Customer Relationship

Management

CRM in Modern Health Care Delivery

Group Presentation – IS 6800

Renee’ Ross
Hung Winn M.D., J.D

1
 Agenda

 Definition of CRM
 Importance of CRM to General Managers
 Statistics
 Industry leaders
 Success stories
 Case Study – MU Healthcare System
 Best Practices
 Lessons Learned

2
 CRM – What is it?

 CRM – “Strategy used to learn more about customers’

needs and behaviors in order to develop stronger
relationships with them” http://guide.darwinmag.com/technology/enterprise/crm/index.html?; last accessed
September 27, 2004.

 CRM – “Any application or initiative designed to help an

organization optimize interactions with customers,
suppliers, or prospects via one or more touch points – such
as a call center, salesperson, distributor, store, branch office,
Web, or e-mail – for the purpose of acquiring, retaining, or
cross-selling customers.” Goodhue, D. L., Wixon B. H., and Watson, H. J., “Realizing Business Benefits
Through CRM: Hitting the Right Target In The Right Way” MIS Quarterly Executive, Vol. 1, 2, 2002, pp. 79-96.

 CRM introduced in 1993

3
 Importance of CRM to GM’s

 CRM can….
 Increase customer service levels
 Improve efficiency of call centers
 Cross-sell products more effectively
 Help sales staff close deals quickly
 Simplify marketing processes
 Increase ROI
http://guide.darwinmag.com/technology/enterprise/crm/index.html?; last accessed September 27, 2004 .
4
 Importance of CRM to GM’s

“Research has shown

that companies that
create satisfied, loyal
customers have more
repeat business,
lower customer-
acquisition costs, and
stronger brand
value—all of which
translates into better
financial
performance”
http://siebel.com; last accessed October 17, 2004.
5
 CRM Spending

 2001 - $8.8 billion

 2003 - $9.4 billion
 2005 projection - $30.6 billion
 Gartner estimates that large businesses spend
between $30 million and $90 million on CRM
initiatives over a 3-year period

Mello, A., “Watch out for CRM’s hidden costs” October 17, 2001;
http://techupdate.zdnet.com/techupdate/stories/main/0,14179,2818263,00.html; last accessed on
October 29, 2004.

6
 CRM Spending

 Budgeting for CRM – hidden costs

 Project management
 Software integration
 Data maintenance
 Training
 Gartner revealed many businesses
underestimate CRM costs by 40-75%
Mello, A., “Watch out for CRM’s hidden costs” October 17, 2001;
http://techupdate.zdnet.com/techupdate/stories/main/0,14179,2818263,00.html; last accessed on October 29, 2004.
7
 CRM Infrastructure

Web Direct
Call Center E-mail Store Fax
Access Sales

Refined Business Processes

Process
Business Intelligence
Improvement

Integrated database

Billing Call center

Accounts Fig. 2
Sales
….

Dyche, J., The CRM Guide to Customer Relationship Management, Addison-Wesley, Boston, 2002 8
 CRM Targets / Components

 Applications
 Infrastructure
 Transformation

All three are necessary, to some degree, for

successful implementation of CRM
initiatives
Goodhue, D. L., Wixon B. H., and Watson, H. J., “Realizing Business Benefits Through CRM: Hitting the Right
Target In The Right Way” MIS Quarterly Executive, Vol. 1, 2, 2002, pp. 79-96.
9
 Retention vs. Acquisition
Retention of customers gives greater benefit over
acquisition of new customers
•Builds trust and loyalty
•Up-sell and cross sell opportunities

Move customers through the lifecycle

Acquisition, Growth and Retention
Movement will maximize their value and increase
profits

Studies indicate that increasing the number of

customers a company retains each year by just 5%
can increase contribution to shareholder value by
Ref 21, 22
40% to 95% 10
 Retention vs. Acquisition

 Average U.S. companies

lose 20% of customers
every year – not knowing
why
 Costs 6 to 7 times more to
attain a new customer than
to retain current customers

http://www.crmtrends.com/crm.html; last accessed October 28, 2004.

Bleicher, Paul. “An Imposing Change.” Pharmaceutical Executive. Jun 2004. p.p. 26-30.
11
 CRM Success Stories

 80% of organizations report success with CRM

programs
 Examples
 Union Pacific Railroad (Siebel)
 4500 users / Replaced legacy system / Strategic part of overall business
intelligence strategy
 Northwestern Memorial Hospital, Chicago (PeopleSoft)
 5800 employees / Replaced legacy system / “Automation means
clinicians can focus more time on patient care. Having PeopleSoft as a
support system will help us achieve our mission of patients first.”

Ref 7, 16, 20 12
 CRM Failure

 Failure rate of 15-25%

 85% of CRM users cannot quantify benefits

Krass, P., “CRM: Once More, Without Reeling” March 17, 2003;
http://www.cfo.com/article/1,5309,8948/BS/12/4,00.html; last accessed October 15, 2004.
13
CRM Industry Leaders

14
 Company Information
 Headquarters in San Mateo, California
 Founded 1993
 5000 employees
 2.8 million users at 4,000+ organizations
 2003 revenue - $1.35 billion
 Strategy
 “CRM for Everyone” – CRM software solutions for any kind of organization, any type of user, and any budget
 Product Offerings
 Siebel Business Analytics
 Siebel On Demand
 Siebel Sales
 Siebel Professional

http://siebel.com; last accessed October 17, 2004.

15
 Company Information
 Headquarters in Pleasanton, California
 Founded 1987
 12,000 employees
 Serving 12,200 organizations
 2003 revenue - $2.3 billion
 Strategy
 Flexible and adaptable business solutions
 Product Offerings
 PeopleSoft Enterprise
 PeopleSoft Enterprise One
 PeopleSoft World

1. http://www.peoplesoft.com; last accessed October 17, 2004.

16
 Company Information
 Headquarters in Bellevue, Washington
 900 customers in 50 industries
 Strategy
 Through three audience-specific portals, Onyx Employee Portal,
Onyx Customer Portal and Onyx Partner Portal, Onyx Enterprise
CRM provides proven technology ideal for business environments
that need flexible, reliable and manageable CRM
 Product Offerings
 Onyx CRMExpress
 Onyx Portable CRM
 Onyx Analytics

http://www.onyx.com; last accessed October 17, 2004.

17
 Company Information
 Headquarters in Waldorf, Germany
 Founded 1972
 30,000 employees
 2.8 million users; 1,500 partners
 Mission
 To provide collaborative business solutions for all types of industries
and for every major market
 Product Offerings
 mySAP Business Suite
 mySAP ERP
 SAP xApps
1. http://www.sap.com; last accessed October 17, 2004.

18
 CRM and Electronic Medical
Records (EMR)

 “Initiative designed to help an organization

(physician / hospital) optimize interactions
with customers (patients) for the purpose of
acquiring or retaining customers (patients).”

Goodhue, D. L., Wixon B. H., and Watson, H. J., “Realizing Business Benefits Through CRM: Hitting the Right Target In
The Right Way” MIS Quarterly Executive, Vol. 1, 2, 2002, pp. 79-96

19
 Need for EMR

 Archaic information systems

 According to the Journal of American Medical

Association, “as many as 98,000 patients die each
year in U.S. hospitals from preventable medical
errors

 Lack of reliable health information.

Swartz, Nikki, “A Prescription for Electronic Health Records” Information Management Journal, Vol 38, 4, 2004,
p.20-22.
20
 Market for EMR

 The market for EMR for physicians

excluding the hospitals is $500 M in 2004
and expects to grow to $ 5 B in 2008

J. Larson, The Arizona Republic

21
 National Agenda for EMR

 “ BY COMPUTERIZING HEALTH RECORDS,

WE CAN AVOID DANGEROUS MEDICAL
MISTAKES, REDUCE COSTS AND IMPROVE
CARE”
 In the US, every patient should have EMR or EHR
within 10 years

President Bush’s State of the Union address, 1/20/2004

22
 Electronic Medical Records

 In Massachusetts, Blue Cross & Blue Shield of

Massachusetts plans to donate $50 millions to fund a
pilot project that electronically links patients’ medical
records between the hospitals and health care providers
in 3 communities.

 The goal is building a statewide EM system that connects

hospitals and clinics. This mission has a widespread
support among insurers, hospitals and doctors.
L. Kowalczyk, Global Staff

23
 Electronic Medical Records
(EMR)

 Transition from paper medical records

(PMR) to EMR requires strong physician
leadership and institution’s committeemen of
human and capital resources

24
 Case Study

MU Healthcare System

25
26
 Case Study

 MU HEALTH CARE SYSTEM

MU Health Care system consists of 2
operational entities:
 School of Medicine (SOM)
 University Physicians (UP): medical practice
 MU Health Care
 University Hospital
 Columbia Regional Hospital
 Clinics

27
MU School of Medicine

28
 MU School of Medicine (SOM)

 DEAN
 Associate Deans
 Chairpersons of Basic Science Departments
 Chairpersons of Clinical Departments (Medicine,
General Surgery, Obstetrics and Gynecology,
Pediatrics, Family Medicine…)
 UNIVERSITY PHYSICIANS

29
 University Physicians

 Headcount:
 UP: 635 (370 physicians + 265 staff)
 IT: 22 or 3.5% of total UP headcount
 Budget:
 UP ‘s revenue: 110 M
 IT services: 2.7 M or 2.5% of revenue
 Electronic medical records (EMR)
 IDX system: scheduling and billing

30
 MU Health Care

 EXECUTIVE DIRECTOR
 CIO, CFO
 Hospital Directors
 UNIVERSITY HOSPITAL
 COLUMBIA REGIONAL HOSPITAL

 CLINICS

31
University Hospital

32
 University Hospital

 Tertiary acute care hospital

 All services except Women’s Health and
Neonatal Intensive Care Unit (NICU)
 Trauma Center
 260 Beds
 Number of patients served: 11,532 (2003)

33
34
 Columbia Regional Hospital

 262-bed acute care hospital

 Surgery: Orthopedic Surgery, Urology, General
Surgery
 Medicine
 Women’s Health Services: Obstetrics, Gynecology
and others
 Neonatal Intensive Care Unit (NICU)
 Number of patients served: 6,477 (2003)
35
 MU Health Care

 Headcount:
 MU Health Care: 5700 employees
 ITS: 108 or 1.9% of the total headcount
 Budget:
 MU Health Care: 620 M
 ITS:
 13.5 M or about 2.2% of the total revenue
 50% of budget for personnel
 50% of budget for hardware, software and outside supporting services
 Total beds: 522
 Total in-patients served: 18009
 Total out-patient visits: 544,395
36
 MU Health Care System

 Customers:
 Health care providers: physicians
 Patients
 Electronic clinical information is the
organization’s effort to recruit and retain
customers.
 Operational efficiency
 Improved quality of care

37
 MU HEALTH CARE
SYSTEM

 Hospital Clinical Information System

 Electronic medical records (EMR)

38
 MILESTONE
DEVELOPMENTS

 Fall 2001, Vice Chancellor for MU Health Care System,

committed to develop electronic medical records.
 Dean and Executive Director strongly supported the
project
 A physician leader was appointed as a liaison between IT
leadership and physicians.
 Cerner was selected as a technical provider for the
project.
 Goal: Incremental implementation of system-wide
electronic health information (EHI)

39
 CERNER RELATIONSHIP

 December 2001
 Technology fees, traditionally referred to as
“licensing and support”
 Consulting (implementation) fees – pay as you
go
 September 2003
 Outside consultants to renegotiate the contract

40
 CERNER CORPORATION

 Founded in 1979
 Headquartered in Kansas City
 Leading supplier of healthcare information
technology, with more than 5,273 associates
and 1,500 clients worldwide.
 In 2003, it had a revenue of $839.6 million
and net income of $42.8 million.

41
 CERNER CORPORATION

 Offers centralized electronic medical record to seamlessly

deliver health information such as laboratory results, images,
medication and allergy data to health care teams that depend
on complete, timely information. This increases measurable
quality of care
 Enables executives to manage resources, comply with
regulations and recognize trends and best practices by
combing clinical, operational and financial data from across
the enterprise and the industry.

42
 ELECTRONIC MEDICAL
RECORDS
 The cost of converting paper medical records
to electronic medical records is $10,000 –
30,000 per physician.
 The cost of electronic clinical information is
between $50 M – $100 M for health care
system of 2- 3 hospitals
L. Kowalczyk, Global Staff
M. K McGee, Informationweek.com

43
 EMR’s Progress

 2002
 The projects was launched but progress was
impaired by concerns about MU Health Care
System’s fiscal situation.
 9/2003
 The project was reactivated on an accelerated
time frame.

44
 Patients' Medical Information
Clinics

 Demographic information including

insurance
 History: allergy
 Physical examination
 Laboratory: blood tests, radiographic images
 Diagnoses
 Treatments

45
 Patients’ Medical Information
Hospitals

 Demographic information including

insurance
 Physician’s initial evaluation
 History
 Physical examination
 Laboratory: blood tests, radiographic images
 Diagnoses
 Treatments

46
 Patients’ Medical Information
Hospitals

 Subsequent visits:
 Progress notes: medical students, residents and
attending physicians
 Physicians’ orders
 Nursing notes: vital signs and assessment

47
 Traditional Medical Information
Drawbacks
 Important clinical information is not timely
available:
 outpatient information is not available when the patient is
admitted to the hospital
 Consultations
 Inefficiency:
 Duplication of effort
 Time consuming
 Illegible records
 Missing medical records

48
 HCFA
Compliance

Consultants OR Med record

Transport
Family Attending Clerks

Ethics Pharmacy PATIENT Xray

Techs Residents Nurses Lab Insurance

Student Student
Policies JCAHO
Computer

49
 Hospital Clinical Information System

UH CRH
Medical records Cerner HBOC
Orders Cerner HBOC
Materials management Procure IMMS
Clinical pathology ALG (UH only) ALG (CRH only)
Anatomic pathology CoPath M Western star
Pharmacy Pharmakon HBOC
Operating room SurgiServ ORSOS
Radiology MARS HBOC
Cardiac cath lab Whitt (UH only) Whitt (CRH only)
50
 Accomplished Projects

 Hospital clinical information system (UH)

 Physicians’ orders
 Profile (medical records management) system at UH
 Document imaging – clinical and financial
 EMR (UH and Clinics)
 Clinical information is flowed into the Central Data Center
and thus retrievable through Powerchart
 Documentation with Powerchart
 FirstNet – Emergency Department’s tracking and triage
 Cerner runs the Central Data Center off campus
 Power Chart is an electronic format of standard
consultation notes, progress notes and operative notes.
51
 POWER CHART

 Physicians’ electronic medical records

 Structured documents:
 Consultation notes
 Progress notes
 Operative notes
 Secured electronic signatures

52
 Current Projects
2004
 Pharmacy system – UH – complete
 Operating Room Management system – UH
 Replacing:
 Radiology system - UH/CRH
 Anatomic pathology system - UH/CRH
 Clinical pathology system - UH/CRH
 Blood bank system - UH/CRH
 Physician and nursing documentation on-line for in-
patent documentation
 “Power Chart office” in the clinics
53
 EMR Program’s Goals

Patients: Improved quality of care

Providers: Better working environment

MU Health Care System: Enhanced

financial performance

54
 EMR’s BENEFITS

 Patient care will improve

 Better health outcomes
 Higher satisfaction
 Providers’ lives will be better
 Easier, more time to provide good care from
improved efficiency
 The bottom line will be enhanced
 Decreased costs, increased revenues

55
What are medical errors?

 Adverse event (AE): injury or death of a patient

 Near miss: an event or situation that could have
resulted in AE but did not
 Medical Error:
 failure in execution of plan and its details OR
 use of wrong plan

56
 Complex Nature of Medical
Care

 ICU study
 Average of 178 “activities” per patient per
day
 99% proficiency rate means 1.7 errors per
patient per day
 Even 99.9% may not be safe enough

57
 Latent Errors in System Design

 Three Mile Island, Bhopal, Chernobyl,

Challenger disaster
 “Accidents waiting to happen”
 Human error is proximate cause
 Root cause(s) present in system - long time
 The error is a symptom of the underlying
systemic disorder
58
 Perspective on medical errors

 Physicians, nurses, pharmacists are highly trained,

careful, and dedicated professionals
 Lack of awareness of scale of problem
 Most errors do no harm
 Most errors are symptoms of the underlying
systemic disorder.
 EMR is one of the solutions to the systemic
disorders of the health care delivery

59
 The Work of Providers

 What is the real work of health care

providers, i.e., those with direct patient
contact?
 Process information
 Apply technical skill
 Build relationships

60
 Information Processing

 Start with a baseline knowledge and experience

 Acquire information from the patient
 Supplement with examination and diagnostic
testing – both past and present
 Use baseline knowledge, occasionally
supplemented information at time of care, to
formulate a plan of care

61
 Information processing

 Communicate the plan

 Orders/prescriptions – i.e. information transfer to
other providers
 Information transfer to the patient
 Information to referring physician/PCP
 Orders implemented
 Charges applied to services rendered
 Interfaced with IDX system for efficient billing
and collection 62
 Physicians and Information:
Communication

 With each other…

 InBox messaging
 With our patients…
 IQ Health
 With our referring physicians
 Auto-fax
 Direct access
 Employers
63
 PHYSICIAN’S ORDERS

ORDERS HANDWRITTEN
0:02min Doctor writes order
0:33 Average until unit secretary enters order
0:11 Unit secretary enters order
0:34 Average until nurse begins to verify order
0:06 Nurse verifies order
1:26 Pharmacy receives order
ORDERS GENERATED ONLINE
0:03 Doctor writes order/Pharmacy receives order

Source: Modern Healthcare, 2001

64
 EMR and Physicians’ orders

 In hospitals, when physicians order

medications for patients electronically,
serious medical errors were reduced by 55%.

D. Bates, M.D., Brigham and Women’s Hospital.

65
 Documentation

 Documentation occupies a significant

portion of physicians’ effort in providing
medical care.
 Good documentation improves medical care
and a defense against medical lawsuits
 More lawsuits are defended because of good
record keeping than because of actual events.

66
 Credibility of Medical Records

 Delayed filing of lab results

 Incomplete files
 Illegible records
 Altered records
 Fabricated records
 Loss and concealment of records

67
 Physician Documentation

 MUHC is in the forefront of implementing

these capabilities
 Over 100,000 Power Notes have been completed
– almost all inpatient
 We have the skill and commitment of
physicians necessary to continue progress in
this area

68
 Plan of Care

 The most appropriate plan of care requires

the presence of all needed information at
the point of decision-making
 In its simplest – this concept means everything
now available on paper spread out across a
system of care is available instantly in an
organized, retrievable fashion at all locations of
care via the EMR

69
 Physicians and Information:
Knowledge at the Point of Care

 On-line resources
 Structured documentation
 Order sets
 Alerts & reminders
 Continuous Quality & Safety Improvement

70
71
 Health Insurance Portability and
Accountability Act (HIPAA)

 Secured access to the data:

 Password
 Electronic signature
 Close monitoring access to EMR:
 Employees are prohibited to view even their own
medical records.

72
 Benefits of EMR

 Improves quality of care

 Information available at time and place of care
 Reduces medical errors
 Improves coordination of care
 Providers’ better professional lives
 More efficient
 More effective
 Less professional liability

Ref 3, 4, 5, 6 73
 Benefits of EMR

 Improves the institution’s financial performance:

 Improves billing and collections through timely and more
accurately submitting the charges to insurers.
 Reduces healthcare costs resulting from inefficiency and
incomplete information
 Reduces the cost of professional liability
 Increases volume by retaining and recruiting more
patients and physicians

Ref 3, 4, 5, 6 74
 CRM Strategy

 Balance the business in favor of the customer

 Maintain customer loyalty
 DATA, DATA, DATA
 Qualitative research to understand customers
 Develop specialty programs that meet customers’
interests
 Know which markets and marketing strategies are
the most profitable

Ref. 26 75
CRM Best
Practices

76
 Best Practices

 Vision / Strategy
 Know your Customer
 Differentiate
 Technology – data requirements
 Metrics
 Monitor

Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003;
http://www2.cio.com/analyst/report1483.html; last accessed October 25, 2004.
77
 Vision / Strategy

 Alignment of vision/strategy with:

 Business objectives
 Customer requirements

 Organizational readiness, including

capabilities, policies, incentives and
practices
Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003;
http://www2.cio.com/analyst/report1483.html; last accessed October 25, 2004.
78
 Customer Analysis

 Identify -- know who your customer is

 Segment -- high-value, high-potential, low-
potential
 Profile -- know your customer’s habits,
behaviors and profitability

Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003;
http://www2.cio.com/analyst/report1483.html; last accessed October 25, 2004.
79
 Technology – data requirements

 Define and map data requirements

 What customer data is necessary?
 What system will the data come from?

Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003;
http://www2.cio.com/analyst/report1483.html; last accessed October 25, 2004.
80
 Metrics

 Metrics & goals must be established

up front

Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003;
http://www2.cio.com/analyst/report1483.html; last accessed October 25, 2004.
81
 Monitor

 Get feedback from customers

 Audit customer experiences by periodically

sampling customer touch points

 Use this information to measure effectiveness and

identify areas for improvement

Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003;
http://www2.cio.com/analyst/report1483.html; last accessed October 25, 2004.
82
 Lessons Learned

 Need to pay close attention to triangle: people,

process, and technology
 Get executive involvement – top down
 Establish measurable business goals
 Implement incrementally
 Ensure CRM architecture will scale to future needs
as you grow

Spitz, Keith. “Lessons Learned by a CRM Veteran.” Computerworld. Sep 20, 2004. Vol. 38, p. 26
83
 The Future of CRM

 Top 5 CRM Trends for 2005

 Optimizing past CRM investments
 Customer retention
 Data analysis
 Channel integration
 Partnerships

84
 Questions

?
? ? ?
?

?
? ?
?
?
?
?
? 85
 References

1. Goodhue, D. L., Wixon B. H., and Watson, H. J., “Realizing Business Benefits Through CRM: Hitting the Right
Target In The Right Way” MIS Quarterly Executive, Vol. 1, 2, 2002, pp. 79-96.
2. Swift, Ronald S., “Executive Response: CRM is Changing Our Eras, the Information we Require, and our
Processes” MIS Quarterly Executive, Vol 1, 2, 2002, pp.95-96.
3. Chin, Tyler, “Data Mining,” American Medical News, Vol 46, p. 19.
4. Swartz, Nikki, “Doctors, Hospitals Advised to Keep Records Electronically” Information Management Journal,
Vol 38, 1, 2004, p.9.
5. Swartz, Nikki, “A Prescription for Electronic Health Records” Information Management Journal, Vol 38, 4, 2004,
p.20-22.
6. Finkelstein, Joel B., “Health IT chief: Public-private partnership needed for EMRs” American Medical News, Vol
47, 28, pp. 5-6.
7. Pastore, Michael, “CRM Spending Increases Despite Myriad of Market Players,” November 2, 2000;
http://www.clickz.com/stats/big_picture/hardware/article.php/5921_502171; last accessed on October 11, 2004.
8. http://www.crmtrends.com/crm.html; last accessed October 28, 2004.
9. McGovern, Todd and Panaro, Joseph. “The Human Side of Customer Relationship Management” Benefits
Quarterly, Vol. 20, 3, 2004, pp. 26-33.
10. Powers, Thomas L., and Bendall, Dawn. “The Influence of Time on Changes in Health Status and Patient
Satisfaction”. Health Care Management Review. Jul-Sep 2004. Vol. 29, 3; pp. 240-248.
11. Vandermerwe, Sandra. “Achieving Deep Customer Focus,” MIT Sloan Management Review. Spring 2004. Vol. 45,
3; pp. 26-34.
12. Mello, A., “Watch out for CRM’s hidden costs” October 17, 2001;
http://techupdate.zdnet.com/techupdate/stories/main/0,14179,2818263,00.html; last accessed on October 29, 2004.
86
 References
13. Miller, Robert H. and Sim, Ida. “Physicians’ Use of Electronic Medical Records: Barriers and Solutions.” Health
Affairs: Mar/Apr 2004. Vol. 23, 2; p.p. 116-126.
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