Customer Relationship

Management
CRM in Modern Health Care Delivery

Group Presentation IS 6800

Renee Ross
Hung Winn M.D., J.D

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 GMs

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

Importance of CRM to GMs

Research has shown
that companies that
create satisfied, loyal
customers have more
repeat business,
lower customeracquisition costs,
and stronger brand
valueall of which
translates into better
financial
performance
http://siebel.com; last accessed October 17, 2004.

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 CRMs hidden costs October 17, 2001;
http://techupdate.zdnet.com/techupdate/stories/main/0,14179,2818263,00.html; last accessed on
October 29, 2004.

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 CRMs hidden costs October 17, 2001;
http://techupdate.zdnet.com/techupdate/stories/main/0,14179,2818263,00.html; last accessed on October 29, 2004.

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

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.

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
10
40% to 95%

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

1.

PeopleSoft Enterprise
PeopleSoft Enterprise One
PeopleSoft World
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

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 Bushs 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 institutions 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 Womens 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
Womens 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

organizations 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

EMRs Progress
2002

The projects was launched but progress was

impaired by concerns about MU Health Care
Systems 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
Physicians 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
Transport
Family
Ethics Pharmacy
Techs

Attending

PATIENT
Residents
Student

Nurses

Med record

OR

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)

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 Departments 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 Programs Goals

Patients: Improved quality of care
Providers: Better working environment
MU Health Care System: Enhanced
financial performance

54

EMRs 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

PHYSICIANS 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 Womens 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 institutions 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 customers 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

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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
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Target In The Right Way MIS Quarterly Executive, Vol. 1, 2, 2002, pp. 79-96.
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Affairs: Mar/Apr 2004. Vol. 23, 2; p.p. 116-126.
Krass, P., CRM: Once More, Without Reeling March 17, 2003;
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Larson, J., The Arizona Republic

President Bushs State of the Union address, 1/20/2004
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88