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Closing the Feedback Loop: An Interactive Voice Response System to Provide Follow-up and Feedback in Primary Care Settings

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Abstract

In primary care settings, follow-up regarding the outcome of acute outpatient visits is largely absent. We sought to develop an automated interactive voice response system (IVRS) for patient follow-up with feedback to providers capable of interfacing with multiple pre-existing electronic medical records (EMRs). A system was designed to extract data from EMRs, integrate with the IVRS, call patients for follow-up, and provide a feedback report to providers. Challenges during the development process were analyzed and summarized. The components of the technological solution and details of its implementation are reported. Lessons learned include: (1) Modular utilization of system components is often needed to adapt to specific clinic workflow and patient population needs (2) Understanding the local telephony environment greatly impacts development and is critical to success, and (3) Ample time for development of the IVRS questionnaire (mapping all branching paths) and speech recognition tuning (sensitivity, use of barge-in tuning, use of “known voice”) is needed. With proper attention to design and development, modular follow-up and feedback systems can be integrated into existing EMR systems providing the benefits of IVRS follow-up to patients and providers across diverse practice settings.

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Acknowledgments

This project was supported by grant number HS017060 from the Agency for Healthcare Research and Quality (Eta S. Berner, EdD, Principal Investigator).

Integrity of Research and Reporting

Ethical Standards: The experiments/research conducted and discussed here in comply with the current laws of the United States of America, the country in which the research was conducted. This study was approved by the Institutional Review Board of the University of Alabama at Birmingham.

Conflicts of Interest

CDNA is copyrighted by the University of Alabama at Birmingham. James Willig, Marc Krawitz, Anantachai Panjamapirom, Midge Ray and Eta Berner are inventors of CDNA. The other co-authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294, USA

    James H. Willig, Midge N. Ray, Christa R. Nevin & Eta S. Berner

  2. Physician Innovations, LLC, 620 Bienville Lane, Birmingham, AL, 35213, USA

    Marc Krawitz

  3. The Advisory Board Company, 2445 M St, NW, Washington, DC, 20037, USA

    Anantachai Panjamapirom

  4. Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Thomas M. English

  5. United Cerebral Palsy of Greater Birmingham, 2920 Redmont Park Lane, Birmingham, AL, 35205, USA

    Mark P. Cohen

  6. Department of Health Services Administration, 1675 University Blvd, Room 534, Birmingham, AL, 35294-3361, USA

    Eta S. Berner

Authors
  1. James H. Willig
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  2. Marc Krawitz
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  3. Anantachai Panjamapirom
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  4. Midge N. Ray
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  5. Christa R. Nevin
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  6. Thomas M. English
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  7. Mark P. Cohen
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  8. Eta S. Berner
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Corresponding author

Correspondence to Eta S. Berner.

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Author’s Contributions

All authors contributed to aspects of the design and implementation of the IVRS system, participated in revision of key intellectual content in the present manuscript and approved the final submitted version.

Mark Cohen is now retired from United Cerebral Palsy where this study was conducted.

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Willig, J.H., Krawitz, M., Panjamapirom, A. et al. Closing the Feedback Loop: An Interactive Voice Response System to Provide Follow-up and Feedback in Primary Care Settings. J Med Syst 37, 9905 (2013). https://doi.org/10.1007/s10916-012-9905-4

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  • DOI: https://doi.org/10.1007/s10916-012-9905-4

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