. So we don’t have that technology turned on for our behavioral health line, which is actually a separate direct line. We asked all staff to actually disable. We did we go through and do random audits of making sure that those staff have that feature turned off for outbound calls. That assist card only works when the calls are coming through a call center itself, which is our three primary care lines. So Occidental Area Health Center, Russian River Health Center, and Gravenstein Community Health Center.

Jessica Ortiz:

Got it. That makes sense. You are part of our learning network and we’re big believers in collaboration and not reinventing the wheel. You’re part of this Tech Hubs program.

Summer Penn:

Yeah.

Jessica Ortiz:

How did your peers in the program support and help you push this project forward?

Summer Penn:

I love having a place that I can go to and ask my peers questions that I don’t actually feel stupid about asking and even could be a dumb question to someone, but Telecom is a whole separate technology that many IT directors actually are like, yeah, that’s a whole separate technology. So it kind of its own little niche. I love being able to ping ideas to my peers or even just emailing them on the side and saying like, “Hey, have you gone through this?” For example, the transcription is also a recording. It actually records the phone calls.

Summer Penn:

So, I had to ping my California folks because California has that mandate of any time a phone call is being recorded, it has to be a two-party consent. But did find out that as long as you’re actually including that message when a user calls, so part of our greeting recording saying, “Welcome to West County Health Centers. For quality assurance and training purposes your call may be recorded.” That, and by continuing on with that call is considered a two-party consent. So I was able to gain that insight, thanks to reaching out to my peers.

Jessica Ortiz:

Yeah. It’s such a great community of folks that share so openly. With this discussion, we’re thinking about how to share some of these lessons with the broader community. So any advice you have for listeners that are thinking about implementing a similar technology?

Summer Penn:

Yes, actually we didn’t do this in the beginning, but I’m so glad that we did it. We used Lucidchart, but if you have Visio, you can use Visio. We actually drew out every single line and the path that a patient goes through, even naming anytime there’s a recording given we put that name in there, as well as essentially the choice options, the tree options, and the path. So, listing that out, and we’re actually about to make that information transparent to all of staff because we realized we only know about these Lucidcharts within my department and within the executive team, but really, the large majority of staff don’t.

Summer Penn:

We recently spun up a SharePoint site. So we’re building out a SharePoint site specifically to Dialpad so that we have all of our training resources, our FAQs, as well as having a one notebook dedicated to essentially the call tree in the systems there within. As well as being able to listen to the recordings without having to call each line and kind of become a secret shopper. There’s a hyperlink to our OneDrive folder where we stored all of our recordings and the scripts for those recordings. So one would be able to go there if they were curious.

Jessica Ortiz:

Trying to make things that are complicated as accessible as possible, right?

Summer Penn:

Exactly. Yeah. For example, I don’t think our clinical staff actually know we have a Zoom Assistance line. So we implemented that with our office managers based on the calls that were coming in. I don’t recall us really kind of sending a communication or making that information transparent, which I could see being really helpful for clinical staff to know like, “Hey, if you’re talking to a patient and they have a hard time getting onto your Zoom appointment, you can dial 2 to get to our Zoom Assistance line,” for example.

Jessica Ortiz:

Yeah. It sounds like a lot of planning, a lot of planning for that to roll out and continue to be accessible for folks.

Jessica Ortiz:

It sounds like much of this was driven by necessity. Would you advise others to do this voluntarily given the outcomes you’ve seen so far?

Summer Penn:

I would go to a VoIP system, whether or not I would have gone to Dialpad, which definitely we’re finding has its quirks. I think I would probably want to vet more VoIP systems before we were to make a decision and have that be a longer vetting process in the future. But I think a VoIP system is the way to go, including kind of moving most infrastructure to the cloud.

Jessica Ortiz:

Thanks so much, Summer, for sharing your project, your expertise and experience with the broader communities that can learn from what you all have done with this and how to potentially adopt this technology. I’d love to hear what’s next for you.

Summer Penn:

We are actually rolling out – we’re in the build phase, almost test phase – for rolling out Luma Health as our new patient engagement communications tool. So all of our text messages, bidirectional secure texting, e-intake forms or eForms, eConsents, email reminders, broadcasts, everything will be done through the new Luma Health system. We’re pretty excited about that.

Jessica Ortiz:

It’s been great to have you on the call, Summer. Thanks for sharing again your expertise and your experience and being a valued member of this Tech Hub learning community.

Summer Penn:

Thanks for having me. It was a pleasure.