Customer Relationship
Management
CRM in Modern Health Care Delivery
Group Presentation – IS 6800
Renee’ Ross
Hung Winn M.D., J.D
1
Agenda

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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….
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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 customeracquisition costs, and
stronger brand
value—all of which
translates into better
financial
performance”
http://siebel.com; last accessed October 17, 2004.
5
CRM Spending

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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

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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
Call Center
Web
Access
E-mail
Store
Direct
Sales
Fax
Refined Business Processes
Process
Improvement
Business Intelligence
Integrated database
Billing
Call center
Fig. 2
Accounts
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
Ref 21, 22
Studies indicate that increasing the number of
customers a company retains each year by just 5%
can increase contribution to shareholder value by
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
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Union Pacific Railroad (Siebel)
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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
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Company Information
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Headquarters in San Mateo, California
Founded 1993
5000 employees
2.8 million users at 4,000+ organizations
2003 revenue - $1.35 billion
Strategy
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“CRM for Everyone” – CRM software solutions for any kind of organization, any type of user, and any budget
Product Offerings
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Siebel Business Analytics
Siebel On Demand
Siebel Sales
Siebel Professional
http://siebel.com; last accessed October 17, 2004.
15
 Company Information
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Headquarters in Pleasanton, California
Founded 1987
12,000 employees
Serving 12,200 organizations
2003 revenue - $2.3 billion
 Strategy
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Flexible and adaptable business solutions
 Product Offerings
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1.
PeopleSoft Enterprise
PeopleSoft Enterprise One
PeopleSoft World
http://www.peoplesoft.com; last accessed October 17, 2004.
16
 Company Information
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Headquarters in Bellevue, Washington
900 customers in 50 industries
 Strategy
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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
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Onyx CRMExpress
Onyx Portable CRM
Onyx Analytics
http://www.onyx.com; last accessed October 17, 2004.
17
 Company Information
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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
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1.
mySAP Business Suite
mySAP ERP
SAP xApps
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
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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:
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UP: 635 (370 physicians + 265 staff)
IT: 22 or 3.5% of total UP headcount
 Budget:
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UP ‘s revenue: 110 M
IT services: 2.7 M or 2.5% of revenue
Electronic medical records (EMR)

IDX system: scheduling and billing
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
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:
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MU Health Care: 5700 employees
ITS: 108 or 1.9% of the total headcount
 Budget:
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MU Health Care: 620 M
ITS:
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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:
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Health care providers: physicians
Patients
 Electronic clinical information is the
organization’s effort to recruit and retain
customers.
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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

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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:

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
Duplication of effort
Time consuming
Illegible records
Missing medical records
48
HCFA
Compliance
Consultants
Med record
OR
Transport
Family
Ethics Pharmacy
Techs
Attending
PATIENT
Residents
Student
Nurses
Clerks
Xray
Lab
Insurance
Student
JCAHO
Policies
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)

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
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 inpatent 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, lowpotential
 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
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85
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
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.
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.
Chin, Tyler, “Data Mining,” American Medical News, Vol 46, p. 19.
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