Beyond the Call

Having an efficient, integrated call center can be a matter of life or death. Imagine a pharma company not knowing for several weeks that the active ingredient in a life-saving drug was left out of the final product? How would they learn of the error if the quality control at the manufacturing plant failed to identify the problem? Most likely, the next opportunity for identifying such a crisis is through the call center—the key interface between healthcare professionals, consumers, and the company. However, it's not enough to log complaints about a product's efficacy. Once documented, complaints need to be routed to the right department, evaluated, and consolidated. If a streamlined process isn't in place, weeks could pass without anyone ever taking any action—even as adverse event records pile up.

Understanding Call Center Functions

While such an example may seem extreme, it demonstrates the serious job facing all call centers, regardless of size and budget. But even putting safety issues aside, streamlining call center systems is still vital because it helps companies keep compliant with FDA requirements. After all, unreported errors that put the public in jeopardy can lead to enormous fines.

To avoid such mistakes, call center managers need to be aware of the available options for structuring their organizations. What follows is a discussion of the key components of call center operation and an introduction to the types of integrated solutions available to aid system efficiency. In addition, this article looks at advances and emerging medical communications technology.

The Basics

HIPAA

The aim of the Health Insurance Portability and Accountability Act (HIPAA) is to streamline inefficiencies in health industries, reduce system abuse, allow for continuity of medical coverage when changing jobs, provide better access to health insurance, and ensure confidentiality of patient health information. In particular, patient privacy is a concern whenever it is gathered in a pharmaceutical call center. While there are valid uses of such information (adverse event reporting, for example), a very real opportunity for abuse also exists. Taking inquiry details and mining the information for marketing campaigns and targeted sales efforts is a prime example of how this information can be misused. A business system must be implemented in a manner that is mindful of HIPAA law.

INCOMING CALLS Initial call routing is as simple or complex as the business dictates. In its simplest form, calls into a toll-free number ring on someone's desk until they pick up. More productive systems employ interactive voice response (IVR) to allow the caller to self-route their call. Systems with automatic call distributor (ACD) can route calls based on a number of criteria, including the called number that may be associated with literature on a particular product or from a particular business unit.

More useful in medical communications is the ability to quickly gather the relevant inquiry information and then close the inquiry in real time by answering the question and assembling the response package for delivery. The gold standard for turning around a response is 24 hours, but typical industry turn-around times are two, three, even up to seven days and beyond.

TECHNICAL CHALLENGES Pharma call centers serve as a communications bridge between a company, the medical community, and the general public. They routinely receive up to thousands of inquiries each day—primarily by phone, but also by e-mail, fax, and postal mail. Whether the call center is comprised of a few individuals, or it is a tiered, multi-skilled organization with a large staff of MDs, RNs, and PharmDs, all pharmaceutical call centers face similar core issues and challenges.

In today's instantaneous business environment, medical communications departments struggle to quickly respond to product inquiries from healthcare professionals, patients, and field-based sales representatives while maintaining high levels of customer satisfaction and audit trail requirements. Fortunately, medical communications systems—comprised of customer relationship management (CRM), electronic content management systems (CMS), and XML authoring tools—have been developed and are specifically tailored to meet the pharma call center challenges of managing risk, while improving overall customer support.

By integrating the latest technologies with proven business practices, pharmaceutical companies can optimize and streamline their call center communications, which will yield significant returns and competitive advantages. On the other hand, failure to modernize call centers can lead to gross inefficiencies and potential catastrophic penalties. When systems are not integrated, call center personnel can wind up working in multiple systems simultaneously, switching back and fourth between interfaces to properly collect and disseminate information.

Best Practices

"The way I see it, you either customize and build your own system from the ground up internally, or you go out and get a system that is off-the-shelf and then you can totally customize it, or minimally customize it," says Lesley Fierro, PharmD, senior director medical information services at Sanofi-Aventis, who was charged with creating a more integrated system within her company's call center.

"We wanted to have a very efficient way to keep all the demographic information about who was contacting us, and keep all of the responses that we were using with that system," says Fierro.

When Fierro's team first started out, they evaluated the best options available. (Traditionally, almost all companies start with homegrown systems.) The group quickly decided that they did not want to go that route. "For one, they become obsolete too quickly. It is just not flexible," says Fierro.

Instead, Fierro's team opted for components that were commercially available that could be minimally customized and integrated so they could continually be upgraded as technologies changed.

UNDERSTANDING CRM To provide efficient, accurate, and appropriate responses that are documented in an FDA-compliant manner, many pharma companies have turned to CRM systems for managing and integrating data from all caller interactions, and across several channels, to create a unified view of the caller. When carefully and strategically implemented, commercial CRM software can significantly improve the speed and performance of call center operations, maintain a high level of quality, and ensure regulatory compliance. Some pharmaceutical companies have incorporated CRM software systems that span other functional areas, such as sales. Others develop homegrown systems pieced together by in-house information technology staff.

As an adjunct to CRM systems, CMS serve as repositories of a company's product information. These systems also provide a detailed audit trail of how content was changed, by whom, and when. They also track the approval process that is required to release a document for public consumption.

Having these advanced systems, however, does not guarantee that they will be used in the most effective and efficient manner. Often, companies fail to realize the potential of these systems because it can be difficult to synchronize and merge information between them, which requires call center staff to toggle between systems. Simple inquiries, such as, "Which documents have been updated since our last communication with Doctor X?" are not simply answered using CRM or CMS applications alone.

ACHIEVING COMPLIANCE AND EFFICIENCY Integrating the data between CRM and CMS systems helps call center professionals answer calls faster and with greater accuracy. Such integration can provide an accurate audit trail and ensure the quick retrieval of customer interaction history. A notable benefit of these solutions is that they allow staff to quickly correlate and respond to product inquiries and adverse events while maintaining compliance with FDA requirements.

When an inquiry comes in, the system enables the call center staff to quickly review the call history and evaluate the parameters for a possible adverse event. The system assembles the relevant response information quickly and maintains a record of what, when, and how the staff responded to the request. This audit trail includes detailed information such as the time of the call, its resolution, when it was transferred to the safety department, how the safety department acted upon it, and a record of any letters or other information sent.

Fierro's team opted to marry Sanofi-Aventis' CRM and CMS systems. "The benefit of this is that we are not logged into multiple systems at the same time, which is difficult," Fierro says. "We are logged into one system and we can speak to the customer, record the demographic information that we need, but at the same time we are able to find the documentation in order to respond quickly and efficiently."

This efficiency is highlighted by the fact that under an integrated system, response materials for inquiries by laypeople are filtered to reveal that information that has been approved by FDA. Response materials for an inquiry by a medical professional, on the other hand, are broader and often contain extensive references.

Emerging Technologies and Trends

WORKFLOW AUTHORSHIP

Automated workflow can be used to enable tremendous efficiency gains in how call centers handle inquiries. The new systems allow administrators to control who has clearance to view and alter response documents. This type of system can further differentiate those who have author control from others who have approval control. The ability to divide multiple groups of people into roles by access allows a new level of quality control in the call center process.

ONLINE CAPABILITIES Already, some of the newest software systems have built-in Internet capability. This gives call center representatives the ability to respond to queries through e-mail or through web chat features. Although many companies are responding to e-mails, very few are currently communicate through web chat features at this time.

GLOBALIZATION Today, the medical affairs staff at most US-based pharmaceutical companies provide support in English and Spanish, while some global companies support a wider variety of languages. In the future, globalization will undoubtedly continue and call centers must be ready for the added challenge of disseminating content on a local level, and in multiple languages.

SELF-SERVICE The combination of increased regulations, an evolving market, and advances in technology point the way toward even greater levels of automated support in the future. With the advent of some powerful new systems, executives should expect to see pilot projects for advanced web self-service initiatives that have business rules which allow the systems to service customers with artificial intelligence. These features will make companies more cost effective and time efficient.

INTERACTIVE SESSIONS With the increasing availability of broadband Internet, expect to see more companies experimenting with interactive online sessions that include multimedia content, such as voice and streaming video.

SMART ANALYTICAL PROGRAMS This technology promises to have the biggest near-term impact on pharma call center operations. These programs will sift through data from millions of incoming inquires and provide real-time insight into questions such as: Where are the calls coming from? How many queries are received? Do the queries diverge from the historical norms for the drug? Are there any early indicators that will allow companies to address problem areas before they get too serious?

All in all, having that information will allow companies to serve—and protect—their customers and themselves more effectively than they are today.

Stan Zehner is director of pharmaceutical and IT services, and Beth Ann Pelegan is division director in RWD Technologies' applied technology solutions group. They can be reached at szehner@rwd.com and bpelegan@rwd.com respectively.