by Renee Twombly

The caller is a 77-year-old woman who has been seeing an Emory Clinic urologist in Smyrna but doesn't like negotiating her car through the busy intersection where the physician's office is located. She wants a different Emory-associated urologist at a better location for her. Fingers flying on the keyboard, voice soothing her caller, Victoria finds a new physician and then rings his office, transferring the call after informing the clinic receptionist an appointment is needed, thank you very much.

The next caller, a 48 year-old man, needs immediate medical attention. He was treated for cirrhosis of the liver two years ago and now is asking to see the same physician he saw then, as soon as possible. Victoria discusses the man's symptoms with him as she finds out online that the doctor isn't available, and then she helps the caller find the best physician for him to see, given his history, near his home.

And so it goes for Victoria and the 13 other professionals who work the seven different telephone lines that comprise Emory HealthConnection. Theirs is a job that requires a precise mix of skills, including medical knowledge, sincere interest in people, and efficiency -- in short, the kind of telephone presence that a leading academic medical center would choose to represent itself.

No wonder, then, that HealthConnection is staffed by nurses, says its director, Lori McLelland, a former director of cardiovascular nursing at Emory. "Perceptions of Emory are based on whether a consumer feels someone on the other side of the line is listening," she says. "Consumers seek quality, hope, skill, and caring and nurses have an altruistic, companionable tone that sets a very good patient satisfaction standard."

Having nurses answer Emory's consumer and physician referral lines also puts Emory Healthcare ahead of competing medical call centers in the greater Atlanta metro area, none of which use comparable medical staff. HealthConnection nurses also serve as a resource for physicians and potential patients who call from all over the Southeast in search of the right medical expert.

Call centers such as HealthConnection tap into the ongoing boom in health care consumerism. Like banking and financial service companies, these one-stop service centers allow customers to get closer to the physicians they seek by integrating telephone and computer systems. They are an integral part of for-profit managed care companies, valued for the efficiency they offer. But call centers are often folded into marketing departments at academic medical centers, and in these stressed times the cost of marketing remains controversial at some of the most prestigious universities -- Emory included.

Still, HealthConnection has earned respect of the administration because it is the very vocal connection to the world beyond the campus and clinics. Every one of the 115,000 consumer calls received last year had the potential to result in an appointment -- and in fact, more than 37,000 did. For example, HealthConnection refers up to 200 new patients a month to the Emory Spine Center alone and directs them to the right specialist depending on their muscle pain. "They do a great job, building good will with patients," says Pruett Roof, orthopaedics administrator. Moreover, referral calls from physicians received by HealthConnection resulted in about 10,000 additional patient appointments throughout Emory Healthcare.

HealthConnection also helps Emory administrators respond to what callers want. By compiling data on the hundreds of telephone calls answered every day, HealthConnection knows, for example, that, by a ratio of 8 to 1, women prefer a female gynecologist, a fact that Emory could act on and then use to draw in even more patients. HealthConnection also found that advertising Emory's expertise in plastic surgery in print publications brings in many more patients than direct mail does, dollar per dollar. Such targeted marketing is not only efficient, it is cost-effective.

HealthConnection is "a gem for Emory," says Una Newman, the senior director of marketing, who oversees the service. And she has the data to prove it.

Whom to call

HealthConnection answers inquiries
and links patients to doctors and
doctors to doctors:

HealthConnection
404-778-7777 or 1-800-75EMORY
This consumer-to-MD referral line
links callers to physicians at
The Emory Clinic, Emory Hospitals,
and EHCA community hospitals
and to community doctors. Staff
also provide health education
and information.

Emory Consultation Line
404-778-5050 or 1-800-22EMORY
Connects referring MDs to Emory
Clinic specialists.

Wesley Woods Aging HelpLine
404-778-7710
Refers physicians and consumers
to services at Wesley Woods.

Emory Children's Center
404-778-3242 or 1-888-322-3242
Links callers to physicians at the
Emory Children's Center.

CancerWise
404-778-5566 or 1-800-466-5566 Provides cancer education and
information.

Emory Cartersville
Physician Referral Line
770-607-1060

Emory Eastside
Physician Referral Line
770-972-7570

The nurses in telephone headsets help people find the right doctor, help physicians locate specialists to refer their patients to, and also help physicians calling through a consult line seek second opinions from Emory specialists. They also act as a resource for outpatient clinical trials and sign up participants for Emory's special events.

It's a big job. Consider the numbers:

• The total number of consumer calls for 2000 was 115,078 -- almost three times the 1993 volume. Of those calls, 62,409 were referred to an Emory specialist, and 60% resulted in an appointment.
• There were 15,278 physician calls last year, of which about 11,000 came through the special physician referral line and 4,000 came through the telephone number consumers use. Physician-to-physician calls increased 400% from 1999 to 2000.
• Last year, 65% of physician calls resulted in a patient appointment.
• There were 2,261 referrals made to clinical trials last year.
• HealthConnection registered 5,238 enrollees for 135 special Emory events.

Not only do they hand out information, they take a lot in. The nurses know why people call HealthConnection: 55% were seeking a specialist last year, and the top three areas of specialty care they want are dermatology, obstetrics/gynecology, and ophthalmology. Of the rest, 23% were searching for a primary care physician, and 22% wanted general assistance or health information.

McLelland and her staff have even determined the reason that consumers ask for specialists. Almost 40% are looking for a specific doctor listed within that person's insurance plan. Less important to them is the availability of appointments.

Given the surfeit of medical information on the Internet and sometimes fierce competition among health care providers, consumers are often savvy and know exactly what they want. It might be a clinical trial for a new cancer treatment or a doc who offers radiation with heart artery stenting to help prevent new blockages. "Often the very educated are seeking specific care," says McLelland. "They think they know what Emory has to offer. Our job is to make sure we know about it too."

Referring physicians, on the other hand, generally seek a different selection of specialists than do consumers who call HealthConnection. Many (14%) ask for referral to a doctor by name, but the majority seek specialists within a field -- 11% for neurology, 10% for cardiology, 5% for gastroenterology, and 4% each for neurosurgery, orthopaedics (spine center), and ophthalmology.

Every piece of information the nurses gather during their calls is compiled into a central database that feeds information back to Emory administrators, potentially resulting in changes that increasingly attract patients.

HealthConnection knows how often older physicians are requested, whether Spanish-speaking health care workers are needed, and which hospitals are more popular with callers.

"Our goal is to tell administrators what their customers want, what brings people into the clinics," says McLelland.

Shari Capers, associate director of Emory Healthcare's strategic planning office, says information collected by HealthConnection is a major component of a market analysis performed to determine whether new services should be offered at Emory or if current services need to be expanded. "The HealthConnection data is one method for trying to understand the level of demand for a specific service," she says. "This information, combined with other market intelligence and statistics, provides the material for a complete market analysis."

HealthConnection takes a proactive role by contacting patients as well. In a pilot project with Emory University Hospital's emergency department (ED), HealthConnection staff call patients who have visited the ED since April. Nurses ask how the patient is doing, whether they have made a follow-up appointment with a physician, and how their experience at the Emory ED went.

"People who don't have a physician often go to an ED," notes ED director Doug Lowery, "so it's important that we follow up on their care. And we get feedback on how we're doing as well." In addition, HealthConnection staff referred more than half of the ED patients they contacted to Emory physicians.

"HealthConnection interacts directly with the community, both as a voice to help those seeking Emory health care, and as an ear listening to what potential patients need and prefer. Those roles are invaluable," says John Fox, president of Emory Healthcare, "and all of us at Emory should strive to be as attentive and customer friendly as these nurses."

He adds, "HealthConnection's other role - its responsiveness to the needs of referring physicians - is another way they help us achieve one of Emory Healthcare's most important objectives."

Another light flashes on Victoria Pickwick's telephone console, but this time she answers, "Physicians Consultation Line . . . ." On the other end is a Valdosta physician whose patient has cardiomyopathy. Pickwick connects him with an Emory cardiologist and helps set up an appointment for the patient. A survey last spring of physicians who referred their patients to Emory measured their satisfaction and gathered suggestions for improving the service. More than half of respondents said that Emory's expertise was the main reason they referred patients, and about the same number said that Emory was "good" at meeting their needs. But the physicians also said that the worst aspect of working with Emory was low availability of appointments, followed by a lack of feedback from physicians about patients who were treated at Emory. Survey results, gathered by HealthConnection, now give Emory Healthcare comprehensive information to help get the most from their physician referral program, McLelland says.

HealthConnection is beefing up efforts to let physicians know that the consultation line can help them. It gives them one phone number and one nurse, who will follow through and make sure that the patient gets an appointment.

Dollars are a precious commodity to academic medical centers, whose administrators are often happier buying a full-body PET scanner than an advertising campaign. But that attitude changes when paying patients flock into clinics as the result of well-positioned marketing.

HealthConnection is poised to find out what works best -- a radio spot for the spine center which runs at noon on an easy-listening station or a print ad in the "Lifestyles" section of the Atlanta Journal-Constitution? Is direct mail best, or a judicious use of all three media?

How do they find out? Advertisements for Emory services as well as for special events such as health screenings, birthing classes, or cooking classes carry the HealthConnection telephone number, and when respondents call, they are asked how they found out about the service or event. "HealthConnection provides back-end tracking for every marketing effort," says Newman. It can actually determine how many new patients marketing efforts brought in.

For example, McLelland says that radio advertising is bringing in patients to Emory's Spine Center -- more than 10% of the center's new patients report hearing those radio spots. Conversely, print advertising seems to work best for the plastic surgery department, where 11% of prospective patients report that they called because of the ads.

"Our job is to be as creative and as cost-effective as possible. We can do that by knowing what works best," says Harriet Berger, a media consultant who has worked with Emory Healthcare marketing for the past five years. "HealthConnection can be a fabulous tracking tool."

There is nothing like seeing new patients walk through clinic doors on the power of advertising, Berger says. "It produces believers in marketing."

That's why it's rewarding to Holly Korschun, interim director of health sciences media relations, to know that a story she pitched this spring to local and national media about "virtual colonoscopies" prompted more than 700 calls within two hours to HealthConnection from people interested in receiving the procedure. "It's a wonderful medical advance that has caught the interest of a lot of people who might not otherwise seek a colonoscopy," says Korschun. "If we have something new, we communicate it because the public may be interested. With HealthConnection providing feedback, we know when we have succeeded."

Daily, Emory communicators feed story ideas to an ever-hungry medical media, but it is often difficult and expensive to track the newspaper, television, and radio stories that result from the effort -- information that helps administration justify a communications budget. HealthConnection feedback not only shows which media outlet may be the most effective to target, but can demonstrate that stories generated patients, Korschun says.

Back after a break, Victoria Pickwick dons her headphone and prepares for the next caller. A former hospital nurse in New York City, Pickwick has been enormously satisfied in her three years of work at HealthConnection. She likes talking to callers, and in an odd way, she can take more time with people than she could as a nurse rushing from bed to bed. "I go home knowing that I have done my best to help people," Pickwick says as a light goes on at her switchboard. Lickety-split she answers with a smile -- even though the caller can't see it. "Thank you for calling Emory Health Care. This is Victoria. How can I help you?"

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An appointment is made for that afternoon. Today, so far, Victoria has helped 15 patients see the right doc, out of hundreds this week . . . and thousands this year.

Renee Twombly is a freelance writer.