ST. LOUIS - Medical call centers are a mixed bag. Some hospital systems have huge facilities that serve multiple hospitals; others have a small center that serves only one. Some handle internal inquiries only. Some are staffed with nurses who dispense symptoms-based advice; others are staffed with health information specialists, who typically perform class registration and physician referral. But nearly all operate in a traditional brick-and-mortar facility.SSM Health Care's (SSMHC) call center is an exception. The St. Louis facility handles after-hours triage for 31 pediatricians in six area hospitals and manages help-line calls for four managed care firms. Two years ago, upon relocating to a new office, SSMHC's three night-staff nurses voiced fears about working alone on a largely empty campus. Bob Jaeger, director of SSMHC's health and wellness line, first considered installing more security cameras, even hiring additional security personnel, but the call center couldn't afford it. Then Jaeger learned the corporate office had added a\u00a0Siemens\u00a0Telework Server to its existing 9006 PBX so workers there could take calls at home. He decided to give it a try.Today, 11 staffers work half their shifts at home, and plans to send another six are in the works. Jaeger and his nurse supervisor work from home part-time, and Jaeger's goal is to send everyone home permanently within three years.Jaeger's enthusiasm mainly stems from his employees' increased productivity. But some virtual call-center experts contend call-center employees aren't easily migrated to home offices. Jaeger disagrees: "Nearly every nurse is outperforming what she did in the office. The number of calls is up; the length of calls is down. When there are issues with downtime, people make it up, probably by taking fewer breaks."Unfortunately, there have been issues with downtime. For telephony, Jaeger has put a Siemens OptiSet handset in each nurse's home. Nurses log on to the Telework Server via\u00a0DSL\u00a0or cable. When a call comes in to the Siemens 9006 PBX, the Telework Server routes it to an analog line at the nurse's home. On the data side, nurses connect to the Windows NT network via a VPN, and access a medical call-processing application via Citrix Metaframe.The Siemens Telework Server rarely drops a call, Jaeger says. However, nurses are sometimes disconnected from the call-processing application during a patient call. He suspects Metaframe or the broadband connections is the problem."The staff was winging it," Jaeger says. "Some feared speaking up would jeopardize the whole teleworking program, so they just toughed it out." That meant staff often had to resort to making additional phone calls to access data, or they'd use hard-copy reference materials that might be outdated. "Sometimes it was a week before we'd find out something wasn't working," he says.To improve communication, Jaeger brought the nurses back into the office 50% of the time. The night-shift nurses come into the office one shift every two weeks. There, staff can exchange hard-copy information, attend staff meetings, and touch base on a host of telework issues.In an effort to stabilize the data connection, SSMHC is contracting with\u00a0SBC\u00a0to set up a private network connection called RLAN. "It will eliminate a lot of the connectivity problems," Jaeger says.SSMHC's network analyst Tom Clifton isn't so sure RLAN will fix things. "It remains to be tested against the problems we've been having," he says.Even so, Jaeger remains committed, and philosophical. "This is why we're giving ourselves three years to get the technology up to speed," he says. "If you're doing teleworking in healthcare at all, you're really ahead of the curve."