Customer Relationship Management

Customer Relationship Management
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

CRM – What is it? CRM – “Strategy used to learn more about customers’ needs and behaviors in order to develop stronger relationships with them” 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 – 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 CRM introduced in 1993 CRM is an integrated approach to identifying, acquiring, and retaining customers. By enabling organizations to manage and coordinate customer interactions across multiple channels, departments, lines of business, and geographies, CRM helps companies maximize the value of every customer interaction and achieve improved corporate performance. Today’s organizations must manage customer interactions across multiple communications channels—including the Web, call centers, field sales, and dealers or partner networks. Many organizations also have multiple lines of business with many overlapping customers. The challenge is to make it easy for customers to do business with the organization any way they want—at any time, through any channel, in any language or currency.

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 Customers are the heart of business success. CRM helps business use technology and human resources to gain insight into the behavior of customers and the value of customers last accessed September 27, 2004.

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” 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 CRM’s hidden costs” October 17, 2001; 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% CRM has hidden costs. Watch out for hidden costs which can be found in the four areas. Training is the biggest cost that is underestimated. Mello, A., “Watch out for CRM’s hidden costs” October 17, 2001; last accessed on October 29, 2004.

CRM Infrastructure In CRM theory, each time a customer interacts with any of a company’s touch points, the information that is collected (quantitative, qualitative, and behavioral) is sent to the company’s systems database. This information is then deposited into a single CRM data warehouse where it is cleaned, analyzed, refined, sorted and made available for future interactions with the customer. For example, if a customer now calls into a call center, the representative can now see their sales history, places they frequent, what they access the web for; not just their call history with the call center. This gives the representative the ability to personalize and customize the call by making references to recent sales, etc. 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 Applications refers to which business process you want to target for improvement. Some common applications are database marketing, call centers, and field sales. Infrastructure refers to how data is shared and connected across various applications. Transformation refers to the organizational change the company goes through to become truly customer-centric. 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

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 40% to 95% Ref 21, 22

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 last accessed October 28, 2004. Bleicher, Paul. “An Imposing Change.” Pharmaceutical Executive. Jun p.p

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

CRM Failure Failure rate of 15-25%
85% of CRM users cannot quantify benefits Krass, P., “CRM: Once More, Without Reeling” March 17, 2003; last accessed October 15, 2004.

CRM Industry Leaders

Company Information Strategy Product Offerings
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 last accessed October 17, 2004.

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 last accessed October 17, 2004.

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 last accessed October 17, 2004.

Company Information Mission Product Offerings
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 last accessed October 17, 2004.

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).” Implementing electronic medical records can be classified as a CRM initiative. If we go back to our original definition, we can substitute physician/hospital for organization and patient for customer. 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

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. Information systems of hospitals and clinics directly affect the quality of care patients receive Quote Problems persist because of industry wide failures connected to the lack of reliable health information Healthcare is the most information-intense enterprise in the country. It is years behind less information-intensive industries like banking. Swartz, Nikki, “A Prescription for Electronic Health Records” Information Management Journal, Vol 38, 4, 2004, p

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 New official is dedicated to digitizing the US healthcare industry. Includes responsibility for the development, maintenance and direction of a strategic plan to implement EMR.

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 New official is dedicated to digitizing the US healthcare industry. Includes responsibility for the development, maintenance and direction of a strategic plan to implement EMR.

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. New official is dedicated to digitizing the US healthcare industry. Includes responsibility for the development, maintenance and direction of a strategic plan to implement EMR. L. Kowalczyk, Global Staff

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 New official is dedicated to digitizing the US healthcare industry. Includes responsibility for the development, maintenance and direction of a strategic plan to implement EMR.

Case Study MU Healthcare System

Columbia has consistently ranked as one of the best American cities to live in according to Money Magazine's yearly survey. Columbia is one of only two cities to appear among the top twenty places to live for five consecutive years. Growing community of nearly 90,000

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

MU School of Medicine

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

University Physicians
Headcount: UP: 635 (370 physicians 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

MU Health Care EXECUTIVE DIRECTOR CIO, CFO Hospital Directors
UNIVERSITY HOSPITAL COLUMBIA REGIONAL HOSPITAL CLINICS

University Hospital

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)

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)

MU Health Care Headcount: Budget: Total beds: 522
MU Health Care: 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

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

MU HEALTH CARE SYSTEM Hospital Clinical Information System
Electronic medical records (EMR)

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)

CERNER RELATIONSHIP September 2003 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

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.

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. Their solutions automate processes, eliminate redundancy/delay and bring the best medical science to every decision, enabling measurable quality and safety improvements. They also help providers eliminate variance and optimize outcomes. . Cerner solutions facilitate comprehensive analysis for effective decision-making.

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 The president has articulated a goal of an EMR or EHR for every patient in America within 10 years.

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.

Patients' Medical Information Clinics
Demographic information including insurance History: allergy Physical examination Laboratory: blood tests, radiographic images Diagnoses Treatments

Patients’ Medical Information Hospitals
Demographic information including insurance Physician’s initial evaluation History Physical examination Laboratory: blood tests, radiographic images Diagnoses Treatments

Patients’ Medical Information Hospitals
Subsequent visits: Progress notes: medical students, residents and attending physicians Physicians’ orders Nursing notes: vital signs and assessment

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 Prenatal records, GBS Laboratory results from different laboratories

HCFA Ethics Insurance JCAHO Computer Compliance Policies Xray Lab OR Techs Pharmacy Transport Med record Student Consultants Clerks Attending Family PATIENT Nurses Residents

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

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.

POWER CHART Physicians’ electronic medical records
Structured documents: Consultation notes Progress notes Operative notes Secured electronic signatures

Current Projects 2004 Replacing: 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

EMR Program’s Goals Patients: Improved quality of care
Providers: Better working environment MU Health Care System: Enhanced financial performance

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 Example: signing the medical records

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

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

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

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

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

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

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

Physicians and Information: Communication
With each other… InBox messaging With our patients… IQ Health With our referring physicians Auto-fax Direct access Employers

ORDERS GENERATED ONLINE
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

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. The president has articulated a goal of an EMR or EHR for every patient in America within 10 years.

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.

Credibility of Medical Records
Delayed filing of lab results Incomplete files Illegible records Altered records Fabricated records Loss and concealment of records

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

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

Physicians and Information: Knowledge at the Point of Care
On-line resources Structured documentation Order sets Alerts & reminders Continuous Quality & Safety Improvement

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.

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 New official is dedicated to digitizing the US healthcare industry. Includes responsibility for the development, maintenance and direction of a strategic plan to implement EMR. Ref 3, 4, 5, 6

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 New official is dedicated to digitizing the US healthcare industry. Includes responsibility for the development, maintenance and direction of a strategic plan to implement EMR. Ref 3, 4, 5, 6

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

CRM Best Practices

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; last accessed October 25, 2004.

Vision / Strategy Alignment of vision/strategy with:
Business objectives Customer requirements Organizational readiness, including capabilities, policies, incentives and practices In determining if an organization is ready, you should consider if you have buy-in from all of the organization groups involved, and whether or not they understand their roles. Do you have the resources needed to support the initiative? Is training needed, if so, do you have it lined up? In order to use CRM successfully, a company needs to have a CRM-focused vision. This means more than simply having one company department focus on CRM. It means having the company’s mission statement, strategies, goals, and expectations all focused on CRM Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003; last accessed October 25, 2004.

Customer Analysis Identify -- know who your customer is
Segment -- high-value, high-potential, low-potential Profile -- know your customer’s habits, behaviors and profitability CRM is always about the customer! It’s impossible to implement a CRM without fully understanding your customer. Do some research and analysis of your customer to find those that are most valuable. Valuable customers are those that provide increasing revenue, are profitable and require a low cost to service. For CRM to be successful, the strategies of each company need to focus on the end-customer relationship. Although most companies focus on selling what they already make or offer, a company that is focused on the end-customer should focus on selling what the customer wants. Part of this customer focus includes measuring customer attitudes as the CRM system is implemented in order to determine if the program is improving customer information. Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003; last accessed October 25, 2004.

Technology – data requirements
Define and map data requirements What customer data is necessary? What system will the data come from? Technology is key to CRM. Without the right technology, the data and information collected from CRM initiatives cannot be effectively used. This includes, the applications, architecture and infrastructure necessary to implement the initiatives. Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003; last accessed October 25, 2004.

Metrics Metrics & goals must be established up front
How can an organization know if their CRM program has been a success if no metrics or goals were established up front. Quantitative metrics can provide insight and measure success. Defining metrics helps you better identify and quantify the problem, define objectives, project return on investment, set implementation priorities and measure success. Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003; last accessed October 25, 2004.

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 Feedback from customers is necessary to develop or revise a CRM strategy. Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003; last accessed October 25, 2004.

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 A major business change will include all three parts of the triangle; a change in only one or two is unlikely to produce any meaningful improvements and may even reduce productivity. Spitz, Keith. “Lessons Learned by a CRM Veteran.” Computerworld. Sep 20, Vol. 38, p. 26

The Future of CRM Top 5 CRM Trends for 2005
Optimizing past CRM investments Customer retention Data analysis Channel integration Partnerships Over the past decade, millions has been spent on CRM. Companies will now focus on how to gain additional benefits from those same investments. Increased focus on data analysis – understanding customers and their behaviors and getting them moved through the life cycle. Channel integration –consistent experience across all touchpoints (call centers, sales, web, ) Increased focus on partnerships to bring customers more benefits

Questions ? ? ? ? ? ? ? ? ? Over the past decade, millions has been spent on CRM. Companies will now focus on how to gain additional benefits from those same investments. Increased focus on data analysis – understanding customers and their behaviors and getting them moved through the life cycle. Channel integration –consistent experience across all touchpoints (call centers, sales, web, ) Increased focus on partnerships to bring customers more benefits ? ? ? ? ?

References 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 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 Chin, Tyler, “Data Mining,” American Medical News, Vol 46, p. 19. Swartz, Nikki, “Doctors, Hospitals Advised to Keep Records Electronically” Information Management Journal, Vol 38, 1, 2004, p.9. Swartz, Nikki, “A Prescription for Electronic Health Records” Information Management Journal, Vol 38, 4, 2004, p Finkelstein, Joel B., “Health IT chief: Public-private partnership needed for EMRs” American Medical News, Vol 47, 28, pp. 5-6. Pastore, Michael, “CRM Spending Increases Despite Myriad of Market Players,” November 2, 2000; last accessed on October 11, 2004. last accessed October 28, 2004. McGovern, Todd and Panaro, Joseph. “The Human Side of Customer Relationship Management” Benefits Quarterly, Vol. 20, 3, 2004, pp Powers, Thomas L., and Bendall, Dawn. “The Influence of Time on Changes in Health Status and Patient Satisfaction”. Health Care Management Review. Jul-Sep Vol. 29, 3; pp Vandermerwe, Sandra. “Achieving Deep Customer Focus,” MIT Sloan Management Review. Spring Vol. 45, 3; pp Mello, A., “Watch out for CRM’s hidden costs” October 17, 2001; last accessed on October 29, 2004.

References Miller, Robert H. and Sim, Ida. “Physicians’ Use of Electronic Medical Records: Barriers and Solutions.” Health Affairs: Mar/Apr Vol. 23, 2; p.p Krass, P., “CRM: Once More, Without Reeling” March 17, 2003; last accessed October 15, 2004. . last accessed October 17, 2004. last accessed October 17, 2004. last accessed October 17, 2004. last accessed October 17, 2004. last accessed October 17, 2004. Spitz, Keith. “Lessons Learned by a CRM Veteran.” Computerworld. Sep 20, Vol. 38, p. 26. Bleicher, Paul. “An Imposing Change.” Pharmaceutical Executive. Jun p.p Lipscomb, Darrin, “Making the Case for Customer Relationship Management” CRM Guru, April 12, 2004; the Case for Customer Relationship Management; last accessed October 15, 2004. “Making the most of CRM” last accessed October 12, 2004 last accessed September 27, 2004. Nelson, Scott, “Eight Building Blocks of CRM” Gartner Group, June 19, 2003; last accessed October 25, 2004. Nancarrow, Clive and Rees, Sharon and Stone, Merlin, “New Directions in Customer Research and the Issue of Ownership: A Marketing Research Viewpoint,” Journal of Database Marketing, Vol. 11, 1, 2003, pg. 26. Dyche, J., The CRM Guide to Customer Relationship Management, Addison-Wesley, Boston, 2002

References Larson, J., The Arizona Republic
President Bush’s State of the Union address, 1/20/2004 Kowalczyk, L., Global Staff McGee, M.K., Informationweek.com Modern Healthcare, 2001 Bates M.D., J. Brigham and Women’s Hospital

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