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Don't Ask a Nurse, Ask a Computer

St. Al's scales back call center program in favor of the Internet

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Health care facilities in Idaho have been slowly implementing computerized systems to make operations more efficient, but could this trend be whittling away personal connections to care?

Saint Alphonsus Regional Medical Center will pare down its 24-hour nurse telephone hotline to run only half the day to free up resources so it can bolster its on-line medical information system. The switch, happening next week, will limit call center operations from 6 a.m. to 7 p.m., Monday through Friday.

Leslie Kelly Hall, vice president of marketing and communications for the hospital, said that there has been a decline in people calling the hospital's nurse hotline--which, despite popular usage, isn't called "Ask-a-Nurse," she said, because the hospital hasn't registered that brand moniker. But for the past year, call center nurses have been asked to refer patient callers to the hospital's Web site and teach them how to use the hospital's information database, she said.

"We're saving some money but maintaining the call center at the same time," Hall said. "The question is how to deploy resources more effectively and how do you meet community need?"

David Ensunsa, the public relations manager at St. Al's, said the transition of moving resources online is a "big initiative" in response to more people accessing Web sites like WebMD at home. Neither Hall nor Ensunsa commented on how much money the hospital will free up by whittling the call center or in what way Internet services will be increased.

St. Al's has 18 trained nurses who operate the call center and help roughly 22,500 people a year. When the change goes into effect on November 12, hospital officials said trained technicians will replace the nurses. Officials hope the nurses will be absorbed into other areas of the hospital.

"We have more openings in the hospital than we have leaving the call center," Hall said. "Each nurse is looking at available opportunities ... and each one is meeting with a recruiter to discuss what options are. Our goal would be to retain all of them."

BW was unable to talk on the record with a St. Al's call center nurse because the call line telephone number posted on several Web sites had been disconnected. The service is not listed in the latest edition of the Yellow Book phone directory, unlike competitor "Call St. Luke's." Representatives of St. Luke's say they have no plans to pare down or cut their 24-hour nurse hotline.

Jan Miller, director of Call St. Lukes, said the call center nurses mainly serve parents of small children. "Obviously kids don't get sick 9 to 5 Monday through Friday or when doctor's offices are open, so we provide a forum where parents or any patient can call in and talk about their symptoms to choose an appropriate level of care. The personal one-on-one review of symptoms is frankly what you couldn't get if you went online to get health information."

She said Call St. Lukes receives about 8,000 calls per month, and expects that at the end of the month, when St. Al's slices its service, they'll get busier.

"The call center phenomenon isn't obsolete because of access to the Internet," said local nurse Sara, who said she didn't want to identify herself because her opinion might be connected to the hospital where she works. "Information on the Internet can be very inaccurate, whereas in an ask-a-nurse situation, there are professionally trained nurses who have a good solid background in medicine. The sources people can find on the Internet are not all verified and could have incorrect information."

Sara said she feared the switch could lead to people incurring costs of an unnecessary trip to the emergency room. Roughly 230,000 Idahoans are without health insurance, so having a voice on the phone to talk down a person's concern of a serious health problem can help people save money, she said.

Miller agreed, saying the hospital regularly saves money by having people avoid trips to the emergency room. "We could keep them out of the ER, and have the patient incur the cost of a doctor personally. Nurses can assess whether their symptoms are life threatening and advise they call a doctor in the morning. So we can help a person gauge what's critical and non-critical."

Tim Day, a Boise resident who uses the Internet for researching pharmaceutical drugs, agrees that actually talking with a professional helps in emergency situations. "In an emergency situation, you don't have the time to look for help on a computer," he said. "But there are two problems in this situation. Aside from taking that service away, now as a layperson in need of medical help, you have to formulate and make judgments without the assistance of someone who's educated and trained in the field."

Hall said people concerned about their health and subsequently the cost of an emergency room visit can still call the hotline during the new hours, or phone a physician's office directly. Meanwhile, she said the hospital has several venues to get health news to its patients, including a health magazine sent to about 100,000 area patients and other direct mailers that advertise the Internet. Aside from that, "We have physicians who practice at St. Al's who are also writers for Healthwise, which is a great source of medical information."

The nonprofit Healthwise medical group, based out of Boise, licenses tomes of medical information to both Boise hospitals and to national Web sites like WebMD, MSN, Yahoo! and the American Association for Retired Persons, said spokeswoman Brenda Foster. "With our Internet and software products, we can cover thousands of topics in depth and help people in any level of care." She said the group of writers, medical staff and other professionals have produced information on 6,000 health-related topics and continue to write on more issues.

"Information is so important in health care, people are happy to get it, and it means better health decisions for consumers. I think we're so fortunate to be in this community where our hospitals embrace this concept."

In response to whether moving more health services to the Internet will help or hurt the public, Foster said, "I think that every individual has different learning styles or preferences, so some want to pick up a book, some go on the computer and some talk with an actual person."