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crm5_cs_jabber_mckesson.pdf

Jabber, Inc.

Remote Call Center Solution for Clinical Nursing Services

THE CHALLENGE

When a patient calls McKesson Health Solutions CareEnhance® Nurse Triage, the situation may be urgent. Most times patients need advice about seeking appropriate medical care—but in a few critical cases, the call can actually be a life-or-death situation. When this happens, the McKesson registered nurse who receives the call must summon multiple resources in real-time: notify a supervisor of the critical call situation, collaborate with team members to manage urgent medical needs, and contact local emergency medical services to possibly dispatch an ambulance all without interrupting the patient call.

That the CareEnhance service can manage such critical service requirements is impressive. But dramatically more so when you realize that the nurses, supervisors, and other team members may be working from home—separated by miles or perhaps time zones.

The current core vehicle of the CareEnhance service is the call center, but this also presents a business challenge for McKesson: how to maximize coverage to varying and shifting call arrival patterns, manage costs, ensure the highest level of clinical services for every customer, and continue to attract and retain high caliber nursing talent in a tight labor market.

McKesson determined that the answer to its challenge was to establish a “work-from-home” solution for call center nurses, eliminating the need for nurses to travel to and from a brick-and-mortar work facility. To make this solution a reality, McKesson identified a series of governing requirements:

Maintain Team Resource Connections. A basic benefit for nurses working in a call center is direct access to resources for support and escalation. Moving nurses to their homes could introduce an element of isolation unless nurses could maintain direct, real-time access to their colleagues and supervisors.

Ensure Security and Reliability. The services provided by McKesson nurses are directly governed by the requirements of the Health Insurance Portability and Accountability Act (HIPAA) for patient record security—and are also highly sensitive in nature: some customer cases are truly “life-or-death.” Systems must be able to meet stringent security requirements and ensure the highest possible level of uptime performance.

Reduce Operating Costs. In addition to looking to improve recruiting and retention of talented nurses, a prime motivation for moving the nurses out of call centers is to reduce overhead expenses. Therefore, the solution must directly reduce costs and not require significant technical support, additional equipment, or infrastructure.

THE SOLUTION: JABBER XCP

To achieve its objective of creating a work-from-home solution for the CareEnhance program, McKesson implemented the Jabber Extensible Communications Platform (Jabber XCP) as its enterprise instant messaging (EIM) solution and integrated it with its existing information technology (IT) infrastructure. Jabber XCP is the glue that holds the system together, allowing nurses to work at home while still maintaining direct real-time connections with all required resources. McKesson chose Jabber XCP as its EIM solution for five compelling reasons:

Security and Compliance. McKesson’s nurses deal with confidential patient information so security is of the utmost importance and communications must comply with current regulations. Jabber XCP provides secure behind-the-firewall Internet and server-to-server connections across system boundaries. Because Jabber XCP is hosted on McKesson’s network, all instant messaging (IM) communications are encrypted. This ensures that no personally identifiable information is sent in clear text, which conforms to HIPAA security requirements. Finally, Jabber XCP can archive all message traffic for auditing purposes.

Open Standards. Jabber XCP is an open system based on the Extensible Messaging and Presence Protocol (XMPP) standard, the first complete presence and IM standard to be Internet Engineering Task Force (IETF)-approved. As a result, Jabber XCP is built upon an extremely mature and widely adopted protocol, providing McKesson with investment protection and the ability to connect to other Jabber systems. Another asset McKesson finds valuable is the ability to leverage the leading-edge technologies continually being developed within the Jabber open source community.

Open Platform. McKesson required a solution that would easily integrate with its existing applications, communications systems, and IT architecture. Jabber XCP fits seamlessly within McKesson’s existing corporate Active Directory, hardware platforms, and operating systems. McKesson also wanted the ability to roll presence and messaging services out to its other business units, which would require an open system capable of integrating with diverse IT assets, including legacy systems and a wide variety of wireless devices. Jabber XCP integrates with virtually any extensible markup language (XML)-based system and has clients for wireless, desktop, and Web-based environments.

Cost Effective. To quickly implement the remote CareEnhance program, McKesson required a scalable yet cost effective solution. In addition, they needed to able to implement the solution with existing hardware and human resources. Because Jabber XCP is up to four times as hardware efficient as competing systems, runs on multiple operating systems, and leverages existing IT infrastructure, McKesson was able to implement the system with minimal investment. In fact, because Jabber XCP runs via the same server and communications architecture already in place it presents almost zero incremental support requirements.

Zero User Impact. Jabber XCP is easy to learn, intuitive to use, and requires no configuration by the user. As a result, work-from-home nurses are able to begin using the system immediately with no re-training or loss of productivity.

The Solution Architecture

McKesson deployed a central Citrix server farm to make enterprise applications available to remote nurses via a secure connection. These applications enable nurses to do their jobs and access centralized data resources, but Jabber XCP is what ties the nurses together in real-time.

Using a single sign-on Citrix gateway, nurses have secure access to all in-house applications. For additional security, all Jabber XCP and enterprise application data transmissions are encrypted beyond HIPAA requirements and validated through a central Active Directory to determine access privileges.

The Jabber XCP server is hosted in a secure virtual local-area network (VLAN) to isolate IM traffic from other application resources, while the Citrix thin client is remotely installed on user machines during an intial connection. All Jabber XCP application updates and maintenance are managed from the data center and are transparently delivered to users.

THE RESULTS

In the CareEnhance work-from-home program McKesson uncovered a complex problem that was solved with a simple solution: the ability to connect remote nurses to shared resources in real-time—a goal that can only be achieved via Jabber XCP. Jabber XCP enables McKesson to reduce costs, enhance service delivery, and retain employees without re-engineering the core process that makes CareEnhance a success to begin with. McKesson’s direct business benefits from its Jabber XCP solution include:

Return On Investment. Perhaps the most important aspect of return on investment for this program is found in the urgency of the opportunity and the corresponding rapid delivery of the solution. For the nurse work-from-home program, McKesson was able to go from idea to implementation—accommodating several significant proprietary work processes unique to the clinical healthcare industry—in less than six months. Because Jabber XCP is an open platform that integrates seamlessly with all of McKesson’s existing IT infrastructure, it was rolled out to users in a matter of a few weeks after other process elements had been developed.

Additionally, McKesson has identified direct cost savings from this program that add up to millions of dollars per year, including reduced overhead costs for physical facilities, lower labor costs due to more flexible staff scheduling, and potential savings on equipment and IT infrastructure. The Jabber XCP real-time solution has already proven to be a key component in real, life threatening emergencies, providing incalculable value.

Service Quality Improvement. CareEnhance staff are able to further enhance the quality of service they provide to customers because teams are tied together via Jabber XCP with a real-time connection that can be used to escalate urgent calls, tie-in multiple resources for crisis situations, and provide real-time coaching for nurses without interrupting the patient telephone call. In addition, McKesson is able to more effectively address staff allocation for shift overlap.

Staff Retention and Enrichment. McKesson is able to offer clinical nurses an opportunity to work-from-home, which provides significant quality-of-life benefits that complement the direct business benefits related to real-time access to shared resources. Because nurses enjoy the work-from-home experience, offering this opportunity assists McKesson in attracting the highest caliber of nurses and retaining them longer. Further, because the Jabber XCP solution eliminates the boundaries of distance and location, McKesson can retain a high quality employee even if the nurse chooses to move away from the call center market.

THE FUTURE

McKesson sees opportunities to include its brick-and-mortar call centers as well as additional business units in a centralized EIM system that would streamline many more processes in the near future.