Public Health Emergency Preparedness

Appendix 4 (continued)

3.0 Interactive Response Tool Business and Functional Requirements (Analysis) Document

Based upon our understanding of our call center's interactive response (IR) technology, it has the ability to facilitate automated information dissemination and collection to callers using touch tone telephones. During a health emergency event it will likely be necessary to increase the ability to provide appropriate information to communities without the benefits of increased human resources. Therefore, we decided to explore the potential application of our IR system to assist us in responses to certain scenarios and the health needs we anticipate. We present this IR solution as a model that could efficiently and effectively handle surges related to certain public health emergencies, without compromising current medical information and triage advice services, for consideration.

The purpose of this section is to provide the business requirements and technical specifications for an IR solution and its applications as a model for other community health call centers. The information contained in this requirements document is an example of the steps that any call center would take to either replicate this IR solution within their technology environment or to adapt this solution for another purpose. This document should serve as a guide for determining the specific requirements and identifying key criteria to be applied towards the final design of an IR solution (hardware and/or applications). This document can also be used for determining specific requirements for non-technology solutions for the same capabilities within a call center (such as development of call handling procedures for call center staff to provide the information).

This document is intended for medical or public health community call centers and their technical personnel. This document could be useful for public health agencies that may want to develop such capabilities for responding to events and it could assist them in discussions with their community health call centers partners.

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3.1 Business Requirements

Business requirements and benefits to be realized with the strategic deployment of the proposed IR solution and its applications are outlined below:

• The IR solution must be capable of operating multiple applications based on the identified needs of the public in the event of a health emergency. This IR solution and its applications will address current gaps in response and preparedness efforts faced by many jurisdictions for meeting the increased surge capacity demands on the health care delivery system that terrorism, accidents, disease outbreaks, and natural disasters could cause. This IR solution should assist in providing the public with adequate information to make educated decisions about perceived health concerns via telephone, potentially lessening the demand for evaluations at health care facilities.
• The implemented IR solution should support the following applications:
  • Point of Dispensing (POD) Application: The POD Application will disseminate information in a public health emergency to enable inbound callers to receive locations for drug dispensing sites specific to their county, based on the zip code that the caller enters. The callers dialing into the POD Application should be given clear directions from the menu messages to be able to repeat any message or the location of the drug dispensing sites. Callers should also be given a choice to select another zip code after getting information for their first entered zip code. The POD Application will be designed to accommodate two language selections (English and Spanish) that the caller will select at the beginning of the call. The POD Application will also provide reporting on how many callers selected each of the available message options. The POD Application will be required to have the ability to provide an individual message for each zip code within a county to allow for the greatest potential for relaying customized information.
  • Drug Identification (DI) Application: The DI Application will allow inbound callers to obtain self-service identification for the different appearances of antibiotic drugs that are being dispensed at POD sites during a public health emergency. The callers should be given clear directions from the menu messages and be able to repeat messages or descriptions of the identified drug. The caller should also have the ability to identify more than one drug appearance per call or to repeat messages. The application should have messages that refer callers to other resources if they cannot utilize the self-service application or the drug appearance is not included as an option (this could be modified to automatically transfer them to an information provider for assistance). This application will be designed to accommodate one language selection (English), however future programming changes may be needed for additional language selections that the caller will select at the beginning of the call (just as with the other three applications). The DI Application will also provide reporting on how many callers selected each of the drug identification options. The DI Application should be able to accommodate options for all expected antibiotic drug appearances that are to be distributed.
  • Quarantine/Isolation (QI) Monitoring Application: The QI Monitoring Application should have the capability to automatically place outbound calls to individuals in home quarantine/isolation to assess their current health status. The directions given to the quarantined person by the application should be clear the person should have the ability to repeat a message. The application will be designed to accommodate two language selections (English and Spanish) that the call recipient will select at the beginning of the call. The application will call the quarantined person at specified time periods, provide them messages identifying the purpose of the call, require them to select an option that reflects their current health status (transferring them to an information provider for assistance if needed) and provide them information about who to call if assistance is needed before the next monitoring call. If a person does not answer a call upon the first attempt, the application will initiate a second call attempt within a defined time period. If the second call attempt goes unanswered, the application will flag this person as non-compliant. The QI Monitoring Application will also provide reports on compliance so follow ups can be made by appropriate agencies.
  • Frequently Asked Question (FAQ) Library Application: The FAQ Library Application will disseminate up-to-date, consistent and accurate information approved by health department epidemiologists to the public and health care providers from a searchable library of FAQs. Callers dialing into this application should be able to select desired information with discernable directions from the application including maneuverability throughout the menus. Also callers should have the ability to select an option to speak with an Information Provider, if needed. The application will provide reports on how many callers selected all message options.
• The IR solution and its applications should be implemented without affecting daily patient care business.
• The IR solution should be implemented with adequate trunking capacity (call volume capacity) incorporated; thus minimizing delay to disseminate information to the general public. The key to handling call surges effectively during a health emergency is that consistent and accurate information be disseminated to inform the greatest number of callers with minimal staffing levels.
• The IR solution should be implemented such that the telephone switch (e.g., for our center an Avaya S8700 PBX) is the primary contact point to the public switched telephone network (PSTN). This configuration allows the proper resource to handle the call most effectively and thereby benefits from the other call handling capabilities of the telephone switch.

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3.2 Functional Requirements

The following functional requirements have been identified for an IR solution within our call center infrastructure. It is not necessary that other call centers create an IR solution with all the same specifications, but we recommend considering them in the development process.

Technical Specifications

The proposed IR solution was developed and implemented using the following hardware and software:

Platform

• Avaya IR version 2.0 on a Sun Microsystems Blade 150 running Solaris UNIX software.
• Real Speak version on separate windows server Dell Power-Edge 2850 Intel Xeon Processor at 2.8 GHZ/2MB Cache; Operating System = Windows Server 2003 R2 Standard Edition. Memory= 1GB DDR2 400MHz.
  • The Real Speak solution will be used in future application modifications to have the IR play back to caller text file as speech, utilizing licensed channels to provide 6 simultaneous instances of either English or Spanish text-to-speech connections.
• Microsoft SQL 2000 is used to create tables for the IR to access for either playing back text records in voice or pulling records from tables directing the IR to call phone numbers. The IR also updates tables on the SQL server with record status for reporting purposes.

Diagram of the implemented IR solution is shown below:

[D] Select for Text Description

Integration

• The IR solution should be capable of integrating with existing telephone switch.
• The IR solution should be capable of integrating within existing LAN and allow more than one user to log into the system at a time.
• The IR solution should have the ability to operate multiple applications simultaneously (POD, DI, QI Monitoring and FAQ Library applications) without compromising current call traffic.
• This IR solution should be "self-contained" and easy to administer.

Functionality

• The IR solution should be capable of a minimum of 24 T1 channels and should have the flexibility to expand to 96 channels without the need of purchasing another IR system (expandability of the IR system should be cost effective).
• The IR solution should have the ability to organize, backup, and save applications and operating system files to the LAN as well as to external media for off-site storage.
• The IR solution should have an easy reporting method to retrieve calls from a given application in a fast and efficient manner. Search criteria are items such as, but not limited to which application was selected by caller, call center the call may flow out to, date of call, time of call, and duration of call.
• The IR solution should be a validated system. All documentation of the systems operations should be proven to work PRIOR to the installation of said system as well as afterwards. Furthermore, the system should not lose archived recorded announcements. Refer to the following link for questions regarding validated system: http://www.fda.gov/cdrh/comp/guidance/938.pdf.
• The IR solution should have alarm and alarm reporting capabilities such as (but not limited to) audible alarms, e-mail notification, dialing out for assistance (SOS System), and 24 X 7 service/support.
• The IR solution should have built-in redundancy such that no information is lost during an alarm or if a system failure event were to occur.
• The IR solution should be capable of unique login identification along with the capability of user rights (allowing only certain access to system for some logins and more access for other logins - allowing running of multiple applications).
• The IR solution should have an audit mechanism to track of who has logged into system and their actions which ideally can be printed out or exported to a file (HIPAA Compliance).
• The IR solution should be compatible with current LAN and System Applications (implementing this solution should not cause other Windows-based applications to fail).

Performance

• The IR solution should be capable of meeting the Telecommunications Standard of five nine availability; the system must be fully functional 99.999 percent of the time, maintenance time excepted.
• The IR solution should be capable of having more than one user logged into the system for listening to or modifications to applications from different channels at the same time.
• The IR solution should be capable of operating multiple different applications in different call centers using different criteria; flexibility for changing business needs.
• The IR solution should be capable of archiving and retrieving records for future research in an efficient manner.
• The IR solution should have reporting capabilities with standard output formats that allow for sharing without special software.

Scalability

• The IR system should have built-in capacities for additional applications and other "Right to Use" ports that may be required for further expansion (such as speech-to-text or speech recognition).

Ease of Use

• The IR solution should be easy to use and maintain for both day-to-day monitoring as well as implementing new applications to serve evolving business needs. It is strongly suggested that the system be capable of rapidly receiving changes to announcements or a specific application in order to meet the changing needs during an emergency. Furthermore, the administrators of this system must have the capability of monitoring the progress of said changes to ensure that needs are being met.
• The vendor of the IR solution should provide on-site training for systems administrators as well as on-site training for all initial users of the IR solution. Training will empower systems administrators to operate and maintain the system and its applications and to explore their adaptation for other uses. User training will empower supervisors and call center management to run reports as well as collect and review data from caller interactions with applications to analysis operational effectiveness.

Security

• The IR system should be capable of segmenting users to certain levels of access within the system including ability to set up user objects/rights.
• The IR solution should integrate with current Windows security user objects within the LAN.

Manageability

• Ideally, a call center would have the ability to perform remote administration duties on the IR solution in case staff members cannot physically access the facility; the solution should have the ability to allow technicians to remotely access the device and manage all functions as if physically at facility.

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