Interactive voice response system (IVRS) in health care services

doi:10.1016/S0029-6554(03)00161-1

Nursing Outlook

Volume 51, Issue 6, December 2003, Pages 277-283

https://doi.org/10.1016/S0029-6554(03)00161-1 Get rights and content

Abstract

Recent advances in telecommunications technology have created opportunities to enhance the quality of health care services through telehealth, the use of telecommunications and information technologies to deliver health care. However, the diverse technologies and applications encompassed by telehealth have tended to confuse discussions of the effectiveness of these programs. An interactive voice response system (IVRS) is a simple, yet effective telehealth application that improves access to health care by continuing care beyond the hospital setting, with specially tailored programs that are easily accessible to patients around the clock. Often described as a telephone connected to a “talking computer,” an IVRS allows patient interaction for data collection or to deliver recorded telephone messages related to medication compliance or behavior modification. Despite easy access to touchtone telephone services and growing familiarity with IVRS, many health care providers are unaware of these programs. This paper reviews the infrastructure of IVRS technology and its uses in health care.

Section snippets

IVRS technology

The interactive voice response system (IVRS) is a computer-automated telephone system that uses specialized telephone hardware and manipulation of a digitized voice. It is often described as a telephone connected to a “talking computer” that can provide health care services, such as education or information, assessment, or treatment. IVRS improves access to health care by continuing care beyond the hospital setting, with specially tailored programs that are available to patients 24 hours a day,

Types of access to IVRS

There are two ways to gain access to the IVRS: (1) Call-out, in which the computer- generated program automatically calls the subject, and (2) call-in, in which the subject calls a toll-free number. In either case, the subject is given a code number and password to ensure patient anonymity and security of personal data. The subject must enter his/her individual identification number and password before the IVRS questions commence.

Levels of interactivity

The IVRS consists of two types of systems: (1) A one-way communication system in which the telephone is used for dissemination of information and/or reminders, but one which has no ability to receive responses from the subject or no data collection capability, and (2) a computer system combined with a telephone network that allows interactivity, with responses solicited from the subject and data actively gathered and reported by the system.

HIPPA and IVRS applications

In the creation of an IVRS, protection of individually identifiable health information is particularly important. On December 28, 2000, the Secretary of Health and Human Services (HHS) released final privacy regulations relating to the protection of patients' individually identifiable health information as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Using electronic transactions including interactive voice interaction data collection and other privacy

Recommendations for future research

New microcomputer-based interactive telephone systems (IVRS) can be delivered by prerecorded telephone messages or instructions, reminders, or informational lectures, and can also be interactive. However, for the most part, IVRS has been under-utilized. Further studies are needed to develop the IVRS in health care to enhance self-treatment and self-care as well as self-symptom monitoring. Also, there is a strong need for systematic evaluation studies to determine the effectiveness of IVRS-based

Conclusion

An IVRS provides services ranging from simple reminders to interactive data collection and management. For less complex, frequently occurring clinical applications, the IVRS can effectively provide reminders without requiring users to input new data or to evoke the program. More complex computer programs can be developed to include reminders along with education/treatment information, and data collection. For example, the subject may have several choices for receiving additional information on

Haeok Lee is an Associate Professor at the School of Nursing, University of Colorado Health Sciences Center, Denver, Colorado USA.

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2023, International Journal of Hospitality Management
The main objective of this research note is to turn healthcare organizations’ and scholars’ attention to the challenges experienced by patients as they interact with various artificial intelligence (AI)-based applications, particularly interactive voice response (IVR) systems, in the healthcare industry. While the existing literature reveals a substantial scholarly interest in the adoption and utility of these technologies in various contexts, the paucity of comprehensive research investigating how some of these technologies lie in contrast to the culture of hospitality in healthcare and the potential health and financial risks involved are striking. More importantly, a multi-dimensional assessment tool to measure the quality of AI-based healthcare services has not been established yet.
Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD
2017, Advances in Chronic Kidney Disease
Citation Excerpt :
IVRS uses basic telephone transmission to allow patients to respond to a variety of questions through either a touch-tone keypad or voice responses. Such a system has 2 characteristics.39,40 First, it uses the more ubiquitous and low-cost platform of the public-switch telephone service using landlines with voice and digital transmission via standard handset or cellular phone.
CKD patients have several features conferring on them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired kidney function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated kidney function loss, acute kidney injury, ESRD, and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations that hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review, we summarize previous assessments of the pre-dialysis CKD populations' proficiency in using telemedicine modalities and describe the use of interactive voice-response system to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded interactive voice-response system use in CKD to address the safety threats inherent to this population.
The Complementary Nature of Patient-Reported Outcomes and Adverse Event Reporting in Cooperative Group Oncology Clinical Trials: A Pooled Analysis (NCCTG N0591)
2015, Journal of Pain and Symptom Management
Clinical trials use clinician-graded adverse events (AEs) and patient-reported outcomes (PROs) to describe symptoms.
The aim of the study was to examine the agreement between PROs and AEs in the clinical trial setting.
Patient-level data were pooled from seven North Central Cancer Treatment Group, two Southwest Oncology Group, and three Radiation Therapy Oncology Group lung studies that included both PROs and AE data. Ten-point changes (on a 0–100 scale) in PRO scores were considered clinically significant differences (CSDs). PRO score changes were compared to AE grade (Gr) categories (2+ yes vs. no and 3+ yes vs. no) using Wilcoxon rank-sum or two-sample t-tests between Gr categories. Incidence rates and concordance of CSD in PRO scores and AE Gr categories were compiled. Spearman correlations were computed between PRO scores and AE severity.
PROs completed by patients (n = 1013) were the Uniscale, Lung Cancer Symptom Scale (LCSS), Functional Assessment of Cancer Therapy–Lung (FACT-L), Symptom Distress Scale, and/or Functional Living Index-Cancer. Significantly worse PRO score changes were found for the FACT-L in patients with Gr 2+ AEs. Worse scores were seen for the Uniscale for patients with Gr 2+ AEs (P = 0.07) and LCSS for patients with Gr 3+ AEs (P = 0.09). Agreement between incidence of any Gr 2+ (Gr 3+) AE and a CSD in PROs ranged from 27% to 67% (36%–61%). Correlations between PRO scores and AE severity were low: −0.06 Uniscale, −0.03 LCSS, 0.10 FACT-L, −0.11 Symptom Distress Scale, and −0.51 Functional Living Index-Cancer.
These results support previous work and an a priori hypothesis that AEs and PROs measure differing aspects of the disease experience and are complementary.
A randomized trial of weekly symptom telemonitoring in advanced lung cancer
2014, Journal of Pain and Symptom Management
Citation Excerpt :
We elected to use telephone-based interactive voice response (IVR) technology for our Symptom Monitoring and Reporting System for Lung Cancer (SyMon-L) because of the telephone's widespread adoption and familiarity. In our observational, single institution pilot study,46 we found IVR monitoring to be feasible and acceptable to patients, which also has been demonstrated by others.47–56 This paper describes a multisite, prospective, randomized controlled trial (RCT) evaluating whether technology-based weekly symptom monitoring and automated reporting of problematic symptoms to the clinical team reduces on-treatment symptom burden of people with advanced lung cancer compared with monitoring alone (i.e., with no reporting to the clinical team).
Lung cancer patients experience multiple, simultaneous symptoms related to their disease and treatment that impair functioning and health-related quality of life (HRQL). Computer technology can reduce barriers to nonsystematic, infrequent symptom assessment and potentially contribute to improved patient care.
To evaluate the efficacy of technology-based symptom monitoring and reporting in reducing symptom burden in patients with advanced lung cancer.
This was a prospective, multisite, randomized controlled trial. Two hundred fifty-three patients were enrolled at three sites and randomized to monitoring and reporting (MR) or monitoring alone (MA). Patients completed questionnaires at baseline, 3, 6, 9, and 12 weeks and symptom surveys via interactive voice response weekly for 12 weeks. MR patients' clinically significant symptom scores generated an e-mail alert to the site nurse for management. The primary endpoint was overall symptom burden; secondary endpoints included HRQL, treatment satisfaction, symptom management barriers, and self-efficacy.
This randomized controlled trial failed to demonstrate efficacy of symptom monitoring and reporting in reducing symptom burden compared with monitoring alone in lung cancer. HRQL declined over 12 weeks in both groups (P < 0.006 to P < 0.025); at week 12, treatment satisfaction was higher in MA than MR patients (P < 0.012, P < 0.027). Adherence to weekly calls was good (82%) and patient satisfaction was high.
Feasibility of using a technology-based system for systematic symptom monitoring in advanced lung cancer patients was demonstrated. Future research should focus on identifying patients most likely to benefit and other patient, provider, and health system factors likely to contribute to the system's success.
Feasibility of computerized adaptive testing for collection of patient-reported outcomes after inpatient rehabilitation
2014, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Special effort is required to assure that lower income patients are able to access technology used in CAT-administered instruments. IVR is an important option given that more respondents in this study selected the IVR option and that telephone access is greater than Internet access.37-39 Among those who completed the CAT-CPI, most (61%) selected and completed the IVR option; patients who completed the CAT-CPI using the IVR were 3 days quicker, on average, than those using the Internet.
To evaluate the feasibility of computer adaptive testing (CAT) using an Internet or telephone interface to collect patient-reported outcomes after inpatient rehabilitation and to examine patient characteristics associated with completion of the CAT-administered measure and mode of administration.
Prospective cohort study of patients contacted approximately 4 weeks after discharge from inpatient rehabilitation. Patients selected an Internet or telephone interface.
Rehabilitation hospital.
Patients (N=674) with diagnoses of neurologic, orthopedic, or medically complex conditions.
None.
CAT version of the Community Participation Indicators (CAT-CPI).
From an eligible pool of 3221 patients, 674 (21%) agreed to complete the CAT-CPI. Patients who agreed to complete the CAT-CPI were younger and reported slightly higher satisfaction with overall care than those who did not participate. Among these patients, 231 (34%) actually completed the CAT-CPI; 141 (61%) selected telephone administration, and 90 (39%) selected Internet administration. Decreased odds of completing the CAT-CPI were associated with black and other race; stroke, brain injury, or orthopedic and other impairments; and being a Medicaid beneficiary, whereas increased odds of completing the CAT-CPI were associated with longer length of stay and higher discharge FIM cognition measure. Decreased odds of choosing Internet administration were associated with younger age, retirement status, and being a woman, whereas increased odds of choosing Internet administration were associated with higher discharge FIM motor measure.
CAT administration by Internet and telephone has limited feasibility for collecting postrehabilitation outcomes for most rehabilitation patients, but it is feasible for a subset of patients. Providing alternative ways of answering questions helps assure that a larger proportion of patients will respond.
A scoping review to explore the suitability of interactive voice response to conduct automated performance measurement of the patient's experience in primary care
2016, Primary Health Care Research and Development

View all citing articles on Scopus

Haeok Lee is an Associate Professor at the School of Nursing, University of Colorado Health Sciences Center, Denver, Colorado USA.

Mary Ellen Friedman is an independent telehealth consultant at M.E. Friedman Telehealth Consulting, Boulder, Colorado.

Peter Cukor is an Adjunctive Associate Professor at Fletcher School, Tufts University, Boston, Massachusetts.

David Ahern is an Assistant Professor at Harvard Medical School and a National Program Director at Brigham and Women’s Hospital, Health e-Technologies Initiative, Chestnut Hill, Massachussetts.

View full text

Interactive voice response system (IVRS) in health care services

Abstract

Section snippets

IVRS technology

Types of access to IVRS

Levels of interactivity

HIPPA and IVRS applications

Recommendations for future research

Conclusion

Pat Edu Counsel

Comput Human Behav

Am J Prevent Med

Prev Med

Am J Prev Med

Add Behavior

ComputerlineElectronic support for the home caregiver

Adv Nurs Sci

The effect of a special computer network on caregivers of persons with Alzheimer's disease

Nurs Res

The virtual visitUsing telecommunications technology to take care of patients

J Am Med Info Assoc

A computer-administered telephone interview to identify mental disorders

JAMA

Factors affected the use of a telephone-based intervention for caregivers of people with Alzheimer's disease

J Telemed Telecare

Comparison of interactive voice response and written self-administered patient survey for clinical research

Orthopedics

A meta-anlaysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting

J Am Med Info Assoc

Randomized trial of a “talking computer” to improve adult's eating habits

Am J Health Prom

Decline in alcohol consumption during two years of daily reporting

S Stud Alcohol

Telephone-linked care for cancer symptom monitoringA pilot study

Ca Pract

Interactive voice response systems in clinical research and treatment

Psychi Serv

A telecommunications system for monitoring and counseling patients with hypertensionImpact on medication adherence and blood pressure control

Am J Hypert

The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diatetes careA randomized, controlled trial

Med Care

Evaluation of telephone computer-generated reminders to improve immunization coverage at inner-city clinics

Pub Health Rep