Pharmacy system supports Muscogee Creek Nation's native speakers

In what tribal officials call a “game changer,” an automated interactive voice response (IVR) system added to pharmacy software has improved the efficiency of the Muscogee Creek Nation’s healthcare system and is helping to preserve the unique language of this Native American people.

Adding automated IVR to the front end of an existing pharmacy software system has helped to take the burden of fielding hundreds of telephone calls from the pharmacists. “It was a time-consuming process,” Robert Coffey, CIO of the Muscogee Creek Nation’s Department of Health, said of systems’ installation. “But once it was accomplished, they couldn’t believe how much time it saved.”

And almost as important as the efficiency of automating the prescription refill process is the significance of the multilingual system developed by Enacomm in preserving the people’s traditional culture by accommodating the remaining native language speakers. Enacomm offered 31 languages for its IVR prescription, but Muscogee was not one of them when the system was first implemented in 2012, said Enacomm CEO Michael Boukadakis. “They have their own language,” he said. “We built a unique language for them.”

The Muscogee people originally lived in what is now the Southeast United States, primarily in Alabama, Georgia, Florida and South Carolina. The people included several tribes, including the Creek and Seminole. They were removed from their ancestral lands to Indian Territory, now Oklahoma, in the 1830s.

Today, the Muscogee Creek Nation occupies a 75-mile-wide swath of eastern Oklahoma that extends south from Tulsa for about 80 miles along the U.S. 75 corridor. It has about 77,000 enrolled citizens. The nation’s healthcare system, which includes three hospitals and six clinics as well as six pharmacies, also serves members of any other federally recognized tribe. The health department has a staff of about 1,000 and an annual budget of about $85 million.

Although parts of Tulsa are within the nation’s borders and also includes several other towns and cities, many of the nation’s people live in sparsely populated rural areas, making delivery of healthcare, including pharmacy services, challenging.

For years, the health department allowed pharmacy customers to phone in requests for prescription refills. This system is simple, but it doesn’t scale well when pharmacists have to answer the phones, and by 2012 the pharmacies were receiving about 200 phone calls a day, which took time away from their primary jobs of filling 700 prescriptions each day.

“A lot of the pharmacists’ time was spent taking calls,” Coffey said. “It became really cumbersome over the weekend. They would come in on Monday, and the pharmacy line would have 50 voice mails. It became a time-consuming deal and every pharmacy was feeling the pain of this. We needed some help.”

The solution was to remove people from the process, as much as possible, with  IVR. The tool has become common in customer service, as one of a suite of self-service technologies that also includes online Web access and mobile applications.

“The most common means of contact still is the telephone,” Boukadakis said. Phones can use touch tone for interfacing with automated systems – “Press 1 for customer service . . . .” – but speech recognition and machine learning are making IVR an increasingly efficient and common way to interact with callers. The systems already are in use by many commercial pharmacies, but it was new for the Muscogee Creek Nation.

The Enacomm system uses a recorded vocabulary of about 400 words rather than the computer-generated voice often used in text-to-speech applications. “It’s getting better,” Boukadakis said of computer generated speech, “but it’s not very customer friendly.”

The customer can use the phone keypad to enter a prescription number or can speak it. To make sure that it properly understands spoken responses, the system can prompt the user for additional information. Before converting the spoken response to data and passing it to the back-end pharmacy system, the IVR analyzes the voice responses to determine the percentage of certainty that it is properly understood. Business rules assess the accuracy of the system’s understanding, and if necessary questions can be repeated for clarification before sending the data to the back end for processing.

About 70 percent of the business rules for an IVR system come from the pharmacy system it is supporting. The remaining 20 or 30 percent generally have to be created specifically for the customer. “We customize very single one,” Boukadakis said.

Authentication can be done through a variety of factors. The simplest method is to associate a phone number with a customer. For added security, or if an unfamiliar phone is being used, additional factors such as ID numbers or personal information can be required for authentication.

Additional factors also can include voiceprint, fingerprint, retina scans or facial recognition through a selfie taken on a smartphone. A final line of authentication can be provided by third-party services operated by government departments or commercial services such as Equifax.

“It has really paid off,” Coffey said of the system that was implemented in August 2012. The system also gives users the option of speaking to a live operator, “but that has become few and far between.”

The next step was to integrate the Muscogee language into the system. There are about 5,000 Muscogee speakers left, most of them Creek and Seminole in Oklahoma. Many of those are older tribal members, Coffey said. “English is a second language to them. A lot of our fluent speakers are passing on.”

The IVR automated script and vocabulary for the prescription system was taken to the nation’s language department, where it was translated into Muscogee. “It took some time,” Coffey said. The translated scripts were tested in the community, feedback was gathered from the users, and “that became the finished product.” It took about six months to get the translations in place, and within two months of that, 5 percent of the calls were using the Muscogee language option.

The combination of prosaic functionality and cultural preservation through an IVR system has worked well, Coffey said. “We’ve been really pleased with it.” A mobile app is being considered as the next step in the system.