Patient relationship management (PRM) is an overarching strategy (not just a technology) for identifying and anticipating diverse patient and clinician needs and preferences in order to tailor communications and programs accordingly. The currency for these transactions is patient data. The resulting benefits typically include improved customer service, reduced medical errors, better productivity, cost savings, and improved health outcomes, to name a few. This report first outlines the impetus for PRM stemming from the pervasive fragmentation of healthcare delivery and supporting data, then summarizes the ‘nuts and bolts’ of PRM, and finally highlights how several PRM initiatives are providing valuable benefits to both patients and providers.

Fragmentation and Frustration

"One-to-one relationship," "trust," "accurate and complete information" — ideals upon which the tenets of coordinated, timely, and accessible healthcare have always been established. Yet the fragmentation of patient care and supporting data is not new. As Russell and Otley point out, "In the beginning, there was the physician and the patient, whose relationship was built on trust and good communication." But despite the opportunity to establish long-term relationships with patients, yesterday’s itinerant doctor could offer care in only one location at a time within a limited sphere of knowledge and collaboration.

Today, despite medical, technological, and communication advances that minimize professional isolation, transient and discrete healthcare encounters are not uncommon in an age of myriad health care organizations and savvy, mobile ‘customers’ (a.k.a. patients) seeking optimal and immediate care for complicated conditions. Russell and Otley contend that healthcare is "characterized by complexity and fragmentation, with discrete silos of information often controlled by separate entities," with the patient left adrift, feeling frustrated and dissatisfied, and providers "lacking a comprehensive clinical picture of the patient." In essence, this milieu of fragmentation has rendered unwieldy data the elusive ‘ghost in the machine,’ despite best efforts in the past to leverage technology as a panacea for streamlining healthcare.

Optimistically, as outlined in our previous World View report on business intelligence in healthcare, these concerns are now being addressed with improved methods for integrating and analyzing data, transforming analysis from retrospection to prediction and ‘real-time’ processing in order to help organizations adopt best practices. But as Dr. Bob Young points out in his response to that report, the potential for health informatics tools to achieve sustainable quality improvements will only be realized with a strong cultural commitment toward: 1) addressing rising expectations; 2) upholding healthcare as "fundamentally patient-centred activity revolving around effective, acceptable personal communication"; and 3) ensuring the collection and utilization of high quality, integrated, and standardized data with appropriate granularity.

These principles also underpin PRM efforts to restore personalization in healthcare while improving health outcomes and containing costs. PRM can help ‘defragment’ healthcare by eradicating the aforementioned challenges of balkanized data. In fact, "one of PRM’s hallmarks is its ability to take disparate types of data from many sources and pull it together into a comprehensive, standardized resource" (CPM Group).

What Patient Relationship Management Is—and Isn’t

"PRM introduces the principles of CRM to the world of healthcare. …PRM is a commitment to understanding patients as individuals and then communicating relevant information to them and their caregivers using the medium they prefer. PRM is not a technology but rather a vision realized through technology; technology grants the ability to achieve more cohesion between the disparate parts of the healthcare system, which in turn improves both clinical outcomes and patient satisfaction" (Russell and Otley). Key Aspects of PRM

PRM orchestrates a number of methodologies in a synchronized approach to delivering healthcare. Experts caution against rapid implementation and advocate instead a deliberate sequencing of these strategies in order to achieve desired results.

1. Enterprise Identity Management and Data Integration (EIM): A crucial first step is the establishment of a system for accurately identifying ‘customers’ (patients, clinicians, as well as the at-risk well). As Schumacher underscores, "one in 10 returning patients is not properly identified by his hospital system when he arrives for care." He goes on to explain that integration of enterprise-wide data is crucial to improving customer service. EIM provides the integration needed to bridge operational systems (such as electronic patient records) and thus supports data integrity across the organization. This in turn enables the development of "a mission-critical data warehouse of [the] most valuable asset—patient data." Without a rigorous level of data integration, standardization, protection from error, and traceability, PRM solutions will be stymied. An integrated single database enables healthcare organizations to perform what Paddison describes as the "PRM closed-loop cycle": Collect aggregate data – Analyze individual needs and preferences – Develop relevant messages based on individual needs and preferences – Deliver communications through preferred channels (direct mail, e-mail, phone, and fax) – Analyze results and refine the approach.

2. Outcomes Management and Predictive Modeling: Outcomes analysis combined with predictive modeling offer a powerful means to deliver disease management. Healthcare organizations can, by: a) predicting who is at-risk for developing certain conditions, and b) identifying of those already diagnosed who is likely to develop complications, provide preventive interventions instead of more expensive treatments that may otherwise be required for acute episodes. In this manner, according to Plocher, "outcomes for an entire population can be handled—and improved."

This multi-layered foundation serves as the infrastructure for building a successful PRM strategy, the survival of which depends on strong change management and communication plans to ensure alignment between business needs and organizational models in support of strategic objectives (Phillips).

PRM versus CRM in Private and Public Health Care

Given the commercial marketing roots of CRM, it is important to distinguish the applicability of CRM principles to PRM in both private and public health care sectors. In brief, while CRM and PRM involve similar approaches, "the goal of CRM is ultimately to increase consumer spending. Conversely, PRM strives to give patients the information they need to make better healthcare choices, which will ultimately save them and the system money" (Russell & Otley). PRM also requires added consideration for handling complex data and the need to enforce airtight security and the appropriate use of patient data.

Despite the differences, commonalities between CRM and PRM enable stronger relationships that benefit from: greater anticipation of customer needs and wants, improved communication channels, timely and credible information, and the capture of tacit knowledge—in essence knowing people better without wasting their time. However, the marketing tactics of commercial persuasion and manufactured demand do not directly apply in healthcare; therefore, the best ‘marketing’ goal that a private / for-profit healthcare organization can hope for in "the migration of CRM to PRM is the natural evolution of building the perception that when the need arises, the promoted physician practice or hospital is there to help you" (Wilson-Steele).

But ‘perception management’ also applies to public PRM in efforts to nurture relationships with a patient/ provider audience receptive to preventive, cost-saving interventions that stave off the need for expensive acute care services. Responsibility for the public purse creates an impetus for seeking these efficiencies through this form of Citizen Relationship Management—the CRM equivalent in the public realm.

Driven by pressures to decrease costs, PRM in public health systems works to prevent "customer disconnects" and maintain a "360-degree view of the customer" (Phillips), including functions like enhanced referral tracking and automatic reminders aimed at reducing missed appointments. According to Halpern and Bates, in the NHS the cost of "did not attends" (12.5% of outpatient appointments in 2000) "is a source of increasing concern" and "impacts seriously on the health service’s ability to plan and deliver timely care" (Wanless Review). This example illustrates how PRM applies practically in the public arena and could assist healthcare organizations to meet regulatory imperatives such as the UK’s Gershon Review requiring local authorities to achieve 2.5% efficiency savings each year, believed to be possible in large part through IT supported, streamlined processes.

Relationships at Work

Other PRM examples of pioneers unhindered by data challenges highlight the compelling potential of PRM to enhance clinical relationships and improve patient care:

Preventing pain for children: In Chicago, using a unique combination of predictive analytics and data mining to analyze tumor sample data and biomedical treatment literature, physicians are able to more accurately classify life-threatening brain tumors for individual children and provide precise doses of chemotherapy to minimize pain and further damage. These analyses can be performed "faster than…using [the] previous method of manila folders and Excel spreadsheets" (Monegain).

Enhancing Chronic Disease Management: In Ontario, Canada, the vascular tracker component of the award winning COMPETE Research Program marries CRM with CDM (chronic disease management) in order to bring decision-support closer to the point of decision-making. The peer-reviewed algorithms are highly individualized to each patient. "Based on data on a patient’s past medical history, current medications, allergies and vascular risk, the algorithms generate specific targets and recommendation messages" (COMPETE).

Streamlining Home Care: In the UK, a homecare provider recently adopted an integrated customer relationship management system in order to "truly put the patient at the heart of [the] business." Expected benefits included the ability for nurses to more easily generate valuable clinical reports for monitoring care levels and patients’ acceptance and responsiveness to treatment. (Healthcare at Home).

Considering the historical rate of failed IT projects, PRM strategies may hold the key to systematically incorporating IT in the redesign of healthcare without conducting a monstrous experiment with costly results. Pressure on health care systems to comply with budget restraints, regulatory changes, data standardization and integration initiatives, and imperatives to utilize computerization in the process, underscores the reality that simply throwing technology—or money for that matter—at the future is not the solution. Discerning ‘culture’ issues and correctly identifying the problems is. As Weil asserts:

The problems can be identified using PRM because of its dependence on analysis, which in turn "illustrates what opportunities and problems exist in the market and how services and programs can be adapted to meet those needs" (CPM Group). Furthermore, PRM is about leveraging data, not stockpiling it. An exclusive focus on gathering and storing as much patient data as possible neglects the need to use that data to build better relationships—CRM systems can be "like a dusty attic that no one ever ventured into except to pitch in a few more boxes for storage" (Sun Microsystems). Healthcare need not be haunted by under-utilized data—PRM offers smarter solutions to vanquish the data-ghosts from the attic by minimizing healthcare fragmentation.

In computing vernacular, ‘defragment’ literally translates: to reorganize or reallocate the storage on a computer’s hard disk by bringing together files or parts of files to optimize the machine’s performance." Optimization of healthcare delivery requires the integration and provision of accurate and complete information that may be possible with PRM in order to "create an updated version of the most powerful, most effective relationship healthcare has ever known: that of the patient to his or her family doctor" (Russell and Otley). It boils down to "superb customer service" that establishes continuity, restores trust, and bolsters one-to-one relationships that are the hallmark of PRM, if not solely between a patient and a single clinician, then by reuniting patients with their data seamlessly across healthcare encounters and providers.

References

All references with URLs were accessed March 31, 2006.

COMPETE (Computerization of Medical Practice for the Enhancement of Therapeutic Effectiveness). COMPETE III Vascular Tracker.
http://www.compete-study.com/C3_tracker.htm

CPM (Customer Potential Management) Marketing Group. Using your PRM System for Planning. 1) A CPM White Paper. September 2003.
http://www.dmreview.com/whitepaper/WID581.pdf 2) Also: Online Newsletter, CRM Health Lines. Winter 2004.
http://www.cpm.com/providers/press/newsletter_winter_2004/planning.html

Hagland M. Insuring Satisfaction. Healthcare Informatics Online. July 2003.
http://www.healthcare-informatics.com/issues/2003/07/cover.htm

Halpern D and Bates C. Personal Responsibility and Changing Behaviour: The State of Knowledge and its Implications for Public Policy. UK Prime Minister’s Strategy Unit. Discussion Paper.
http://www.number10.gov.uk/files/pdf/pr.pdf

Healthcare at Home Chooses Ascent Relationship Management. E-Health Insider. October 2001.
http://www.e-health-insider.com/news/item.cfm?ID=37

IBS OPENSystems. Gershon Review Encourages Local Authorities to Consider More Innovative Approaches. eGovMonitor. November 2005.
http://www.egovmonitor.com/node/3511

Marietti C. Minding the Store: In the Provider Business of Today, Customers Aren’t Always Patients. Healthcare Informatics Online. April 2004,
http://www.healthcare-informatics.com/issues/2004/04/ed_page.htm

Monegain B. Sifting Mounds of Data. Healthcare IT News. May 2005.
http://www.healthcareitnews.com/story.cms?id=2882

Paddison NV. Healthcare Relationship Management Depends on Tailored Database. Healthcare IT News. May 2004.
http://www.healthcareitnews.com/story.cms?id=740

Phillips J and Panchal S. Meeting the Needs of Customers With Health CRM. Journal of Healthcare Information Management. Vol. 16, No. 3, Summer 2002:35-39.

Plocher DW and Wilson WL. Buying an Outcomes Management System. Healthcare Informatics Online. October 2002.
http://www.healthcare-informatics.com/issues/2002/10/plocher.htm

Russell CS, Otley VC. Patient Relationship Management: Delivering What Patients Want at a Cost Healthcare can Afford. IntelliCare White Paper. March 2003.
http://www.intellicare.com/about/whitepapers.html

Sun Microsystems. Health Plans Aim to Treat Members Like Customers. Boardroom Minutes. June 2004.
http://www.sun.com/br/0604_ezine/hc_crm.html

Wanless D. Securing Our Future Health: Taking a Long-Term View. For HM Treasury. April 2002.
http://www.hm-treasury.gov.uk/Consultations_and_Legislation/wanless/consult_wanless_final.cfm

Weil B. Placing the Patient at the Center of Healthcare. eHealthExecutive. Oct 2002.
http://www.ehealthexecutive.com/body.cfm?id=9&action=detail&ref=12

Wilson-Steele G. The Natural Evolution of Bringing Consumers Into the Healthcare Fold. EHealthExecutive. October 2002.
http://www.ehealthexecutive.com/body.cfm?id=9&action=detail&ref=11