McKesson teleworks nursing care

Whether nurses work in hospitals, private practice or dispense medical advice over the phone, they are social animals, caregivers. At the call centers of McKesson Health Solutions, nurse-agents are quick to celebrate birthdays and organize potluck dinners - developing strong bonds with colleagues.

So when McKesson Health Solutions asked its 400 call center RNs about working from home in 2003, it got a mixed message. While interest was very high, and 40% of the nurses already had the required broadband connection, only 15 nurses signed up for the pilot program. Despite some early reticence and a few technology hurdles, McKesson's Work@Home program is thriving, and yields the company impressive cost savings.

McKesson's goals were specific: The division of the Fortune 12 corporation wanted to reduce call center nurses' hourly wage (at home nurses would make 20% less), increase its pool of applicants in new geographic areas and reduce its real estate footprint.

The division, based in Broomfield, Colo., has call centers in several states, mostly in the West. It conducts two services: inbound triage, where people call about a health problem, and outbound support, where nurses monitor patients with chronic health problems such as diabetes. The latter service is growing considerably. As McKesson wins contracts with state Medicare and Medicaid agencies, it needs to hire nurses in those states. This is because state agencies are pushing to increase local jobs and provide callers with an agent of similar geography and accent.

When McKesson won the Mississippi Medicare contract, it spent $400,000 to set up a call center in Jackson. "We were looking at spending that much in each state. Now we don't have to," says Mike Modiz, vice president of operations and strategic projects. "We have a call center in Dallas, but we're more successful recruiting Spanish-speaking nurses in San Antonio and Houston. So we could hire them straight into the home, avoiding that cost."

Initially, McKesson nurses provided their own PC and broadband connection; the firm provided the softphone and a $300 ergonomic chair. When nurses log on to the Citrix Secure Gateway and launch the softphone, the voice system calls their dedicated landline, "nailing up" a connection. McKesson says it relies on custom-built applications and E-Quality, a data and voice monitoring system from Witness Systems. Nurses also rely on the secure messaging application Jabber .

"I loved working in the call center," says Evette San Nicolas, a single mother living near Denver. "So when I first came home, I suffered from withdrawal. But I wouldn't want to go back. When my kids are sick, I'm here. On my break, I make them lunch."

Health Insurance Portability and Accountability Act regulations requires patient information not be viewable by anyone other than the nurse, but McKesson lets nurses work in a shared area and when family members are home.

"We're adults, we can manage our life, we can manage our work," says Kim Kenote, a nurse and instructor who works from home in the Chicago area. "Some nurses put signs on the front door saying 'I'm working.' Others tell their kids, 'Don't bother Mommy unless you're bleeding.' It's OK to have family around so long as they don't disrupt the work environment."

Elana Bluestone, a 24-year hospital veteran who works in the Denver area, doesn't miss the call center. Her husband, an artist, also works from home and "rubs my shoulders and brings me tea," she says.

Each call center provides two hoteling spots for at-home nurses who occasionally work in the office. Many have used them to east the transition.

But just as nurses were settling into their new roles, McKesson corporate expressed security concerns - not about exposing network data but about delivering virus updates to remote systems. The IT department outfitted the at-home nurses with a Wyse thin client running Microsoft XP Embedded, a Linksys router and KVM switch for toggling between work and home systems.