Are IVR’s Being Designed and Utilized Appropriately in Remote Care

With full disclosure, I started out MedApps many years ago (2006) utilizing smartphones (Bring Your Own Device – BYOD) solution and Interactive Voice Response (IVR).

We truly believed that it would be less expensive to utilize technology and solutions that a patient already had, instead of shipping costly equipment and connectivity devices to a patient in order to keep them connected and ultimately compliant.

One of the big attractions today is to utilize Interactive Voice Response (IVR) in order to engage a patient by capturing their time with a “Teachable Moment / Education,” staying ahead of their disease / chronic care management by asking questions and analyzing the results in a backend analytic solution and collecting their biometric and behavioral data on a regular basis.   The IVR solution allows us to interact with the patient on their terms, wherever they may be, including: home phone, mobile phone, text, email, etc., all at a cost paid for by the patient. I know this sounds all great, until I see people around me and also including me that get so frustrated when an outbound IVR call contacts them to get information at inappropriate times (during their programs on TV, bridge game or eating out with friends).   The solution also offered the ability to take inbound calls from the patient so that they could call when they had time to check in and report their readings, but they weren’t talking to a person (that’s the point: it’s expensive to have a person man the phones).

I went out on the Internet today to listen to a demo for an IVR solution specifically targeted for the VA. It was over four minutes long, gave a lot of education and asked branching questions as well as collected biometric and behavioral data for today.   It was WAY to long.  My mom wouldn’t use it, my elderly neighbor wouldn’t use it and I certainly wouldn’t.  We have to be smart about how we design and engage people today, especially with our new forms of communication (or the platforms that we want to communicate on).  Some people instead of talking to a person would rather text them.   I could see a text popping up on my phone that ask me for my glucose or weigh and only after it analyzes it ask me one or two questions or connects me to a caregiver when “I” push the button to connect. (Not the system chasing me.)

I use my mom as an example many times to confirm the efficacy of new solutions and how she likes to be engaged.  She likes, no, wants, to talk to a person and she wants to talk to the same person out of friendship and trust.   I understand this, but it also the most expensive model.   My mom has recently been switched from her her nurse calling her on a weekly basis to now a IVR calling her and she hates it.  It calls at the inappropriate time, its not personal, it takes too long, and it lectures her.   She has learned how to put the wrong numbers in on the IVR (Readings) so that a nurse has to call her because her readings are out of range.  Similarly, I have seen patients put in lower numbers because they don’t want to get a call from anyone.   They know how to manipulate the system by putting in false data and there is a real danger in that.

We all know that their is a hierarchy to remote care from most costly touch point to the least.

But also there is an intersecting line of ultimate compliance to the least compliance.

The hierarchy in remote monitoring / care in my opinion (most costly to least):

  1. Nurse home visit

  2. Nurse call center

  3. Kitted devices / hubs

  4. Bring Your Own Devices (BYOD)

  5. Interactive Voice Response (IVR)

  6. Log books

The compliance efficacy, I believe, intersects somewhere in the middle and is a balancing act to determine what is the best technology to deploy with the right patient and cost model.  More importantly, the use of the solution (I almost wrote technology – it is NOT always about technology) does NOT need to address 100% of the population with one solution, it will never happen.  There are solutions in this list that can be targeted towards a segment of the population in order to get them compliant and under control, but may and probably will not work on the heavier frequent spenders. (I won’t get on my “One Solution Doesn’t Fit All” soap box.)

Don’t get me wrong, I do believe that IVR’s are cost effective and a needed tool.

In fact, back when we started MedApps in 2006 and we owned an IVR / Automated Call Routing solution we took it a step further.   We believed that once we had the patient captured, there were teachable moments and that based on their past readings (coming in automatically) and the answers to their current questions, we could do “Just in Time Triage or Triage on the Fly,” getting the patient to the right care giver / specialist above the rest of the patients in order to avoid a hospitalization.  I do believe that Healthcare IVR’s need to dip into patient records to determine the course of action while they are on the phone, but they need to do it quickly, seamlessly and transparent to the patient.

Let me know your thoughts.

So my question for today is: Do you think that IVR’s have a place in Remote Patient Monitoring / Care?   Do you think they have been effective so far and what would you change about them to make them better suited to be engrained painlessly into our lives?

Do you think that the younger generation want to engage in quicker conversations and interactions, say via text messaging and that the older generation needs a voice call?

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