A leading HMO that provides phone consultations by professional nurses through a call center, sought to improve the service given to its patients – by using an advanced AI system
Background and Challenges
Have you ever needed a medical consultation with a nurse while your HMO branch was closed?
A leading HMO has a nurses call center, that provides phone consultation by a professional nurse. A patient may call this center and consult with a nurse.
The nurse will ask the patient a set of pre-defined questions – according to the medical protocol. After reviewing the symptoms, the nurse will consult the client as for his further medical actions – and may even refer the patient to the ER.
The number of nurses working in a call center is limited, and the nurses' time is limited, too. As a result, the time that the patient spends over the phone, waiting for a nurse to answer, is long.
The HMO decided to implement an advanced AI system, Commitigo, in the nurses center. This AI system:
• Maps all the stipulations, laws and recommendations, and imitates the nurses' decision-making process
• Contains the precise medical protocol, written by doctors
• Learns the nurses' questioning process in order to give the patients the exact medical diagnosis and further medical actions
After implementing the system, the HMO replaced some of the nurses with telephone receptionists.
They take the calls, question the patients according to the medical protocol the system instructs them (such as: "how old is the patient?" "what is the problem?" "what is the patient's fever?" "how long does he have this fever?" etc.).
The receptionist enters the patients' answers into the system. Then, the system determines the right question to be asked, according to the patient’s answers and the medical protocol. Then the system refers the receptionist to tell the client what will be the next medical action: wait till the morning and go to the doctor, go to the ER immediately, etc.
Thanks to the Commitigo AI system, the patients receive a better, faster and more accurate medical advise.
The patients calling the center
• Enjoy shorter waiting time and a faster diagnosis service
• Rightly referred to other medical solutions, rather the usually over-loaded ER – thus saving a lot of time and avoiding “running around”.
Moreover, the HMO managed to save over 40% in operating the nurses' call center costs. While so, the nurses benefit from this improvement, as they are able to invest their valuable time in chronic patients.
Performance Improvement, Transformation and Change Management Expert