Chapter 1:

Introduction and Review of Literature

1.1 History of CRM

1980s: Database Marketing.

The promise of database marketing is to speak individually to countless
customers. The reality: It's too costly, too difficult, and doesn't pay out on the bottom
line, except in the case of business-to-business key account marketing. Then with
compromise database marketing companies can do quite well simply by knowing how
recently and frequently customers purchase; how much they spend; what they
purchase.
1990s: Relationship Marketing.
Major phenomenon is loyalty programs and its promise is Loyalty. Major
result is that Companies such as airlines now have an enormous incremental layer of
expenses, without much to show for it.
Early 2000's: Customer Relationship Management (CRM).
Major phenomenon: Great promise. Major reality: Promise unattained.
1.2 Review of Literature
Perspectives on what the concept of CRM means to an organization can vary
greatly (Annexure I, U, III). Some see it as a series of IT projects; some view it as a
software implementation and some as a technology deployment. Others perceive it as
a combination of business processes and technology applications that support
customers. While CRM_is_a_busiliess_strategy:,that seeks to optimize profitability,
revenue and customer access, performance driven CRM is more. It is an ongoing
mechanism, based on continuous improvement that allows organizations to sustain
lasting relationships and gives them the ability to understand, anticipate, manage and
personalize the experience with their current and potential customers and employees.
It starts with a clear understanding of:
• Customers and their needs;
<• The organization and its competencies;
• The organization's commitment to quality service - from both an internal and
external customer perspective.
It requires measures / standards and benchmarks and a mechanism to create change in
process, actions, organizational structure and people competencies. CRM can survive
only with continuous performance improvement. There is no doubt that in today's
business environment. It is becoming increasingly difficult to manage customer
relationships profitability because:
• Increasingly informed customers have more choice and are less loyal to their
suppliers.
••• New distribution channels and communication media mean that the customer
interaction mix is more complex, difficult to integrate and potentially
expensive.
• Delivery channels are increasingly complex.
• Numerous powerful technology enables are now available but are expensive to
implement, and historic returns are uncertain at best.
• Marketplaces and exchanges threaten to bring manufacturers closer to their
customers - disintermediation.
• 6-They are not able to measure the value of their customers.
• 7-They lack insight into what their customers really need rather than what they
think that they need.
• 8-They have no strategic approach to how to treat different customers.
• 9-They have no strategic approach to how to treat different customer's
different ways.
To make CRM make money, organization must think business first,
technology second. Strategic considerations, which target long-term value growth,
should firmly control one's management of customer relationships. Then a customer
focused learning culture inside the organization can be created and marketing
decisions can be based on comprehensive and value - driven analysis.
People often equate CRM with a software solution. But in part it is about
establishing a culture of data collection. It's a strategy used to learn more about
customers' needs and behaviors in order to develop stronger relationships with them.
1.3 Customer Relationship Management in Healtticare
In today's world the medical sector is finding the need to know more and more
about their current and prospective clients. The more efficient service, hospitals can
give their patientsuhelfurther they will go in retaining them. Why is this essential? It
springs from the eternal truth that the more you know your patients, the better you can
respond to their current needs and predict what their future needs may be as well. The
Health Care sector is now opting for Customer Relationship Management (CRM) in
its daily application. CRM Health Care consists of a wide array of software products
that help healthcare organizations to maintain excellent relationships with their
clients. CRM enables the health care industry to get essential customer information
and use it as efficiently as possible. CRM thus enables the health care sector to
improve patient health, increase patient loyalty and patient retention and add new
services as well.
It's not surprising that consumers are often dissatisfied with their healthcare
experience. Today's healthcare environment is fragmented and complex, with
numerous entities controlling access to information that exists, yet is inaccessible to
both providers and patients. A lack of integration and workflow impedes the ability to
deliver complete, accurate patient information, which has a negative impact on patient
satisfaction and quality of care. In seeking better tools to manage patients across the
continuum of care, healthcare providers are turning to CRM software because it offers
several components to address these issues. It provides integrated business systems
that serve the medical staff, the administrative staff, and hospital stakeholders while
also directly serving customers, giving them easy access to their healthcare history
and on-demand knowledge of potential remedies. CRM can deliver ROI to healthcare.
In the time of considering a CRM project, healthcare organization can take advantage
of the previous experience of both healthcare and non-healthcare organizations to
accelerate benefits and reduce risk.
The most important part of healthcare CRM is integrated patient records.
Currently, all patient data is stove piped; lab work, imaging, and history are kept in
separate systems. One of the things CRM systems must do is enable communication
between these soloed systems.
If organization doesn't match two records that it should have put together, such as
with drug allergies, it will have more than just a dissatisfied customer. So there's good
reason for importance of integrating data. Effective CRM systems are starting to
integrate personal health records with the hospital's data to provide a system for
managing care-related activities, costs and benefits, and enabling patients to have
better online access to enhance the management of their healthcare. The benefits of
this approach include:
• The ability to analyze the performance of routine processes over time (such
as admissions, discharges, transfers and referrals) in order to eliminate
unnecessary steps and increase patient satisfaction.
• Developing customized workflows to automate care coordination activities
between provider organizations (e.g. physician office, hospital and home
health) which can lead to improved patient outcomes, increased operational
efficiency and reduced costs.
• Proactively managing chronically ill patients (e.g., diabetes and congestive
heart failure) to target them with communications about educational offerings
and remind them of ways to manage their illness.
• The ability to improve care coordination and reduce the risk of patient
readmission.
• Reducing costs by consolidating systems and pooling resources to obtain
economies of scale, improving utilization of appropriate healthcare resources
and understanding the cost of treatments to drive business planning
• Preventing and mitigating medical errors by integrating CRM data with
medical history and clinical data.
• Generating marketing campaigns targeted at specific patient types by
combining a knowledge base with scientific analytics and feedback
mechanisms.
• With the advent of electronic medical records and the infusion of federal
stimulus money that is helping to drive the widespread adoption of
technology, CRM software may well be the next logical step in the increasing
reliance and utilization of IT in healthcare.
1.4 Types of customers in a hospital
The most valuable asset of any business is its customers. Customer can be
defined as the recipient or beneficiary of the outputs of work effects or the purchaser
of products and goods. The types of customers in a hospital can be defined as follows:
• Patients are those persons who come to the hospital for treatment and to avail
the facilities rendered by the hospital.
• Attendants are accompanies of the patients or the visitor who come to visit
the patient during his/her stay in the hospital.
• Clients can be the employers of companies who refer their employees to a
particular hospital on emergency. They can also be the doctors who refer their
patients to a particular hospital in certain contexts.
• Customers are presently healthy to avail the benefits offered by hospital in
respect of health packages and insurance schemes etc. The present study is
related to these customers.
1.5 Characteristic Features of Present Day Customers of a Hospital

1.5.1 Highly Knowledgeable

Today's customer even in health-related issues wants to make his own
decisions. The cliche 'Leave it to the doctor' seems to be no longer true always. The
patient and the patient attendants want to know the disease profile, the methodology
of the treatment to be given, the medicines administered and the side effects
entailed. A whole study is conducted by them with the help of the Internet about the
nature of the disease, the symptoms, the percentage of success rate if surgery is
involved and such other aspects.

1.5.2 Value Seekers

The consumer of health care services is demanding more value addition and
wants to reduce his/her risk by dealing with trustworthy companies, services and
products. He/she requires immediate attention and service, He/she has become more
demanding and is not willing to adjust, and the expectations have risen very high.
The rise of voicing customer dissatisfactions and opinions has increased
considerably. There is not only high quality of service expected from the service
providers from the medical fraternity but also from service providers from the non-
medical areas.
1.5.3 Cost Conscious
The consumer today attaches great importance to the component of 'cost' in
the treatment. There are price comparisons done on various packages. Many times
there remains a feeling in the minds of the customer that the hospital victimizes their
fragile condition and charges far more. This feeling rises at the time of payment of
bills. Customers have a lot of doubt about the payment structure and feel cheated.
They do indulge in clarification of doubts.
1.5.4 Possess Preferences
The consumers have a range of preferences when they come to avail of medical
services. These would include preference for hospital, food, color (for example:
customized ambience based on choice of color for curtains and patient gowns), room
type, regional language usage while obtaining (receiving) hospital services and so on.
There is increased pressure on the hospital to provide these services at the earliest,
making flexibility the key to customer—the 'WOW effect, the excitement of the
customer on experiencing the product / service.
1.5.5 Desire Customized Services
The customers would like to receive individually differentiated services. They
are willing to pay extra in order to make their stay in the hospital more pleasant. For
example, there are customers who want to make ID/ STD calls from the room itself or
require air conditioning in the out-patient waiting room. In the race for customer
acquisition and retention, the one who can deliver faster and better wins the hearts of
the customers.
1.5.6 Perform Continuous Analysis
In the past customers would chiefly rate a hospital based on the quality of
medical services provided. Consumers today have a host of factors based on which
they rate the hospital. These include:
<• Clean environment;
•> Availability of latest technology;
• Hospital's staff personnel mannerisms while service provision;
• Time spent and methodology of imparting patient;
<• Implementation of suggestions given;
 • Clarity and transparency of billing procedure;
<• Systematic nature of work.
1.6 Profitability of Loyal Customers to the Hospital
1.6.1 Lower Costs of Service
Loyal customers are easier and cheaper to service, since they are familiar with
the products and services; they don't have as many questions, are less likely to make
mistakes and would have adjusted their behavior to simplify their relations with the
supplier.
1.6.2 Increased Purchase
Loyal customers tend to buy more as time progresses, either because they
learn about part of the product line or they give a higher proportion of their spending
to the favored ^ u r c e .
1.6.3 Less KkejSensitive
They tend to become less price sensitive and willing to pay a premium. As the
relationship strengthens over time, they are less susceptible to competitors' appeal and
since they are satisfied by what they are receiving from the enterprise, they are
prepared to pay more.
1.6.4 Favorable word-of-mouth
A hospital being a service industry with a noble cause cannot utilize
advertising techniques in the way other industries can. In designing an advertisement,
care needs to be exercised so as not to sound desperate for clients. This being the case,
word-of-mouth is one of the most apt advertising methods the hospital can rely on.
Word-of-mouth is personal communication about a product or service between target
buyers, neighbors, friends, family members and associates. This could be obtained by
creating a positive and meaningful experience for the customer. The power of word-
of-mouth is often quoted in terms of how satisfied or dissatisfied customers
communicate their experiences with others. This would help to create a lasting
impression in the minds of the customers but any happy experience serves to create a
positive brand image.
1.7 High Return on Investment
Almost every business should invest money upfront to brine in new
customers through the door. Most of the costs are easily identifiable: advertising,
commissions on sales, sales force overheads and the like. These may add up
to high operating costs. On the other hand, in the case of an already acquired
customer the operating costs are low as customers get more awareness about a
firm's services, which make them less dependent upon the firm's employees for
information and advice. In most service industries, the human interface holds
paramount importance so that the cost benefits of loyalty spiral directly from the
way the long-term customers and the long-term employees interact and learn
from one another. The repeat customer tends to be pleased with the value they
receive and their satisfaction is a source of pride and inspiration for the
employees. The customer gets to know the employees better which leads to
better service, builds greater customer satisfaction and further improves the
relationship and the company's results. Another advantage of holding on to
the firm's customer is that in most business relationships, customer spending tends to
accelerate over time by up-selling and cross-selling. Besides, in most
industries old customers pay effectively higher prices than the new ones.
This may be due to the price discounts available to the first time customer or
else the willingness of the old customer to pay more for the perceived
greater value of the service to him/ her. Thus an organization that undertakes
pro-active measures to create a wonderful experience for the customers
would yield high dividends in the long run.

1.8 CRM Drivers and Key Factors

A number of factors have contributed to the growing relevance of CRM as a
source of competitive advantage. They can be subdivided into four classes
(Hamil, 2000)
1. Market drivers,
2. Customer-related drivers,
3. Business drivers,
4. Technological drivers.
In the past, a few companies have begun CRM projects, just developing systems
based on new technologies and neither identifying an appropriate strategy able to
support the business goals nor focusing on change management initiatives able to
support the radical modifications of the processes involved (Bum,1989 ).
The creation of a customer relationship strategy is the very first step in a CRM
project. It requires various steps:
•> Knowledge: It is necessary to identify the most profitable customers.
••• Listening: The emphasis is on customer loyalty: therefore it is imperative to
find out key values and needs for each customer class.
• Growth: Through communication and value production in the most suitable
way for each customer class, the company is able to develop a relationship
with its customers.
*l* Results evaluation.
Again, to face these stages properly, the company has to review and integrate
its infrastructures and business processes, paying particular attention to two crucial
factors: communication and knowledge sharing. As for communication (Price water
house Coopers, 2000), four main classes can be identified.
1. Mass communication: It has a great impact, though it is generally not aimed
at a particular market, and it is brought about through media and traditional
channel advertising.
2. Communication per market segment: The Company seeks the optimum
combination of channel and their relative frequency of use, so as to reach
specific segments.
3. Direct marketing: aimed at a particular portion of a specific market segment,
using tools such as mail, e-mail, telephone.
4. One-to-one communication: based on direct interaction between company and
customer, via e-mail, telephone, mail or sales agents. It is usually supported by
CRM systems.
Communication has a fundamental role, as the level of company to customer
dialogue shows the degree of CRM strategy development reached by the company for
instance, if a company entertains a superficial relationship with its customers, the
relationship will be concerned merely with product - based aspects (such as features,

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price) If, on the contrary, the company implements a fully customer oriented strategy,
it will be able to develop a deep and lasting relationship . The depth of the
relationship, customer value in time and the investment in maintenance of the
relationship become critical success factors (Shesburnoff, 1999 - Scott Tillet, 2000).
Another important issue is customer knowledge sharing (Keene, 2001).
The company has to develop systems that enable it to:
<• Gather information on customers,
*l* Organize data so as to perform effective analyses,
• All decisional process. A further positive effect should be the Systematization
of technologies available on the market, in order to avoid cases of adaptation
induced by imitative intentions.
• Proper training of users in the use of Business Intelligence and CRM tools,
because in most cases the users are the very people who are best acquainted
with business goals and what matters are fundamental to a competitive
advantage.
1.8.1 CRM Continuum
1- CRM defined narrowly and tactically:
CRM is about the implementation of a specific technology solution project.
2- CRM is the implementation of an integrated series of customer-oriented
technology solution.
3- CRM defined broadly and statistically: CRM i s ^ h o l i s t i c approach to
managing customer relationships in order to creap shareho^er value.
1.9 Types / Variations of CRM systems
There are several different approaches to CRM, and at present there is no one
software package that allows all of these approaches to be applied.
1.9.1 Operational CRM
Operational CRM provides support to 'front office' business processes,
including sales, marketing and service. Each interaction with a customer is generally
added to a customer's contact history, and staff can retrieve information on customers
from the database when necessary. One of the main benefits of this contact history is
that customers can interact with different people or different contact channels in a
company over time without having to describe the history of their interaction each

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time. Consequently, many call centers use some kind of CRM software to support
their call center agents.
Operational CRM processes customer data for a variety of purposes. :
• Managing Campaigns
• Enterprise Marketing Automation.
•J* Sales Force Automation.
1.9.2 Analytical CRM
Analytical CRM analyzes customer data for a variety of purposes:
1- Design and execution of targeted marketing campaigns to optimize marketing
effectiveness.
2- Design and execution of specific customer campaigns, including customer
acquisition, cross - selling, up selling, retention.
3- Analysis of customer behavior to and product and service decision making
(e.g. pricing, new product development, etc)
4- Management decisions, e.g. financial forecasting and customer profitability
analysis.
5- Prediction of the probability of customer defection (chum analysis) Analytical
CRM generally makes heavy use of data mining.
1.9.3 Sales Intelligence CRM
Sales Intelligence CRM is very similar to Analytical CRM, but it is intended
as a more direct sales tool. Features include the delivery of 'alerts' to sales people
based on analysis of such factors as :
<• Cross - sell / Up-sell / Switch-well opportunities.
*> Customer Drift.
• Sales performance, good and bad.
•t* Customer trends
• Customer margins.
1.9.4 Campaign Management
Campaign management software is marketing - oriented CRM software that
combines elements of Operational and Analytical CRM and allows campaigns to be
run on an existing client base. Campaign Management is used when you need to

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create personalized offers when it is prohibitively expensive to personally contact
each client. Campaign management software functions include:
1. Choosing campaign recipients from the client base according to selected
criteria.
2. Development of a campaign offer (this is often done "out-of-the-system"
and is not automated)
3. Assigning specific campaign offers to selected recipients.
4. Automatically sending offers to selected clients via selected channels
(either directly, via channels such as e-mail, or indirectly, by creating lists
for use in channels such as direct mail).
5. Gathering, storing, and analyzing campaign results (including tracking
responses and analyzing propensities)
1.9.5 Collaborative CRM
The function of the Customer Interaction System or Collaborative Customer
Relationship Management is to co-ordinate the multi-channel service and support
given to the customer by providing the infrastructure for responsive and effective
support to customer issues, questions, complaints etc.
Collaborative CRM aims to get various departments within a business, such as sales,
technical support and marketing, to share the useful information that they collect from
interactions with customers. Feedback from a technical support center, for example,
could be used to inform marketing staffers about specific services and features
requested by customers. Collaborative CRM's ultimate goal is to use information
collected from all departments to improve the quality of customer service.
1.9.6 Geographic CRM
Geographic CRM (GCRM) is a customer relation management information
system which collaborate geographic information system and traditional CRM.GCRM
combines data collected form route of movement, types of residence, ambient trading
areas and other customer and marketing information which are matched with relevant
road conditions, building formations, and a floating population. Such data are
conformed to a map and is regionally analyzed with OLAP (On - Line Analytical
Processing) for visualization. This enables a company to examine potential customers

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and manage existing customers in the region.^ere'spmmary of the most common
problems: —
1. Lack of a clear business case and objectives, i.e., a recognized and identifiable
business problem to solve, and measurable benefits to justify the investment or
too fuzzy and all embracing really to mean anything.
2. Lack of active sponsorship to articulate the above and ensure project
momentum. It is not enough to have an executive's name associated with a
project there also needs to be a full - time director or manager reporting to the
sponsor to actually run it. Since this is really the case, the executive sponsor
soon becomes a figurehead whose distance from the day-to-day running of the
project ensures its eventual demise.
3. An IT - led project. When IT is the main driver, the project assumes a
technology focus rather than a business focus, and is then presented to the
business as an IT project instead of a business benefits project. This
diminishes user buy-in. A lot of CRM projects are IT-led, though this is not
always an attempt by IT to want to be in the driver's seat. The business also
mistakenly sees CRM as being primarily about systems and technology, which
explains why a figurehead executive sponsor (previous point) is quite content
to turn over the running of the project to IT.
4. Thinking of CRM as a system. Most companies have the impression that CRM
is mainly about installing systems and technology. There's no such thing as a
CRM system, at least not in absolute terms, as for example a spreadsheet or a
word processor, which organization can install and start using straight away.
It's a business concept, linked to business processes, and adequately supported
by systems, technology - and people. (Qualifier for convenience, we will
nonetheless use the term 'CRM system' or 'CRM solution' when referring to
packaged solutions from 'CRM vendors').

5. Lack of organizational for CRM. Certain prerequisites in terms of

organizational and process maturity must be in place for CRM to happen.
Otherwise it's like trying to get the company to run when it hasn't learnt how
to walk properly. When projects are launched under such conditions, the

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 original CRM objectives are quickly shown to be unattainable until the
required maturity has been reached. These prerequisites can take a year or
more to achieve, effectively suspending the original project.
6. An unrealistically wide project scope. Because CRM spans the enterprise,
there is often a tendency to want to deliver results across multiple functions
from day one, e.g. for both sales and order management. This represents a
Herculean challenge in terms of people, processes and systems, which is more
realistically managed via a phased, modular approach. CRM is ultimately a
journey, not a destination, and needs to be planned with realistic milestones
that take into account the complexities of the terrain and the uncertainties of
the road ahead.
7. Insufficient change management resources within the business to nurture the
solution once it is in place, i.e. to define training from a business perspective,
to drive process change and ensure data quality. This is mistakenly thought of
as 'IT support', and insufficiently budgeted for. When reality finally dawns, it
is usually too late, to obtain the required funding within the current budget
cycle. The business is therefore unable or unwilling to provide the people for
this critical function.
8. No buy - in from end users. Executives and management ( who rarely use the
system ) mistakenly assume that end users will be naturally motivated to take
up CRM because it makes sense, is good for the customer, the company, etc.
In reality, users have jobs to do, which they usually perceive as having nothing
to do with CRM, and will only accept a new tool and new processes if they
deliver tangible benefits that make their current jobs easier. This is especially
true for the sales force.
9. Signing a blank cheque to systems integrators, and expecting , them to do the
job. While integrators and consultants can and do deliver value, the client has
a huge responsibility for creating and sustaining the conditions under which
this will occur. At best this is seriously underestimated by the client, and at
worst totally ignored. This once again ties into the mistaken perception that
CRM is all about putting a system in place, and hence the idea that

15
 organization can outsource it to an integrator and come back there to six
months later when it's ready.
10. Organizational change and company politics: Companies don't start CRM
projects; people do. These dynamic visionaries are often the key to
successful projects. However, the realities of company politics mean such
people are usually unable or unwilling to find allies at executive level. So once
the sponsor moves on after the umpteenth executive reorganization, and
tangible results are not yet visible, the initiative almost always dies a natural
death.
11. Absence of a proper operational pilot of sufficient duration ( two to three
months ) to be able to validate the business objectives, obtain buy - in from
end users, and identify and correct the real - world problems that only show
up when used in a live environment. Many projects start off as either a big-
bang implementation or a pseudo - pilot, i.e. a first phase with no option for
backtracking. Such projects stand a high chance of ending up in damage
control mode from day one, and then either fail outright or are suitably
descoped in order to meet deadlines, regardless of the usefulness of the
deliverables.
12. Poor data quality, usually the result of years of data neglect in legacy systems,
which not surprisingly are unable to provide clean data for migration to the
new CRM system.
1.10 Misunderstanding about CRM
Given its recent emergence, it isn't surprising that there are a number of
common misunderstandings about the nature of CRM. These are described below:
1.10.1 Misunderstanding 1: CRM Is Database Marketing.
Database marketing is concerned with building and exploiting high quality
customer databases for marketing purposes. Companies collect data from a number of
sources. These data are verified, cleaned, integrated and stores on computers, often in
data warehouses or data-mark. They are then used for marketing purposes such as
market segmentation, targeting, offer development and customer communication.
Whereas most large and medium sized computers do indeed build and exploit

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customer databases. CRM is meets wider n scope than database marketing. However,
database marketing is less evident in strategic operational and collaborative CRM.
1.10.2 Misunderstanding 2: CRM Is A Marketing Process.
CRM software applications are used for many marketing activities, market
segmentation, customer acquisition, and customer retention and customer
development crossed - selling and up-selling, for example however, operational CRM
extends into selling and service functions.
The deployment of CRM software to support a company's mission to become
more customers - centre often means that customer - related data is shared more
widely throughout the enterprise than by the marketing function alone. Operations
management can use customer - related data to produce customized products and
services. People management (Human Resources Management) can use customer
preference data to help recruit and train staff for the front-line jobs that interface with
customers. Research and development management can use customer - related data to
focus new product development.
Customer data can not only be used to integrate various internal departments,
but can also to be shared across the extended enterprise with outside suppliers and
partners. For example, Tesco, the international supermarket operation, has a number
of collaborative new product development relationships with key suppliers. Tesco
also partners with Royal Bank of Scotland to offer financial services to Tesco
customers. Both these activities require the sharing of information about Tesco
customers with supplier and partner. Clearly, there is more to CRM than marketing
process.
1.10.3 Misunderstanding 3: CRM Is an It Issue.
Many CRM implementations are seen as IT initiatives, rather than broader
strategic initiatives. True, most CRM implementations require the deployment of IT
solutions. However, this should not be misunderstood. To say that CRM is about IT is
like saying that gardening is about the spade or that art is about the paintbrush. IT is
an enabler, a facilitator. Improvements come about in the way customers are managed
through a combination of improved processes, the right competencies and attitudes
(people), the right strategies and the right enabling technologies.

17
 The importance of people and processes should not be underestimated. People
develop and implement the processes that are enabled by IT. IT cannot compensate
for bad processes and unskilled people. Successful CRM implementations involve
people designing and implementing processes that deliver customer and company
value. Often, these processes are IT - enabled. IT is therefore a part of most CRM
strategies.
All CRM initiatives don't involve IT investments. An overarching goal of
many CRM projects is the development of relationships with and retention of, highly
valued customers. This may involve behavioral changes in store empowers, education
of call centre staff, and a focus on empathy and reliability from sales people. IT may
play no role at all.
1.10.4 Misunderstanding 4 : CRM Is About Loyalty Schemes.
Loyalty schemes are common place in many industries, such as car hire,
airlines, food retail, hotels, Customers accumulate credits, such as airmail from
purchases. These are then redeemed at some future point, Most loyalty schemes
require new members to complete an application form when they join the program.
This demographic information is typically used, together with purchasing data, to help
companies become more effective at customer communication and offer development.
Whereas some CRM implementations are linked to loyalty schemes not all are.
Loyalty schemes may play two roles in CRM implementations. First, they generate
data that can be used to guide customer acquisition, retention and development.
Secondly, loyalty schemes may serve as an exit barrier.
Customers who have accumulated credits in a scheme may be reluctant to exit the
relationship. The credits accumulated reflect the value of the investment that the
customer has made in the scheme, and therefore in the relationship.
1.10.5 Misunderstanding 5: CRM can be Implemented by Any Company.
Strategic CRM can, indeed, be implemented in any company. Every
organization can be driven by a desire to be more customer-centric. Chief executives
can establish a vision, mission and set of values that bring the customer into the heart
of the business. CRM technology may play a role in that transformation. Some
companies are certainly more successful than others. The banking industry has

18
implemented CRM very widely, yet there are significant differences between the
customer satisfaction ratings and customer retention rates of different banks.
Any company can also try to implement operational CRM. Any company with a
sales force can automatic its selling lead management and contact arrangement in
processes. The same is true for marketing and service processes. CRM technology can
be used to support marketing campaigns, service requests and complains
management.
Analytical CRM is a different matter, as it is based on customer - related data. At the
very least, data are needed to identify which customer are likely to generate most
value in the future, and to identify within the customer base segments that have
different requirements. Only then can different offers be communicated to each
customer group to optimize company and customer value over the long term. If these
data are missing then analytical CRM cannot be implemented.
1.11 Tangible Benefits of CRM
Before deciding whether CRM is right for organization, you should review all
the potential benefits of CRM in detail. Senior management needs detailed evidence
of measurable benefits to justify what may grow into a large capital investment, plus
the investment in time, resources, and staff A growing number of tangible and
intangible benefits associated with CRM are available, and there are specific ways to
measure them. I define tangible benefits as those that can be measured in hard
numbers. These include increases in the following benefits:
1. Time spent by sales personnel with existing customer:
Consider measuring the number of service calls made per day by sales personnel
or the number of hours spent by sales personnel in their interactions with existing
customers.
2. The number of new customer prospects pursued by sales representatives:
While most sales representatives like to call on existing customers with whom
they have an ongoing relationship, new customers are the key to future growth.
Consider measuring the number of new prospects versus existing customers contacted
by the sales representative per day, per week, per month, or per quarter.

19
 3. Time spent by sales managers in contacting customers and working
Coaching sales personnel is critical, but managers never seem to have enough
time to do it. Consider measuring the number of hours per day that sales managers
spend in contact with customers and prospects, and with sales representatives
discussing customer issues.
4. Customer service efficiency
Customer service may be the key differentiator between those companies that lead
and those companies that wonder what happened. Consider measuring the turnaround
time for customer service issues as well as the number of customer service errors
made as a result of misinformation.
5. Timeliness of follow-up correspondence to customers/ prospects:
Consider measuring the number of days between the date the customer / prospect
was contacted and the date that the customer / prospect follow - up information is
sent.
6. Higher close ratios:
CRM helps move prospects efficiently through the sales pipeline. Consider
measuring the lift in close/rations\ that result from CRM tools and techniques.
7. Revenue per montnTor each sales representative
This important CRM benefit depends on careful management to ensure that time
is saved as a result of automation of the organization's sales, marketing, and customer
service functions used productively to deliver more sales. Considering measuring the
increase in base revenue generated per month per sales representative.
8. Overall business results
The sales manager of one company I worked with set up a competition between
sales personnel based on their use of the CRM system. The results were
overwhelming. Healthy rivalry between personnel led to a significant increase in
overall business results ( as well as a seven - day cruise for the winning salesperson
and his or her spouse ). Consider measuring the percent of dollar increase over the
budget for the entire sales team each month. All too often, the "technology"
component of a CRM initiative is given a disproportionate emphasis, sometimes to
the detriment of the overall project. Of course, a hyper-focus on technology is
somewhat under standable given the ever - growing number of innovative technology

20
solutions. There are two critical concerns related to CRM initiative, the need to deal
with software vendors and the challenge of staying on top of technology trends. On
the upside, the internet, which has revolutionized company - customer relationships,
is an extremely useful technological tool (consider if the primary one) for achieving
CRM goals.
1.12 Is the Organization Ready to Start CRM?
Here's an exercise to start CRM on the organization's way. Organization must
answer the following questions about its readiness to create a CRM vision. A scoring
guide and evaluation of organization's readiness to proceed can be found at the end of
the checklist.
To a very To a very
Limited great
Extent Extent

1. Customer segments are well defined 1 X 3 4 5

2. The company uses customer satisfaction 1 2 3 4 5

Surveys for understanding customer needs
And what satisfies and dissatisfies customer

3. Human resources management practices

empower all employees to participate in
improvement initiatives.

4. Employees at all levels receive the

education and training they need to
participate effectively.

Senior executives are personally and

visibly involved in demonstrating that
improved customer satisfaction is
a high priority strategic goal.
6. Customer service performance measures
Exist at the organizational, departmental
and individual job levels and are widely
Publicized and acted upon.

21
7. Communication is frequent and 1
Informative.

8. All employees are aware of their internal 1

customers and suppliers.

9. The working environment is conducive 1

to the well-being and morale of all
employees.

10. The organizational hierarchy does not 1

inhibit effective and constructive two-
way communication over process
improvement issues.
11. The company's values are clearly 1
articulated and understood by all
employees . They are constantly and
consistently reinforced by the actions
of all managers.

12. Goals for customer satisfaction make us 1

stretch but are attainable.

13. The company encourages close 1

collaboration and teamwork.

14. The employee performance appraisal 1

recognition and reward process strongly
promote involvement in delivering
customer satisfaction.

15. Business processes are regularly 1

received to eliminate non value-adding
activities and improve customer satisfaction.

16. Relationships with customers are 1

managed effectively and involve
obtaining information from them to improve
products and services.

22
17. Business cases for change are clearly 1
articulated and validated.

18. Customer complaints are welcomed and 1

resolved quickly and positively.

19. Effective process for determining current 1

and future customer requirements and
expectations are applied both systematically
and rigorously.

20. The strategic and business planning 1

processes have a strong focus on
customer service and produce clear
objectives for improvement.

Scoring:
If score was
Less than 40: oiganiiatiuii iiiujt t^^wwfitetBP^tBWiH^wiiW
40 to 74: A de-cpu uiidLiJtuiidiif^^HwgBniBHliw^iii^^lP
competencies is necessary.
Greater than 15:—ui gaiiimtiutmfi'HHiiwH^WHWPni^fWWB^
technologies.

1.13 Return on Investment for CRM initiatives

A very basic challenge for young business is not only pooling the resources
but also allocating resources wisely and ROl arguments help young health care
organizations make those choices, typically marketing budget and outlay decisions
focus on operating expenses like public relations, advertising, trades shows, anti direct
mailing. However, CRM can involve capital investment decisions. To be successful,
marketing/CRM practitioners should learn to speak the language of business and build
ROI analysis to support CRM initiatives. How do organizations calculate the ROI for
CRM initiative?

23
Detail the CRM costs;

• Hardware—computers, servers, accessories

• Software—database, campaign management software
• Implementation costs of hardware/or software
• Internal resource costs associated with the development of the capital
improvement
• Upfront investments in call centers, staff and so on
• Estimate the revenue impacts
• Increase in patient response rates
••• Increase in patient conversion rates
•> Increase cross-sell ratio
• Decreased account attrition rates
• Increase in fees
<• Increase in average spend per account
• Increase in average number of transactions

Health care organizations can use past experiences to guesstimate the

revenue impact. Firms with limited CRM experience can use public information and
expert's knowledge to estimate the revenue impacts.
Once organization calculate the revenue and cost impacts, it need to calculate the net
Present value of its CRM initiative. For CRM initiative (or any other project), if the
NPV is greater than zero, that means CRM initiative will make money ; if it is less
than zero, that means it will not .NPV calculations include:
1. Investment—money hospital expend for the initiative at the beginning.
2. Revenues that hospital accrues as a result of the initiative over a period-can be
one time or a recurring revenue.
3. Costs that hospitals accrue as a result of the initiative over a period- can be
one time or a recurring item.
4. Discount rate—hospital's accountant or Finance department can give this rate.
5. Time Period-define the time period for which hospital would like to compute
the NPV.
NPV is the cumulative differential between the revenue and cost stream discounted at

24
the discounted rate minus the investment. Remember, NPV is simply a guidehne to
help organization quantify the CRM results to make informed investment decisions.

1.13.1 ROI Calculation in the hospitals

1. Gross charges x PCR (patient to charge ratio) = Net Revenue*

2. Net Revenue x Net Operating Profit % = EBITA (product
line if available)
3. EBITA _ Marketing costs** = Marketing Profit

* Net Revenue is projected based on PCR

** Marketing costs include: All creative costs, agency fees, letter shop costs,
paper, printing and postage.

1.14 CRM Strategy

Several commercial CRM software packages are available which vary in their
approach to CRM. However CRM is not just a technology but rather a
comprehensive customer - centric approach an organization's philosophy in dealing
with its customers. This includes policies and processes, front - of house customer
service, employee training, marketing, systems and information management. Hence,
it is important that any CRM implementation considerations stretch beyond
technology, towards the broader organizational requirements.
The objectives of a CRM strategy must consider a company's specific situation and
its customers' needs and expectations. Information gained through CRM initiatives
can support the development of marketing strategy by developing the organization's
knowledge in areas such as identifying customer segments, improving customer
retention, improving product offerings ( by better understanding customer needs ) ,
and by identifying the organization's most profitable customers.
To be effective in managing the customer relationship, an organization must
deflne and understand its four strategies:
<• It must define its customer strategy. To do that, there must be an
understanding of customer segments and their needs. This is a mandatory
requirement if one is to understand which products and services to offer for
each segment.
*l* It must create a channel and product strategy . This defines how the
organization will deliver its products and services efficiendy and effectively,

25
 ensuring sales productivity and effective channel management. It will help to
determine which products and services are necessary to offer to which
customers, through which channels. It is not one size fits all for your customer
base. Some customers may be favored.
*l* It must understand the importance of a robust and integrated infrastructure
strategy, and this is where technology comes into play. That strategy will
encompass not only technology, but also organizational structure and
organizational competencies.
But for those organizations that desire lasting CRM, there is one more element that is
required: a performance management strategy and action plan. That strategy must
embrace performance standards and metrics and an all - encompassing performance
program. To be effective, the organization will have to prepare a performance
program that will tract its performance and be capable of alerting the organization to
changes that are necessary for continuous improvement.

1.14.1 Three steps to develop an effective CRM strategy

Step 1 — Set the Destination: Managers are urged to create their own definition of
CRM to gain buy-in and cohesiveness from those involved in the initiative. A vision
with desired results should be established immediately.

Step 2 — Audit the Current Situation: Analyze past CRM initiatives to understand
what did/did not work. Don't take shortcuts in information gathering. And according
to Gartner, "seek information from external sources first, and weight customer and
consumer feedback highest."

Step 3 — Map the Journey: Identify the steps to achieve the vision. According to
Gartner, three to five top-line objectives for CRM initiatives should be established.

A CRM strategy must be linked to the overall corporate strategy.

1.14.2 Adapting CRM strategy for the healthcare market

Hospitals are moving from mass advertising to target direct marketing and
they are developing "customer outreach" databases and are using traditional direct

26
marketing techniques. Database marketing is profitable for hospitals .This
Profitability varies by competitive environment. By this technique their spending for
billboards, radio, newspaper and other "mass" advertising will decrease. The main
goal of direct marketing is to Increase profitability from existing patients. The world
of mass marketing is drifting away to make room for one to one real time customer
relationship management. Profitability analyses have shown that while 20% of an
organization's customers generate its profits, 80% reduce profit. Therefore. Retaining
these 20% is imperative for the organization. This can be achieved through planned
CRM practices. The heart of any successful strategy is to manage and satisfy the
customers and the ability to listen to the customer and find out the level of satisfaction
with the services offered by hospital and analyze the feedback given by customers.
1.14.3 Segmentation and Scoring Models
• Solucient uses "cluster" methodology, along with other data elements.
• CPM Corp.
Uses neural net technology to score names by house and prospect and by
service line, e.g. cardiology, pulmonary, CPM Corp. uses two different scoring
approaches. Consumer Healthcare Utilization Index (CHUI) and Patient Disease
Index (PDI).CHUI scores run from 0 - 999 to identify an individual's propensity to
use health care services as defined by the major diagnostic categories (MDC) and
specific diseases within the ICD-9 and diagnostic related groups (DRG). The higher
the number, the greater the likelihood the individual will need the service. This is used
for prospects. The Patient Disease Index (PDI) is co-morbidity (Medicine relating to
or denoting a medical condition that co-occurs with another) segmentation system that
uses patient data for segmentation. In other words, if someone has pulmonary issues
there is a likelihood there are cardiology issues.

27
1.14.4 Database Architecture for direct marketing

Internal Data External Data

Health Risk 3" Party

Billing Encounter Call Assessinent / GeodemogrBphk OttierData
Data Data Centef Personally Overlay Sources
Collected Data

Data Hygiene

Marketing Access & Reporting Tools

Database
Segmentation System
Segmentation Scoring

Consumers

i
Direct Mail

Positive
Consumer Response

Call Center
i
L Billing Data Clinical Services Facility Screening

1.15 Successes in implementation of CRM

While there are numerous reports of 'failed' implementations of various types

of CRM projects, these are often the result of unrealistic high expectations and
exaggerated claims by CRM vendors.
Many of these 'failures' are also related to data quality and availability. Data
cleaning is a major issue. If the company CRM strategy is to track life-cycle revenues,
costs, margins and interactions between individual customers. This must be reflected
in all business processes. Data must be extracted from multiple sources ( e.g.
departmental / divisional databases, including sales, manufacturing, supply chain
logistics, finance, service etc ) requiring an integrated , comprehensive business
processing systems to be in place with defined structures and data quality. If not
interfaces must be developed and implemented to extract data from different systems.
This creates a demand far beyond customer satisfaction to understand the full
business to business relationship. For this reason, CRM is more than a sales or
customer interaction system.

28
 The experience from many companies is that a clear CRM requirement with
regard to reports (e.g. input and output requirements) is of vital importance before
starting any implementation. With a proper demand specification, a great deal of time
and money can be saved based on realistic expectations of systems capability. A well
operating CRM system can be an extremely powerful tool for management and
customer strategies.
1.16 Privacy and Data Security
One of the primary functions of CRM software is to collect information about
customers. When gathering data as part of a CRM solution, a company must consider
customer privacy and data security with respect to legal and cultural environments.
Some customers prefer assurance that their data is not shared with third parties
without their consent and that it cannot be illicitly accessed by third parties.
Relationship marketing also produces significant intangible benefits. The prominence
given to customer service encourages customer contact and customer involvement.
1.17 CRM Performance Monitoring
The metrics available to companies wanting to monitor their CRM activities
are largely unsophisticated. For example, there is no internationally recognized set of
standards for CRM against which best practice can be measured. Historically, most
company's performance measurement systems have been functionally driven. The
balanced scorecard, developed by Kaplan and Norton (1996), is a popular attempt to
provide cross - functional measure, but doesn't address the linkages between the
measures, which are critical to understanding how to improve performance.
Companies should ask themselves two key questions if they are to successfully
measure and monitor their C.R.M. performance:
• What metrics and key performance indicators (KPIs ) should we use that
adequately reflect the performance standards across the five major C.R.M.
processes ?
• How are these metrics and KPIs linked, and what opportunity do these
linkages provide for improved results through better management of C.R.M.
across the organization?

29
We advocate that companies consider the following four main Categories:
1. Strategic metrics measure the success of the organization's strategic approach
to C.R.M. They measure, for example, the extent to which marketing
information is used when developing the business strategy; the role of C.R.M.
positioning the organization in the market place; and whether the vision and
objectives of the company focus sufficiently on the customer.
2. Customer metrics measure the value delivered by the organization to the
customer and the value the customer provides to the organization. These set
KPIs to measure, for example, levels of customer satisfaction and customer
retention, customer acquisition costs, and customer lifetime value.
3. Operational metrics measure both people and process performance. People
measures include the appraisal, compensation, recognition, training
progression of staff; measures include employee retention, productivity
employee satisfaction and performance targets; process measures include
customer service levels, supplier performance targets, and product and service
level targets.
4. Output metrics measure the effectiveness of the C.R.M. strategy on national
performance by calculating the value delivered to each of the three main
stakeholders; shareholders, employees and customers. Value is determined in
terms of customer satisfaction, increased key segment profitability, reduction
in operational costs, and employee retention and productivity.
Overall, the test of an organization's performance assessment lies in its ability to
respond confidently to the following fundamental questions:
1. Have we selected the most appropriate C.R.M. performance standards?
We benchmark our standards against best in class.
2. Have we determined appropriate metrics and KPIs? Do we understand where
these performance metrics are linked?
3. Can we determine the impact of each metric, individually and cumulatively
on our results ?
4. Do we have appropriate feedback built into our C.R.M. monitoring process
so that there is continual improvement ?

30
1.18 Developing a Strategic Approach to CRM
The strategic framework outlines above is designed to help companies which
are confused and frustrated in their efforts to adopt C.R.M. It should be approached
with an open mind, applied with a element of flexibility and modified there
appropriate, as no two organizations will share the same circumstances. Because it is
meant to be applied iteratively, it is likely to be refined as organization learns from
using it.
Companies embarking on a CRM strategy should remember:
1. It has to be led from the top.
2. It requires the full commitment of the workforce and supply chain partners.
3. As a strategic activity, it requires co-ordination, collaboration and integration.
4. The aim is to provide a continually enhanced customer experience.
5. No amount of IT can compensate for the need for investment in customer
facing employees.

1.19 CRM Health Care Services

• Strategic Planning
• Communication Services
• Consulting Services
• CRM for Physicians
• Campaign Management
• Database Construction
• Predictive Segmentation
• Communications Strategies

1.20 How CRM helps the Healthcare Industry?

That depends very much on the context, of course there's not much use for
CRM in the emergency treatment sector, but family doctors, dentists, health insurance
companies, home care organizations, nursing/old-age peoples' homes etc. can use
CRM to good effect. Of course, confidentiality expectations and data protection laws
have a significant influence on the implementation - both technical and organizational

31
of CRM in these areas. Customer Relationship Management by its name gives the
ability to manage the customer's data for the business.
Software packages for Health care industry revolves around core domain, like
HL-7 etc standards and EMS, Emergency services and so on...in this case, the front
office [Health care industry components like hospitals, labs, doctors etc] can get
benefitted hugely by concept of CRM since they are nothing but Customers of these
businesses. Hence, the Biggies in software like Microsoft and Oracle has started to
collect the patient data software packages.By this way, Health care front offices, can
manage their information about customers and can derive the benefits by largely
observing Health patterns of their customers. This also has can create a new wave in
health-insurance sector.
What is HL-7? HL7 is an international community of healthcare subject matter
experts and information scientists collaborating to create standards for the exchange,
management and integration of electronic healthcare information. CRM provides the
organization with the chance to acquire and retain customer relationships. It serves to
convert almost every customer interaction into a health management opportunity. Its
diverse functionality enables employers, customers and employees to access common
information. Millions of patients or customers are being contacted daily through
phone, e-mail, fax, and face to face interactions. All these increase the need for an
affective and well coordinated customer approach.
CRM Healthcare supports the call centre by providing customer service
representatives with essential customer information. This helps the health care sector
to access critical information and deliver value to customers.CRM solutions succeed
in transforming healthcare organizations into customer- centric efficient providers of
health care. The healthcare industry has realized the importance of quality of service.
CRM industry leaders now offer customer relationship management solutions to help
healthcare organizations deal with customer service issues while delivering excellent
health services.
It is believed that by 2013 the number of preventable deaths will decrease by
50% due to IT investments. CRM is one of the most useful tools for healthcare
institutions, and one of the largely accepted tools for this industry.

32
Here are the eight most compeUing reasons to consider CRM implementations in
healthcare organizations

1. PRM (Patient Relationship Management) Systems can greatly speed up

routine administrative functions such as admissions, billing, discharge,
referrals, and accounting by eliminating duplication of work and bypassing
unnecessary steps, which can enhance patient satisfaction and reduce costs
substantially.
2. Healthcare CRM Software can empower physicians, nurses, and other
healthcare staff to get a 360-degree view of patient's personal and medical
records with which it becomes easier for them to identify and correlate current
symptoms with future health concerns.
3. With the help of automated CRM processes, healthcare organizations can
easily ensure that all the necessary and critical safety procedures are strictly
followed. Besides, CRM tools can also help in handling issues related with
privacy of patient's records and regulatory compliances.
4. Healthcare entities can speed up the quality and consistency of health care by
analyzing the routine procedures and making the required improvements in the
same.
5. CRM software can allow the clinicians to streamline the appointment
schedules, which is generally a great hassle for them. Physicians can easily
keep track of follow-up and new cases and thereby ensure that they do not
miss out any important appointments. It ultimately helps in saving time and
improving patient satisfaction.
6. With automatic processes and electronic data storage in place, doctors can
access various important information such as treatment plans, relationship
between symptoms and diagnosis, latest research materials and other case
studies to provide quality health care to the patients.
7. Healthcare organizations can target proactive communications by reviewing
patient's case history and data about chronic illnesses
8. CRM systems can centralize the entire data about patient's demographic
information and standardize and streamline various medical and administrative

33
 procedures, which can go a long way in enhancing the service standards and
patient satisfaction.

1.20.1 Health Care CRM Boosts Sales and Marketing

CRM for the health care sector caters to largest health organization's sales,
marketing, and customer service demands. CRM Healthcare helps sales professionals
to forecast business and increases the existing sales effectiveness through excellent
customer approaches. It facilitates sales in that it enables the sharing of information
across sales teams ,increases and hangs onto existing sales leads and ultimately
provides excellent sales as well as after sales support.
CRM helps Health Care organizations plan and carry out sales and medical
management campaigns. Health care CRM software increases the efficiency of call
centers. It also assists the initiatives of medical management and facilitates the
collation of information regarding physicians, hospitals and supplementary medical
providers. In addition to this it maintains secure and comprehensive information
regarding physician profiles that can be used by both the sales and marketing
department.

1.20.2 Health Care CRM Aids in Overall Profitability

Most CRM industry leaders possess the latest IT technology along with
excellent healthcare market industry knowledge and thus succeed in enabling the
reduction of medical errors.
The element of cost has also to be taken into consideration and health care
organizations have realized that they need to make the patient the focal point of the
business application. CRM helps the health sector to reduce operating costs, reduces
errors, and facilitates better relationships with patients. While improving overall
efficiency it assists in supplying medical professionals and their patients with a means
by which they can communicate effectively. It also maintains a comprehensive
database of health care providers, thus enabling health care organizations to
effectively manage their relationships with them.
Health care organizations using CRM can easily sell their products right
across the globe on account of its sales enhancing capacities. CRM products enable
increased efficiency, better health, and increased customer retention. The role of CRM

34
in health care is thus diverse and crucial making it an absolute perquisite for the
industry.
Deploying intuitive Health Care CRM options can produce greater ROI and
enhanced patient and caregiver experience
Healthcare CRM seems like the perfect solution to many of the healthcare
industry's key problems. For improving efficiency and managing patient records
hospital need to track patient's progress electronically. For patient care hospital need
to use metrics and analytics to evaluate those records and identify areas for
improvement. For maximizing quality of care while minimizing cost hospital must
adopt CRM to track and manage patient satisfaction. Unfortunately, the challenges
many other CRM adopters have struggled with in the past that thwarted success and
slowed the delivery of CRM value are arguably even more present in healthcare:

• User adoption: If you think salespeople are difficult to train and motivate to
use new software, try doctors.
• Multiple data sets in multiple systems: Particularly with merger and
acquisition activity in healthcare organizations, and departmentalized data
warehousing efforts, few healthcare organizations have a single integrated
view of all their data.
<• Customer data confidentiality concerns: Many other sectors view this as a
customer confidence issue, but in healthcare, customer data security and
confidentiality is not only important, it's critical—and regulated.
• IT budget challenges: As healthcare organizations have looked to cut costs and
improve efficiencies, investing in broad IT initiatives has not been a common
practice.
Many CRM vendors have targeted healthcare as a key opportunity area.
However, given these challenges, it's not surprising that most CRM vendors have won
more customers in pharmaceuticals, health testing, and other related fields than at
hospitals and other healthcare facilities.

35
1.21 Number of key strategies for success of healthcare CRM system

1. Look beyond the CRM Label

Many CRM vendors provide customized solutions for the healthcare vertical
market and many implementation partners provide vertical-specific on expertise in
making CRM applications work in healthcare. Despite this, it's important to remember
that a number of technologies and not just those with the CRM moniker can deliver
value as part of a broader strategy to support CRM in healthcare. A number of cases
where content management from various vendors enabled companies to improve
patient management and patient care by providing better access to information for
both staff and patients. Another key technology area supporting CRM improvements
in healthcare is data analysis. Business intelligence or predictive analytics tools that
fall more on data analysis than "pure" CRM may present better short-term ROI
opportunities than a broad investment in case management. For example, some CRM
tools are designed to provide all employees with dashboards and reporting to monitor
patient care metrics while others provide predictive analytics, used to predict
outcomes for better proactive management.

2. Think before moving Data

No matter whether it is CRM, content management or analytics, taking a close

look at all three can help healthcare organization leverage data to improve patient
management. Most healthcare organizations have, at best, fragmented data stores,
multiple record-keeping systems and inconsistent data entry processes. Before starting
they should take a closer look at what they have. As an example, a medical testing
company had deployed a CRM solution. During the deployment, the testing company
had imported information from its legacy billing system directly into the application.
It found that incomplete data and lack of a clear understanding of the data structure
required additional changes to make the deployment successful.

3. On-demand Options

On-demand CRM has been a disruptive and positive force in the market. It is
no longer just a strategy for the midmarket or departmental CRM need, nor is it out of
36
the hands of IT. By building a developer community and an on-demand development
language, on-demand can support more complex requirements than it could just
months ago. It can also be an opportunity for internal developers to build customized
CRM solutions and then outsource the ongoing support. Continued innovation and
growth of new marketing, sales and service applications in the on-demand market
place will force the on-premise players to continue to innovate as well. Some have
been concerned about security and integrity of data when deploying on-demand CRM
for healthcare. However, reviewing the data security measures that on-demand
vendors employ to ensure the security of individual customers' data may reveal.

4. Involve Users from Day One

The most successful CRM deployments utilize end-user input in the decision,
design, and development process for greater buy-in and usability. For example, a
number of employees of one hospital organization resisted having to find the
information themselves because they were accustomed to requesting information from
an internal team. In order to counter this resistance and maximize adoption, the
deployment team regularly held focus groups with employees to help them understand
that the deployment would actually enable them to complete their jobs. By sharing
their preferences and requirements with the deployment team during these meetings,
users became more invested in the process, which reduced their resistance.

5. Phase Adoption and Training

Phasing adoption and training can help organization leverage initial

experience to ease adoption with each new department or area of functionality
organization adds to its CRM technology strategy. An example would be a hospital
that first deployed a system to manage emergency room records and is now expanding
the system to support broader patient record management across the hospital. The
findings in the investigation in five largest private hospitals in Bangkok indicate that
the four dimensions significantly affect corporate image, customer satisfaction, and
customer loyalty which are vital in succeed in customer relationship management.
The results of this research indicated that 'doctor concern' is the most important
factor affecting customer satisfaction and customer loyalty and the second most

37
important factor affecting corporate image. Therefore, the management should hire
the right people as experts and well-known doctors to serve their patients as they lead
to reputation and positive image of the hospital. Moreover, the doctors should be
trained on interpersonal skills so as to provide politeness, comfort, and individual
attention to their patients.
Next, 'staff concern' is the second most important factor affecting customer
satisfaction and customer loyalty. For nursing staff, the management should hire a
service minded nursing staff. The nursing staff and other hospitals staff should be
trained on interpersonal skill to provide care, empathy, and courtesy to patients.
Furthermore, 'tangibles' is the most important factor influencing corporate
image. Management should provide clean facilities e.g. patient examination room and
toilet. Moreover, clean and fresh odor is also important for hospitals in reducing
patients' stresses. Hospital should provide enough amenities (e.g. public telephones,
seating, and toilets etc.) for both patients and their family members and friends. Also,
hospital should provide up to date care facilities as it can communicate
professionalism. For signs, symbol, and artifacts, management should provide
adequate signs in communicating direction, location name, and room number so that
patients can easily find ways to the designated place. Moreover, the sign must be easy
to read and very clear for everyone. In addition, 'convenience of the care process'
should be improved especially for waiting time. Therefore, the hospital should
improve the waiting process. Finally, the hospital's management should continue to
collect data about perceived service quality of outpatients on regular basis. This way
they can keep track on perceived service quality of their hospital and continuously
improve their service quality.
Corporate image, customer satisfaction, and customer loyalty may help service
companies to compete in this highly competitive environment. As corporate image
will play an increasingly important role in this environment of increasing competition
and identical service offerings by attracting and retaining customers (Andreassen and
Lindestad, 1998). In addition, customer satisfaction is considered by healthcare
providers as a key component of strategy and a significant determinant of long term
viability and success under competitive situation (Andaleep, 1998). Moreover,

38
maintaining and expanding customer loyalty is significant for any service company's
long term success (Kandampully, 1998).
The delivery of consistently superior service quality has become a very
important prerequisite for many companies success (Parasuraman, Zeithaml, and
Berry, 1988), because it affects corporate image (Nguyen and LeBlanc, 1998),
customer satisfaction (Lee, Lee and Yoo 2000), and customer loyalty (Bloemer,
Ruyter, and Wetzels, 1999). Accordingly, the improvement of perceived service
quality will enhance corporate image, customer satisfaction, and customer loyalty and
CRM. As a result, the company can effectively compete and succeed in an
increasingly competitive environment.
Image may be built up mainly by both the technical and the functional quality
of the company's service (GrOnroos, 1984). Smith and Clark (1990) reported that
quality of physician, advanced technology, and overall quality all have a strong and
positive relationship with the hospital image.
1.22 CRM system software
The health industry is enormous and increasingly competitive. Non-profit and
for-profit care delivery corporations and health care entities are challenged to find
ways to control their costs, deal with managed care, increase their bottom lines and
prove the worth of their programs. The rise of consumer-driven health care and the
increased consumer demand for accurate and timely customer service processes have
forced health care organizations to focus on front-office CRM software systems and
technologies to streamline processes and increase customer satisfaction. Many health
care organizations are discovering that old ways of doing business no longer foster
acceptable customer relafions.
According to a 2008 study by management consulting firm Katzenbach
Partners titled, "The Empathy Engine: Achieving Breakthroughs in Patient Service",
poor health care services drive patients to switch health care providers, or drive them
away from better-qualified providers, leading to inefficiency, higher costs and lower
quality of care.
The most central components of healthcare CRM software are integrated
patient records and using electronic records to facilitate the check-in process, patient
care and patient billing. Other key CRM functions include close integration to back

39
office project accounting systems (see sidebar content) and enterprise content
management systems. As governments, employers, payers, and patients increasingly
demand more timely information about preventive services, pre-service alternatives
and post-service delivery, healthcare providers must respond with enterprise-wide,
integrated business systems that serve both the healthcare provider and provide online
access to patients and other stakeholders. In addition to consistently delivered
customer service, patients want on-demand knowledge of their alternatives and
visibility to their healthcare history.
CRM software in healthcare inherits the typical software implementation
challenges and more. Healthcare IT budgets are often razor thin. Patient
confidentiality and data privacy must be assured beyond a shadow of a doubt.
Software as a service (SaaS) CRM healthcare systems must demonstrate enterprise
level system compliance and information security safeguards. User adoption is
generally cited as a greater challenge in healthcare than with more traditional for-
profit businesses.
1.23 Top Healthcare CRM Systems
Top healthcare CRM systems are delivering by enabling the creation and
customization of health plans for patients, permitting patients online access to manage
their own healthcare and acting as a system of record to better control their healthcare
activities, costs and benefits. Top health care CRM providers include the following:
• Siebel Systems continues to be the lions share leader among healthcare.
• Oracle, Aspect Software, Cerner, Lawson and Avaya round up the second tier.
• SAP, Onyx, Talisma and Microsoft bring up the third tier.
Healthcare leaders are also leveraging CRM for error reduction. As reported in
CRM in Healthcare' by Gear Up, CRM applications can prevent and mitigate medical
errors and their crushing impact to patients, their families, public perception and the
trust of communities. CRM data integrated with medical history and clinician data can
directly impact medical services delivery. Doctors, nurses, pharmacists, and other
medical professionals have always relied on skill, training, and technology to provide
safe and effective care for patients. But as error management expert Jim Reason
cautions, "It is often the best people who make the worst mistakes - error is not the
monopoly of an unfortunate few." Recognizing that CRM data traditional^;

40 TT>-)34^1
for customer services can be logically applied to medical records opens the door to a
greater patient knowledge repository.
1.23.1 CRM for Patients
The ability to store all of a patient's information in one place that is accessible
at various points throughout the hospital can greatly improve processing efficiency.
The cost savings from eliminating manual processing and information-gathering alone
can be quite significant. Information such as prescription and treatment history can
quickly be compared to billing history and insurance information, giving employees
an advantage when performing billing or collections activities. The same prescription
and treatment information can be used to eliminate the need to process lengthy paper
forms, which results in a higher patient turnover rate and virtually eliminates the
possibility of administering drugs that may have a negative reaction to a patient's
allergies or current medication. Data can also be used for marketing purposes,
simplifying appointment reminders and phone checkups.
1.23.2 CRM for Physicians
A unique aspect to CRM within hospitals is the ability to track information on
employees as well as clients. There is much information on a hospital's physicians that
can benefit from being stored in a single place. At a glance hospitals can see the exact
procedures that each physician has performed, along with patient feedback related to
each procedure. Hospitals can track physician performance measurements alongside
pay rates to ensure that bonuses and raises are given to the highest performers. CRM
can also be used to keep track of each physician's certifications and licenses, ensuring
that each physician remains legally certified.

1.23.3 Requirements

It can be difficult to measure return on investment (ROI) for CRM systems,

since they do not directly generate revenue, but rather focus solely on cost savings.
There are many third-party CRM solution providers in the marketplace that can
custom-tailor their existing products to meet the specific needs of organization. The
investment in time and energy required to implement a full-scale CRM solution is just
as large as the financial commitment. Business processes must be re-engineered to fit
a leaner and more efficient model, and all staff must be trained and prepared to

41
operate in the new, tech-savvy environment that will almost eliminate their familiar
paper-filing systems.
1.24 What does CRM really cost?
The total cost of ownership of CRM includes the costs of hardware, software,
professional services (for ongoing maintenance, upgrades and optimization) and
internal costs. Some of the disadvantages of customer relationship management is the
constant maintenance. There is more work that has to be done by inputting data. It can
become boring doing the same thing over and over again, because it is work that is
repetitive. The data base will definitely require a lot of maintenance and this
sometimes take up the resources of the company. The cost of customer relationship
management can shot out of the roof, because it can be very expensive. Sometimes it
can be really difficult to integrate with the company's other systems. It will not be
effective if the system is not compatible or work well with the other systems of the
company. The ability to perform, decreases if the process of the CRM if it is
dehumanized. The processes require human thought to input information as well as to
create the needed information. It is also sometimes difficult to work with which adds
more to the disadvantage of customer relationship management.
1.24.1 Costs of Hardware
Implementation of CRM systems routinely requires purchase of new computer
hardware, systems software, network equipment and security software. The costs of
hardware vary in a wide range dependent on the scope of implementation and
platforms.
1.24.2 Costs of Software
The cost of packaged CRM software depends on the scope of implementation
(# of CRM modules), complexity of software and CRM vendors. CRM software that
involves the integration with external business entities generally costs more. CRM
vendors offer discount for organizations who invest in e-business software suite.
Mid-sized organizations may commit a few million dollars to packaged e-business
software. Organizations tend to purchase more software license than they need.
According to a 2003 Gartner survey that 42 Percent of purchased CRM software goes
unused.

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1.24.3. Costs of Professional Services
• Customization:
The big chunk of costs of professional services is customization. The cost of
customization can easily out-run the cost of packaged CRM software. But it is the
customization of CRM software that can realign the business processes in customer
relationship management for a particular organization. CRM implementation without
customization is often useless.
• Integration:
CRM applications have the potentials to improve both efficiency and
effectiveness in coordination of managing customer life cycle. This is largely
dependent on how well CRM systems are integrated with other enterprise
applications. The benefits of a CRM project is limited without the integration with
enterprise IT infrastructure. Organizations face many challenges in CRM integration -
1) the challenges of integration of various functional CRM modules, 2) the challenge
of integration with other e-business software applications (ERP, SCM and knowledge
management), and 3) the challenge of integration with legacy systems.
••• Testing:

The test of an ERP system is often limited to the workers within organization.
The test of CRM goes beyond the boundary of the organization. It will involve the
external customers. The cost of CRM testing varies significantly in terms of
thoroughness of test and testing software used.
<• Data Conversion:
For many organizations, large amount of customer data may have been stored
in legacy system and in various data format. New generation of CRM systems almost
exclusively use relational database management systems (A relational database
management system is a database management system (DBMS) that is based on the
relational model. Most popular databases currently in use are based on the relational
database model. A short definition of an RDBMS is: a DBMS in which data is stored
in tables and the relationships among the data are also stored in tables. The data can
be accessed or reassembled in many different ways without having to change the table
forms.)A significant amount of data has to be converted and stored in CRM backend

43
database system. Data conversion from legacy systems to RDBMS could be both
time-consuming and expensive.
• Training:
CRM software automates complex business processes and transforms the way
workers interact with customers and with each other. CRM training is expensive
because, workers almost invariably have to learn both a new software system and a
new set of processes of doing business. To reduce the cost of CRM training and to
ease the transitions from old processes to new, organizations often seek the help from
training companies specialized in coaching workers on using CRM software from
particular vendors.

1.25 Front - and Back - office applications

Much of the emphasis on CRM has been directed at front-office applications,
including call centre management and product configuration tools. Front office
applications are used to increase revenues by improving customer retention and
raising sales closure rates. Back office applications support internal administration
activities and supplier relationships, including human resources, procurement,
warehouse management, logistics software and some financial processes. However,
the growth of enterprise - wide systems and e-business is blurring the distinction
between front - and back - office. Goods tracking, for example, have traditionally
been a back - office system used by employees who don't interact with customers.
Now many companies are giving customers direct access to goods tracking software
via the internet so that they can tract their own orders considering opening a network
of branches in recognition that many customers want to deal with a physical
presence.
1.25.1 Back Office Systems
Healthcare providers face the two fold tug of war challenge of increased
customer service demands while at the same time incurring constantly evolving
managed care constraints. CRM software systems for the healthcare industry clearly
support improved, automated and effective patient and customer processes and can
bring about consistent customer experiences and improved healthcare delivery.
However, as managed care continues to drive managed costs, healthcare providers

44
must supplement their CRM software applications with integrated back office systems
in order to further automate the project accounting, administrative and billing
functions and bring together the entire patient life cycle. Managed care fixed costs are
a way of life for healthcare institutions. However, while procedural reimbursement
may be fixed, the costs are often variable and generally not quantifiably known at a
per procedure level. Integrating CRM systems with Project Accounting or project cost
systems can further leverage the customer activities and records with accurate back
office cost figures to bring recognition to those processes and practices which exceed
fixed cost reimbursement and warrant process optimization or other review. Content
management systems have also become integral with CRM applications in recent
years. Pharmaceutical companies have taken a lead role in using content management
systems (CMS) to meet increased regulatory and compliance demands while at the
same time managing the large quantities of content about their product lines across
diverse touch points which include patients, health care providers and business
partners. By integrating CRM and CMS systems, pharmaceutical companies are
linking more relevant data and accessing pre-filtered results with more inclusive
content from the content management system based on CRM information. Medical
staff are afforded only one interface, avoid duplicate data entry, and receive accurate
content in real time for use with each given patient or customer.
1.26 Patient Relationship Management

PRM stands for Patient Relationship Management. This is a means to increase

quality of service for patients through fast, effective and secure responses to their
needs. With healthcare costs on the rise, managers continually strive to streamline
processes and make the best use of resources. With patient relationship management
applications, health industry leaders can: Analyze process improvements and their
impact on patient satisfaction
• Facilitate increased patient-clinician interaction without adding additional
administrative burden
• Increase community outreach focused on education, illness prevention, and
overall health

45
 *l* Integrate and extend existing IT investments using a patient relationship
management system to build automated workflows that bridge gaps and
streamline processes across system
1.26.1 In patient-centric organizations
• Clinicians establish ongoing relationships with patients that increase focus on
education, prevention, and overall patient well-being.
• Patient care is better coordinated across departments and organizations,
helping to decrease potential gaps in care and increase patient satisfaction.
• Instead of requiring patients to conform to each department's unique
procedures, processes are streamlined from end-to-end to be more convenient
for patients.
• Clinicians have access to and can securely share information and resources
that can help patients better manage chronic diseases.

Several factors make the timing right for healthcare organizations to adopt
patient relationship management solutions. Today, the relationship generates synergy
in building up the relationships over the globe. It enables a return to win-win thinking.
Return on relationship (ROR) will be return on investment (ROI) by transforming the
services into relationship-bases customer interactions.
Relationship does not form overnight. A typical man-woman relationship goes
through stages such as dating, romance, marriage, honeymoon and so on. There is
model developed by behavioral scientists on relationship consists of six stages viz.
contact, involvement, intimacy, deterioration, repair and dissolution .The nature of
relationship measure the depth of it. They are Reciprocation, Mutual Benefit, Trust,
Transparency, Concern, Interdependency, Commitment, Shared Values, and
Adaptation. Relationships with customers result in increased use of company's
services by loyal customers, charging of price premiums for customized services and
referrals by satisfied customers that bring new customers. The concept of customer
relations goes a long way in ensuring the marketing policies of the company are
attuned to market needs. It will give an integrated channel of communication with
consistency. The advantages of developing relationship with customers are

46
exponential in nature. A complete customer relationship development strategy creates
a positive wave effect. This effect is:
• A customer acquisition strategy that is targeted and based on understanding
mutual value.
• Customer retention strategy aimed at raising levels of customer satisfaction.
• Customer satisfaction with the organization that leads to customer loyalty.
• Customer loyalty leading to greater share of the customer, lower customer
development costs, referral business. The synergy created by relationship
development leads to mutual profitability for both organization and the
customers.
1.27 Information Everywhere
With the pervasiveness of health-related information available through the
Internet, television, magazines, and newspapers, patients are more informed. They're
starting to take a more active role in their healthcare. They're conducting self-directed
research on symptoms and alternative treatments and are more engaged in proactive
dialog with their physicians.
1.28 Patient Expectations
In the past few years, patient satisfaction and safety top the list of priorities for
healthcare IT leaders, according to the Healthcare Information and Management
Systems Society (HIMSS)* . 1 Reducing errors and streamlining processes are keys to
increasing patient satisfaction. In addition, more healthcare organizations are taking a
cue from the private sector by putting the customer—in this case, the patient—at the
center of service-oriented process improvement efforts.
The outpatient/inpatient waiting time has to be minimized in certain areas,
including waiting at the reception, waiting for the doctor, waiting for sampling, and
collection of reports, waiting for the tests, etc. The time spent by a doctor with the
patient needs to be maximized or increased. Patients will obviously have expectations
from the hospitals they visit and the personnel who deal with them.
*l* Some of the typical expectations of patients are
• Centralized location of the hospital
•> Clean environment
•J* Adequate space to move about in

47
 <• Comfortable lobby seating
<• Adequate space in patients' moms
*l* Availability of diagnostic services, pharmacy and dietary services
within the compound of the hospital
• Implementation of proper procedures
• Full involvement of the doctor in treating them
• Gentle handling by doctors which boosts the patients ' confidence
• Attached toilets in the patients' rooms equipped with geysers
• Laundry service and proper water facility
1.29 Inpatient CRM
The most important issue in the case of in-patient' CRM activities is the
human aspect, which means that every employee in the hospital, who is interacting
with patients should show real Care and concern in his words and deeds in dealing
with patients. The employees should be given proper training in these aspects.
Besides, the employee should ensure that the patient develops faith in the treatment
given in the hospital. Patients should be made to realize that the hospital is doing its
level best to care for him/her.
As regards the procedural part, the hospital should have well-defined
procedures for activities. The employees should be well-versed in the procedure and
should also instruct the patients about the same whenever needed. This will ensure
that patient do not face any hassles during the course of the treatment.

1.30 Outpatient or Post-discharge CRM

The most important aspect of the post-discharge CRM activities is maintaining
a database. Traditionally hospitals have expected the patients to maintain treatment
records. But in this competitive market, hospital should also maintain the records on
its own. It should maintain a computerized database of records of each patient in
detail. This will contribute toward the other CRM activity of the post-discharge
period. That is maintaining a relationship with the patient.

48
1.31 The Promise of Prevention
Despite the lack of a widespread shift to operational and reimbursement
systems that encourage preventive versus episodic care, forward-thinking healthcare
organizations are striving to realize the benefits that continued focus on clinical
prevention may provide. In a World Health Organization global report on disease
prevention, several types of clinical intervention methods are cited as reducing death
and disease and improving the quality of life of people at risk of, or living with,
chronic diseases.
1.32 Current Healthcare Technology Environments Pose Challenges
As much as clinicians and healthcare industry leaders want to adopt patient
relationship management systems to help increase the focus on proactive, coordinated
care, they're hindered by outdated, disconnected technology environments. The
following are challenges healthcare professionals in hospitals, clinics, long-term care
facilities, and home health settings face on a regular basis.
1.32.1 Coordinating care across entities is challenging.
Although many healthcare organizations have automated processes and
electronic medical records, their technology "stops at the front door." When a patient
is referred to a physician in another clinic, manual phone or fax communications
between organizations are typically needed, which adds to clinician workload and
often requires patient involvement. In addition, conflicting or misunderstood
processes across organizations can sometimes result in delays or gaps in treatment.
Systems that enable e-mail-based communications, automate follow-up activities like
appointment scheduling and information sharing, and integrate processes across
organizations can help with care coordination.
1.32.2 Proactively managing relationships with chronically ill patients is
difllcult.
Clinicians understand that patients with chronic illnesses, such as Diabetes or
heart disease, can benefit from frequent educational communications and helpful
reminders. However, the lack of widely available, easy to use systems that automate
tasks—such as scheduling follow-up calls, developing and distributing targeted
communications, and efficiently responding to questions—makes managing ongoing
relationships difficult.

49
Systems that automate relationship management tasks can help clinicians manage
ongoing patient relationships.
1.32.3 Streamlining processes to improve patient satisfaction is complex and
cumbersome.
A big component of patient satisfaction is the ease of interactions with
professionals and procedures in the continuum of care. Improving discrete processes
within one department is doable. When process improvement requires collaboration
and information sharing between departments and entities, things often fall through
the cracks, leaving patients confused and frustrated.
Systems that enable process workflows to be analyzed and customized across
departments and organizations can help streamline processes and improve patient
satisfaction.

1.32.4 Managing ongoing patient communications is difHcult.

Typically, follow-up communications between clinicians and patients are

possible only when nursing aides or administrative assistants are available to make
calls or send letters. For most healthcare organizations, clinical and administrative
staff is limited and ongoing communication relies on persistent patients or heroic
clinicians. Systems that automate ongoing communications without adding
administrative burden can help improve follow-up.
1.32.5 Outreach is inefficient.
Targeted outreach that can help educate and engage community members and
financial donors is tedious to complete. Without systems that help narrow mailing
lists to interested audiences, broad, no personalized mailings have little impact. When
interest is generated, there are rarely resources or systems available to follow up on
responses.
Systems that facilitate cost-effective outreach communications, track
responses and automate follow-up activities can help engage community members
and strengthen donor relationships.

50
1.32.6 System overhauls are unrealistic.
Replacing existing systems has long been perceived to be the best solution,
primarily due to the lack of alternatives. Large-scale system overhauls can take two or
more years, which puts them out of reach for many organizations.
With the emergence of software packages that utilize Web services, enabling
patient relationship management through incremental improvements is becoming an
attractive alternative. While some may choose to develop customized Web-based
solutions that link patient-facing services with records management, billing, and other
systems, others are turning to commercial "off the-shelf' software packages to bridge
gaps and extend current systems. Implementing commercial software packages offers
several advantages, including:
• Lower cost than replacing or upgrading existing systems
••• Ability to spread expenses over time because discrete functionality can be
implemented in a phased approach
• Less burden on staff because software can be customized to map to current
processes
• Reduced risk because incremental changes are easier to manage
••• A well recognized look and feel that makes systems easier and safer to adopt

1.33 Outsourcing in CRM

Outsourcing potentially enables businesses to reduce costs and concentrate on

core competencies while transferring noncore business processes, thereby providing
more effective goods and services elsewhere. Many healthcare organizations are
finding that diverse functions can be outsourced without affecting the core
competency of health care. Outsourcing of CRM is becoming increasingly popular in
times of economic recession, and not only in the midmarket. Outsourcing of course
was already growing in popularity in general, even before the economic meltdown.
Especially outsourcing IT-related activities is popular, as well as for instance
call centre operations. And although CRM is related to IT and to call centre
operations, it is far from the same. Because the supporting CRM technologies and
processes are highly complex and usually require intricate integration and
implementation of major business applications across the enterprise, they are prime

51
candidates for outsourcing to third-party specialists. However, while the contact
center and the CRM infrastructure in an outsourced CRM environment are managed
by an external third-party, the CRM strategy must remain in organization's control,
not the service provider's. Control in this context means leading all actions taken by
the service provider. This is the only way to ensure that all parties — including
company, its shareholders and customers — are duly served by the CRM initiative.
Outsourcing CRM is not without risks. The first obstacle many organizations
face is the lack of a well-defined CRM strategy that is clearly tied to its business
strategy. When a clear CRM strategy, which is backed by an executive champion who
connects it to the company's strategic business plan, exists, the future direction of the
organization becomes clear.
Because the organization understands what it needs to do to improve customer
support, service and information, it is often in a better position to make decisions on
whether to outsource. However, in most cases a well-defined vision does not exist.
The result is internal debate and confusion among the marketing, sales, IT, finance
and service departments about what needs to be done, who should do it and how to
fund it. Because CRM directly touches the customer, it is an extremely sensitive and
highly strategic component.
Often, the proposal to outsource CRM is met with protests that equate to
abdicating responsibility for the customer to a less concerned, less knowledgeable
third party. In addition, since CRM has many different internal constituencies,
achieving consensus on outsourcing CRM functions is often difficult. However, when
organizations begin to look at CRM as a collection of integrated strategies,
applications, platforms, technologies, processes and people, they begin to see how
outsourcing the CRM function can help them meet their strategic, competitive and
financial goals. Consequently, if enhancing CRM systems and processes through
alternative sources can improve customer interactions, available customer information
and customer service, organizations have a strong business case for outsourcing.
These business cases to justify CRM outsourcing projects will require tangible
benefits to customers, shareholders and the business' bottom line. In addition, as
mentioned earlier, if the organization does not have a cohesive CRM strategy

52
(connected to the business objectives, with executive support), these outsourcing
proposals will flail.
1.34 Pervasive myths about outsourcing
The following offers a look at some of the more pervasive myths about
outsourcing, as well as compelling evidence against them.
Myth number 1: It's more expensive to outsource.
Reality: It's more expensive not to outsource.
Cost is one of the most important factors to consider when evaluating an
outsourcing offering. To make a fair comparison, a provider's business case for
outsourcing should compare the projected total cost of ownership (TCO) of
outsourcing versus TCO if the work were to be done in-house. When performing this
comparison, all costs must be considered, including:
• Administrative costs, including human resources, taxes and facilities;
• Cost of capital (financial cost) including hardware, capital depreciation and
software;
• Future expenditures for development, implementation and migration costs to
develop a new solution in-house;
• Research and development for evaluating new technologies and value-added
services; and Consultants and other contract services.
Most providers find that with outsourcing, TCO is often less than keeping
operations in-house. Cost efficiencies can be maximized because outsourcing
provides the ability to add/subtract resources to match project and volume needs.
Additionally, since providers who choose to outsource share facilities and the
information technology infrastructure of the outsourcer, capital investments are
lessened, helping drive down the overall cost per transaction.
Myth number 2: Outsourcing decreases control over data.
Reality: Outsourcing puts organization in control.
The provider will always own subscriber information and retain the choice of
how to service those subscribers. Nevertheless, the outsourcer must take ownership of
performance. To that end, service level agreements (SLAs) should be established
during contract development as control parameters for the performance. Such
parameters give the provider control by making certain that the outsourcer maintains

53
an acceptable level of response to both subscribers and to the provider and by clearly
defining the legal ramifications and/or penalties if that response is not met. Common
areas monitored by SLAs for billing operations include system response time, system
availability, bill timeliness and completion of system enhancements.
Other parameters that can also help the provider retain control include establishing
and/or defining:
• Minimum staffing levels;
••• Change management requirements;
*l* Control reports;
*t* Escalation process for issues;
• Release/version control measures;
• Data security; and
• System accessibility.
Myth number 3:1 can do it myself, really.
Reality: organization has more important things to do...really.
Historically, companies that attempt to build billing operations in-house are
faced with internal departmental competition for financial and human resources
competition that can be magnified by internal politics, which ultimately delay major
project completions. Outsourced billing contracts circumvent this problem through the
development of milestones and timetables that document each phase of the system
development process with associated due dates, enabling providers to maintain
complete control of the entire process.
Furthermore, today's tight economic environment requires providers to make
smart choices regarding how best to use available resources. By outsourcing billing
and customer care, a company can concentrate its knowledge capital on growth
strategies, pricing and product development and delivery issues and allow the
outsourcer to worry about investment in capital assets and items such as training,
quality assurance and staff development, which are included with the most effective
and sophisticated outsourced solutions.

54
Myth number 4: My outsourced system won't change to meet my needs.
Reality: Outsourcing provides more system flexibility than in-house development.
Actually, it is often difficult for providers who keep systems in-house to stay
on top of changes in technology and industry standards. The cost of maintaining such
expertise alone can be overwhelming to those who choose in-house development.
Customization of the system can be difficult to support along with the management of
day-to-day operations.
Instead, outsourcers can maintain such expertise and put economies of scale to
work for individual clients. That way, each provider has access to a dedicated staff of
experienced developers whose core competency is to develop new billing systems and
applications to support corporate business and technology strategies.
Moreover, the outsourcer's annual spending in R&D "future-proofs" billing
products, minimizing the amount of system development required both at the start of a
provider's billing relationship with the outsourcer as well as throughout its lifecycle.
An outsourcing environment also allows providers access to a flexible migration path
for clients to expand billing and customer care capabilities without loss of initial
investment and greater expansion capabilities into new vertical markets or support
systems.
1.35 Leveraging management science in patient relationship management
The major concern in CRM practices in hospitals is the quality of outpatient,
inpatient and emergency services. Entire hospital staff, should be proficient in CRM
practices, and should be a friend, philosopher and guide to the patients, whose
welfare, comfort and satisfaction should be their prime concern. It is important to
have cordial doctor-patient interface and a durable hospital-patient relationship (Das,
2000). Hospitals deal with human beings under stress and strain, and hence it is
important that there is no gap between supply and demand of facilities either. Medical
and paramedical staff should not be merely expert in their profession but they should
be available in optimum size. Certain other very vital hospital resources like beds in
wards for inpatient services and ambulance fleet for emergency services should be
provided in adequate strength which along with adequate medical and paramedical
staff size help in building a deep and abiding hospital-patient relationship.
For computing very vital hospital resources that help for successful CRM like

55
medical staff size, number of hospital beds, and ambulance fleet size a set of
important queuing characteristics have been computed for varying server size. These
include average waiting; probability of waiting more than specified waiting or
average waiting as desired; probability of absolutely no waiting; and probability of all
servers being busy. (Mital ,1981,1982,1983,1988). In the present analysis, a set of
multi-channel queuing models have been used which, among others, include specific
model for probability of waiting more than a specified time; and a model that
measures probability of all servers being busy (Erlang Loss Model).
Resource estimates based on average waiting (El) may lead to somewhat
lower estimates as average arrival and service rates based on past one year statistics
may not reflect critical stress situations during the year when actual waiting at certain
moments may be much more than the average
Outpatient services are one of the most important areas of a hospital which
provide diagnostic, curative, preventive and rehabilitative services. It 15 not uncommon
that OPDs are overcrowded and that patients have to spend considerable part of
their time waiting at different places. Hospital clinics generally function for about
5-6 hours a day (3 to 4 hours in the morning and 1 to 2 hours in the afternoon).
In some hospitals, a doctor in charge of a clinic examines about 25-40
patients per hour. This is considered to be excessive, as a doctor should not be
expected to attend to more than about 10 patients (new and old) per hour. However,
in practice a doctor is constrained to see more patients. Normally, a doctor should not
be expected to attend more than 20 patients (old and new) per hour in any case (Das,
2000).
First interface of patient or his/her relatives with hospital is the hospital
reception/ enquiry counter which is also involved with registration and admission
formalities. The relationship founded at this point will go a long way in building
overall positive image of the hospital (Das, 2000). The CRM practice up to this
stage involves that the patient is properly received and courteously guided about
the investigations that are being contemplated.
This type of queuing analysis helps in combination of different queuing
characteristics which leads to improved patient satisfaction.

56
1.36 Inpatient services and CRM
Inpatient services are an important element in health care delivery which is
provided in hospital wards which can be of general type like male, female wards
or specialty wards. Specialty wards may include maternity wards, isolation
wards, or wards for patients who need hospitalization in particular specialties
such as orthopedics, pediatrics, psychiatry, etc. Intensive Care Units are
essentially the wards for critically-ill patients.
During patient hospitalization, medical and nursing staff should extend
utmost personalized care to the patients undergoing treatment. In maintaining
CRM practices at this stage, support services like dietary, housekeeping,
pharmaceutical services, etc. should be kept up to the mark which can go a long
way in enhancing patient satisfaction (Das, 2000). Medical staff should also
provide all relevant and possible information to patients for thee, adequate
understanding of treatment options, risks involved in various procedures,
duration and the likely expenditure for treatment. All possible queries, doubts,
apprehensions, and precautions to be followed, prior tea during, and after any
procedure or surgery, should be explained and clarified in simple layman's
language to the patient. In addition, some of these explanations may be given in
the form of leaflets or brochures (Das, 2000).
Patients' fears need to be allayed by the attending doctors, Non-verbal
communication such as facial expressions, eye contact, pleasing gestures, and a
comforting touch helps in building up this relationship which may help in
providing anxiety-free stay for the patient in hospital. Nursing services are vital
aspect of ULM practices, which should be properly maintained. In inpatient
services, nurses play major role in building strong relationships with patients. A
cordial behavior and congenial relationship are some of the main aspects CRM
'practices in nursing care.
The housekeeping staffs help in keeping the hospital clean and tidy. Many
of them come in direct contact with the patients. Their services are important
aspects of CRM practices as their activities contribute directly to the patient's
comfort and peace of mind. During the patients stay in the hospital, his physical
comfort contributes greatly to his progress. Hence, maintenance services assume

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considerable significance in hospital CRM practices. The maintenance crew is
expected to attend to the complaint as early as possible, diagnose the fault, and
rectify it.
Hospital security apart from security responsibilities also have role in
affecting welfare and happiness of the patients in many ways (Das, 2000). They
should be somewhat more flexible than the traditional security in other
organizations as they often need to allow entry of relatives when they find them
in overriding distress.
Bed is a very important resource for any inpatient services on which
planning of all other resources depend. It also leads to higher degree of patient
satisfaction for customer services.
Two standards of CRM effectiveness for ambulance services are response
time and service time. Response time is the time elapsed from the dispatch of an
ambulance until its arrival at the emergency scene. Service time starts from the
moment of dispatch of the ambulance till the arrival of the patient at the hospital.
Whereas the first measure indicates quick response of the ambulance in reaching the
site, the second measure reflects rapid transport of the patient front the site to the
hospital where he is to be treated. As an effective CRM practice the focus of
ambulance service has undergone change in recent years with growing emphasis on
the need to deliver timely and effective pre-hospital care (Mital, 1990, 2000).
Efficient ambulance service with adequate fleet size is also one of the
important factors for patient satisfaction at initial stages. Ambulance crew is now
more commonly known as Emergency Medical Technicians who within the
framework of CRM are viewed as key members of the patient care team. Dispatch of
medical records in advance front the ambulance to the doctors for serving better can
reduce the diagnosis time and regular treatment can start either during journey or
immediately upon arrival in hospital. The paramedic using a common wireless
network sends the patients details to the hospital in advance while accompanying
the person to the hospital.
1.37 Example of CRM implementation
CRM Software Helps Identify Heart Disease Patients: "With more women
having and dying of heart disease in its market area than the statewide average, a

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Midwestern U.S. hospital used its database marketing program to identify those
with the greatest likelihood to use or need cardiology services, coupling direct
mail and an online Health Risk Assessment (HRA) to produce a 5.5 percent
response rate of cardiology service utilization.
Both the Customer Relationship Management (CRM) program and the
cardiology campaign were developed by CPM Marketing Group. Prior to
adopting CRM, the hospital had primarily focused on less targeted marketing
communications. CRM's analysis of data on a segment-of-one basis, or
individual level, enabled the hospital to use one solution to target select
individuals and measure service utilization.

1.37.1 Heart Disease Risks

The two-step campaign focused on educating women of the continuous need
to care for their heart and the importance of seeking immediate medical attention if
they experience symptoms of a heart attack. The call to action was to take an online
HRA with the appeal of having the results reviewed by a cardiology nurse free of
charge. The hospital used CPM's patent-pending Consumer Healthcare Utilization
Index (CHUI) and Patient Disease Index (PDI) to identify approximately 20,000
women age 35 and older in its market area most likely to use or need cardiology
services as well as CPM's variable digital imaging technology to customize the
mailings by age.
The design of the campaign allowed for tracking at several different entry
points. The hospital measured the results of the campaign against a control group,
which had the same characteristics as the target group but did not receive any
mailings. In addition to tracking the number of women who took the HRA, the
hospital was able to track the number of women who met with the cardiology nurse. It
also used its CRM database to track utilization of cardiology and overall hospital
services.

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1.38 Management Information Systems
1.38.1 Deflnition:
MIS is a system which handles databases, process the data, provide the end
user computing facihties and gives output in variety of formats. Its purpose is to meet
the general information needs of all the managers in the firm. It helps managers and
other users to identify and understand the problems. The foundation of MIS is based
on basic principles of management, its practices and management control. It also
relies on system theory and information technology.
1.38.2 Role of MIS in Hospital Management
Management information systems play a vital role in the successful
management information of systems because of following main reasons:
• Information is the common denominator underlying the management functions
of planning, organizing, directing and controlling.
• Information systems are closely related to the basic system objectives, policies
and strategies established by the management.
• MIS plays different roles at different levels of management i.e. provide
information to the management as per the level in the organization.
<• MIS provides variety of systems such as Query Systems, Analysis Systems,
Modeling Systems and Decision Support Systems to cater the diverse needs of
the organization.
• MIS helps in functional areas e.g. strategic planning, management control
operational control and transaction processing.
<• MIS affects the performance and productivity, which increases organizations
effectiveness. It provides drastic improvements in efficiency and speed of
transaction processing as well as office productivity.MIS involves several
activities such as:
4- Collection and capturing of data
4- Data processing
4 Information reporting
4- Information communication
4- Problem solving
4- Decision support.

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 • MIS plays significant role in product and service quality.

1.38.3 Various aspects of MIS

• Information technology
• Databases
• Principles of management
• Social Sciences
• Business goals
Therefore MIS is a multidisciplinary approach to the business management.
MIS is dynamic in nature i.e. it changes with time, environment and business growth.
1.38.4 Some of the selected definitions of management information systems are
given below:
1- MIS is a planned organized approach to the transferring of intelligence within
an organization, for the exercise of management. They do not create
information, but simply package it.
J.J.O. Brien
2. Mis are an integrated user machine system for providing information to
support operations, management and decision making functions in
organization. The system utilizes computer, hardware, and software, manual
procedures, models for analysis, planning and control, decision making
and a database.
Gordon B.Davis
3- A MIS is an organized set of processes that provide information to managers
to support the operations and decision making within an organization.
Krober, Watson
4- MIS is a system that aids management in making, carrying out and
controUing decisions.
Jerome Kanter

5- MIS is a set of organized procedures which when executed provides

Information to support decision making.
Henry C. Lucas

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1.39 What Is Health Information Technology?

Health information technology (HIT) is "the application of information

processing involving both computer hardware and software that deals with the
storage, retrieval, sharing, and use of health care information, data, and knowledge for
communication and decision making" (Brailer, & Thompson, 2004). Using computers
and other electronic devices makes it easy for them, doctors, and other health care
providers (such as hospitals, labs, and X-ray facilities) to store, share and access
health information.
As expectations for improved healthcare continue to evolve, older IT systems
will increasingly struggle to deliver a truly integrated flow of information having been
designed traditionally around provider needs, rather than around a patient's needs and
as such, both patients and medical staff increasingly experience healthcare technology
that is below expectation. The healthcare industry is being impacted by advances in
information technology in four major ways: first, a broad spectrum of tasks that were
previously done manually can now be done by computers faster, better, and at lower
costs; second, some tasks can be outsourced to other countries using inexpensive
communications technology; third, detailed analysis of longitudinal and societal
healthcare data can now be analyzed in acceptable periods of time; and fourth, the
best medical expertise can be made available to patients without the need to
physically transport the patient to the doctor or vice versa. Still, there are many
healthcare situations in which face-to-face interaction is the only practical way to
render medical assistance.
Information technology (IT) has the potential to improve the quality, safety,
and efficiency of health care. Diffusion of IT in health care is generally low (varying,
however, with the application and setting) but surveys indicate that providers plan to
increase their investments. Drivers of investment in IT include the promise of quality
and efficiency gains. Barriers include the cost and complexity of IT implementation,
which often necessitates significant work process and cultural changes.
The most immediate barrier to widespread adoption of technology is cost: in
this way patients benefit from better health, and payers benefit from lower costs;
however, hospitals pay in both higher costs for implementation and lower revenues

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due to reduced patient length of stay. Certain characteristics of the health care
market—including payment policies that reward volume rather than quality, and a
fragmented delivery system— can also pose barriers to IT adoption.
Given information technology's potential, both the private and public sectors
have engaged in numerous efforts to promote its use within and across health care
settings. Additional steps could include financial incentives (e.g., payment policy or
loans).However, more specific discussion of IT in health care is challenging due to
the lack of precise definitions, the volume of applications, and a rapid pace of change
in technology. Similar terms can be used to define different products, and the exact
functions of a system will depend on the specifics of its implementation in a given
setting. Both the terms and the functions also change over time.
For example, computerized provider order entry (CPOE), which can minimize
handwriting or other communication errors by having physicians or other providers
enter orders into a computer system, can apply only to prescription drugs, or may also
include additional physician orders, such as x-rays or other images, consultations, and
transfers. For electronic health records (EHRs, also known as electronic medical
records, automated medical records, and computer-based patient records, among other
names), multiple definitions exist, depending on the constellation of functions that are
included (Brailler and Tarasawa 2003).! They can be used simply as a passive tool to
store patient information or can include multiple decision support functions, such as
individualized patient reminders and prescribing alerts.
When purchasing IT, providers must consider multiple functions and literally
hundreds of applications offered by numerous vendors. In general, the various IT
applications fall into three categories:
• Administrative and financial systems that facilitate bilHng, accounting, and
other administrative tasks;
• Clinical systems that facilitate or provide input into the care process.
• Infrastructure that supports both the administrative and clinical applications.

Health information technology (HIT) provides the umbrella framework to describe

the comprehensive management of health information across computerized systems
and its secure exchange between consumers, providers, government and quality
entities, and insurers. Health information technology (HIT) is in general increasingly

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viewed as the most promising tool for improving the overall quality, safety and
efficiency of the health delivery system (Chaudhry et al., 2006). Broad and consistent
utilization of HIT will:

• Improve health care quality;

• Prevent medical errors;
• Reduce health care costs;
• Increase administrative efficiencies
• Decrease paperwork; and
• Expand access to affordable care.

Interoperable HIT will improve individual patient care, but it will also bring
many public health benefits including:
• Early detection of infectious disease outbreaks around the country;
• Improved tracking of chronic disease management; and
• Evaluation of health care based on value enabled by the collection of
de-identified price and quality information that can be compared.

The world healthcare IT market is expected to grow from $99.6 billion in 2010
to $162.2 billion in 2015, at a CAGR of 10.2% from 2010 to 2015. Need to cut
healthcare costs, enhance clinical/administrative workflow of hospitals, and huge
demand for faster, error-free, efficient healthcare delivery, is fueling the healthcare
provider IT market worldwide. Furthermore, the initiatives taken by the government
for adoption of healthcare IT systems globally are also a significant driving force.

1.40 Using Health Information Technology

Health information technology may be useful for:

• reducing paperwork by eliminating the need for handwritten medical records

• reducing medical errors by transmitting accurate information electronically
and eliminating mistakes due to misreading of doctor's handwriting

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 • reducing health care costs by decreasing the need for repeat medical tests by
different doctors and eliminating storage space and staff time to maintain
medical records
• improving quality of care by decreasing medical errors and assuring that all
health care providers have accurate and timely information

1.41 Benefits of HMIS

• Hospitals will require less number of Staff to cater more patients in same time
or even less. You would have the choice to re-deploy them at other suitable
locations.
• Hospital Management information System not only provides an opportunity to
the hospital to enhance their patient care but also can increase the profitability
of the organization.
• HMIS would enable hospitals or Nursing Homes to serve the rapidly growing
number of health care consumers in a cost-effective manner.
• HMIS can also save extra money on current computer hardware shopping.
• Hospital administrators would be able to significantly improve the operational
control and thus streamline operations.
• This would enable to improve the response time to the demands of patient care
because it automates the process of collecting, collating and retrieving patient
information.
• The senior Doctors would spend his precious time more in clinical activities
than to put in clerical activities otherwise.
• This software interface would also save them a lot of time for special jobs
only.
• Accounting sometimes becomes awfully pathetic and complex. This product
will eliminate any such complexity, since the retrieval of information through
its MIS will become virtually on the tip of your fingers.
• Very important for some, the reduced cost of the manpower would pay for the
cost of this product within a short time after its implementation.

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1.42 Modules of Hospital Management System

• Registration and Enquiry Management

• Appointment & Queue Management
• EMR (Electronic Medical Record)
• Casualty & Emergency Management
• In-patient A-D-T (Admission-Discharge-Transfer)
• Pharmacy Management
• Laboratory Information System
• Radiology and Nuclear Medicine
• PACS Radiology
• Operation Theatres Management
• Nursing & Ward Management
• Blood Bank Management
• Service Order Processing
• Ambulance Services Management
• Bed Census Management
• Quality Assurance
• Stores and Inventory Management
• Billing and Financial Accounting
• TPA and Insurance Management
• Patient Referral System
• HR and Payroll Management
• Duty Roster Management
• Physiotherapy and Rehabilitation
• Dietary Management
• CSSD (Central Sterile and Supply Department)
• House Keeping and Laundry Management
• Bio-Medical Waste Management
• MIS (Management Information System)
• Telemedicine

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 Which covers various aspects of a patient while registration which include
personal, physical Registration and Enquiry Management.
This module provides a comprehensive approach for the management of the
front desk activities in a Healthcare organization which include patient registration,
appointment scheduling and certain enquiries related to the admitted patients and
availability of consulting doctors. This module features a very comprehensive
Medical Registration form and demographic information. It also records the Insurance
details as well as overseas patient details.
Features of Patient registration and enquiry module
• Captures detailed information of a patient
• Patient image capture and storage.
• Mandatory fields for crucial patient information.
• Alerts in place to prevent erroneous data entry.
• Checks duplicate and junk data entry.
• Automatically generates a unique MR no.
• Enquiry assistance for Current In-patient details.
• Advanced multi-criteria search for registered patients.
• Bar code generation and scanning facility.
• Provision for recording Insurance Details.
• Provision for recording overseas patient details.
• Appointment scheduling wrt admission type, date, time.
• Appointment scheduling wrt department and consulting doctor.
Appointment & Queue Management:
Appointment & Queue Management scheduhng module facilitates effective
scheduling of appointments of patients with the doctors. This module allows doctors
and nurses to view available time slots and allocate appointments accordingly. This
module prevents the system from creating an appointment if the doctor is on leave or
absent or busy in the OT. The appointments are given right the date, time, department,
doctor and the type of visit of the patient.
Features of the Appointment and Queue Management module
• Set-up of Hospital Calendar capturing non-working days,day-care timings, etc.
• Scheduling multiple services

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 • Availability & Time-slot of Consulting Doctors as per day & time
combinations
• Search for Consulting Doctors as per service
• Appointment Booking of Consulting Doctors on internet, walk-in, etc.
• Booking of multiple slots for patients
• Booking of multiple appointments per slot
• Appointment cancellation / re-scheduling
• Reminders via e-mail, SMS, etc.
• Precise appointment of a consultation subject to its availability
•> Type of appointment is assigned to the patient for special attention if required
• Alerts in place for erroneous appointments.
• Provision for keeping record of a medico legal case.
• Provision for assigning the maximum visits to a consultant.

EMR (Electronic Medical Record):

An Electronic Medical Record (EMR) is the health related information of an
individual which is created, modified and maintained within a healthcare
organization. EMR module helps hospital to record and retrieve the clinical
information of a patient. It provides a central repository for holding the entire medical
records of the patient. It stores data in an organized and structured manner so that a
clinician or any healthcare provider can easily access clinical data based on his role,
needs and security rights.
Features of Electonic Medical Records (EMR) module:
• Superior GUI to make data collection easy for the consulting doctors/
transcriptionists.
• Collated & formatted collection of information on patients, as required.
• Search on patient records by patient name, patient ID, etc.
•:• Complete clinical data repository.
• Capturing basic patient demographic details.
• ICD-10 Codes for Diagnosis and Clinical Findings.
•:• CPT codes for all the Clinical and Diagnostic procedures.
• Real time ordering of tests and medications.

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 • Customized forms for various specialties to simplify clinical history taking.
• Laboratory reports, medical Images, clinical procedure records, etc.
• Built-in reports and user-oriented report-writing capabilities, etc.

Casualty & Emergency Management:

This module is built to serve the emergency patients uninterruptedly. It guides
the management of the patient from his/her arrival in the casualty to his transfer to the
respective department for further management. This module sends alerts to the
concerned departments of the healthcare organization, captures the details of the
patient condition at the time of arrival, course of action undertaken and helps in
planning the further management of the patient.
Features of Casualty & Emergency Management Module
• Capturing of whatever basic patient demographic information available at the
time of registration of the casualty & updating the same when fully available
• Temporary ATD of the patient
• Consulting details
• Clinical follow up scheduling
• Lab test reports
• Diagnosis
•:• Service orders and bookings
• Pharmacy / Surgical details
•:• Statutory forms & reports etc.
In-patient A-D-T (Admission-Discharge-Transfer):
In-patient Admission Discharge Transfer module is a part of patient
management system and takes care of admission, discharge and the transfer process of
a patient. It captures the diagnostic tests, medicines and procedures prescribed by the
doctors and nurses. These orders are then processed by their respective departments.
This module manages the allocation of a bed/ward/room to a patient according to its
availability and also the transfer of patients. This application guides the appropriate
discharge process of a patient and generates a comprehensive discharge summary at
the end.

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Features of In-Patient Admission Discharge Transfer module
• Comprehensive form for collection of precise data regarding the patient.
• Thorough evaluation of the patient condition.
• Tools for accompanying the decision making process.
• Recording the doctors and nursing notes for further management.
• Processing orders in real time to the respective departments.
• Managing the billing process.
• CPT codes for all the Clinical and Diagnostic procedures.
• Managing the payments done by third parties
• Bed and ward allocation and transfer.
• E-prescribing of the medications.
• Final billing and settlements
• Clinical Packages management.
Pharmacy Management:
The Pharmacy module caters to the drug information system, dispensing, stock
management and control functions of the pharmacy department. The pharmacy
module receives the prescriptions from respective departments and doctors in the
form of e-prescribing. The pharmacy module uses the ATC classification of
medicines to facilitate proper management of the drugs. There are provisions for
FIFO and LIFO dispensing of the medicines. The batch nos., mfg. dates, exp. dates,
drug interactions and all the other details are displayed to check the faulty distribution
of medications within the healthcare organizations. Predefined stock levels are
maintained in the pharmacy to avoid conditions such as OOS (out-of-stock).
Features of Pharmacy Management module
• Provides a comprehensive list of available drugs.
• The ATC classification of medicines is used for research purposes.
• The medicines can be manipulated according to various aspects.
• Deducting the stock depending on their batch nos., mfg. dates, exp. dates
• Accepts E-prescriptions from various departments and consulting doctors.
• Auto generation of alerts when minimum stock levels are reached.
• Online requisition for stock order from the main store.
• Provisions for FIFO, LIFO, etc.

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 • Reporting the consumption details.
Laboratory Information System:
The Laboratory Information system module is used by the pathology lab to
record and disseminate the information regarding the tests performed. The Laboratory
department receives online request from doctors and also allows laboratory personnel
to generate requests. The Laboratory module supports to perform various tests under
the following disciplines: Biochemistry, Cytology, Hematology, Microbiology,
Serology, Neurology and Radiology. Tests are grouped under various sections and
sample type (specimen). Based on the request the user can input the sample and
generate the sample number and get a sample number printed. Results can be entered
based on the sample type either to one test or multiple tests. If the test result requires
approval, the supervisor has to approve the result and it is made available to
concerned doctors.
Unique Features of Laboratory Information System:
• Online receipt of request for investigations.
• Search by using unique patient ID/Record ID/ Name /between any two Dates.
• Information gathering about date of Visit, Referred Doctor name etc.
• Auto generation of sample number for subsequent samples.
• Printing of stickers with bar codes for sample identification.
• Separate & Modified way to handle Culture & Sensitivity.
• Complete Inventory Management.
• Generate Test Reports and receipt generation for printing
• Real time communication of the test result to the Clinicians.
• Normal & abnormal test result values are differentiated on screen & on
printouts.
• Doctor's referrals and amount collected from relevant patients.
• Records of Incentives are also calculated doctor wise & can be analyzed
between any two dates.
Radiology and Nuclear Medicine:
This module provides comprehensive solution for all medical imaging tasks. It
offers basic functionality such as displaying and storing images as well as possesses
networking capabilities. It is designed to integrate medical imaging seamlessly into

71
the complete clinical workflow from registration to billing. It offers great ease of use
and liberty to Radiologists for real time image analysis. Image streams can be
captured, stored, played, labeled and printed using a standard PC and a normal printer.
The diagnostic report along with the required image(s) can be sent in electronic
format by e-mail for action or consultation. It eliminates the need of manual report
writing thus saving time and cost of the Radiologist dramatically.
Features of Radiology Information System Module
• Provision to club radiology images with the EMR of the patient.
• Provision for advance booking of the Diagnostic equipment.
• Real time communication of results to clinicians.
• Clinical decision support tools at the point of care
• Predefined report formats for various tests.
• Provision to send images via E-mail to other hospitals and/or patients.
• Charts for monitoring patients of Nuclear Medicine.
• Indicators to highlight abnormal findings.
PACS Radiology:
Though many radiology equipments now a day's come with their own Picture
Archival and Communication System there are many reasons why one should use our
PACS instead. Our PACS provides better tools for manipulating the DICOM images.
It is fully integrated with the RIS of our product Electra HMIS and hence rules out
any chance of incompatibility with other PACS. It facilitates the storage of the
radiology images against the patients EMR details which provides precise data related
to the date, time and condition of the patient pertaining to which the Diagnostic
imaging was actually done . It provides easy access and manipulation of the radiology
images and their reports.
Features of the PACS Radiology Module
• Ability for all the image storage to be on-line.
• Ability to automatically display warning when the storage space used is above
70%
• Superior tools for manipulation and labeling of images.
• Ability to provide for the maintenance of the storage system without loss of
data or time.

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 • Ability to provide purge, archive and move lists by user-defined criteria
• Ability to track films at the following levels:
1. Master Folder
2. Subfolders
3. Procedure incl. C.T. Scan, DSA (Digital Subtraction Angiography)
4. Reported status
5. Unreported status.
• Picture Archiving Communicating System (PACS) communication with all
Radiology modalities.
• Integrated with the HMIS where films and reports are easily accessed and
previous images/ reports will be available for any references.
• Ability to view radiographic images at wards, ER, clinics, with or without
reports.
• Ability to view primary and final reports for urgent cases at ER and any
selected area.
• Ordering Physicians have the ability to refer any unreported images to
radiologist requesting urgent report.
• Ability to view the same image in deferent areas such as wards, clinic Etc.
• Ability to print high quality diagnostic images in hard copy or to be saved on
CD and any other external storage media.
• Ability to send these images via internet or remote connection such as outside
hospital clinic along with reports.
Operation Theatres Management:
Operation Theater module tracks all surgeries that take place in the hospital. It
helps in scheduling the theaters, surgery team, records the surgery details and all
checklists associated with the surgery. It keeps track of the items used during the
surgery and helps update the items in the Operation Theater. It helps to record an
electronic consent of the patient or the relatives. It also helps in recording the
preoperative and postoperative condition of the patient. All the procedures carried out
in the OPD are recorded in the form of CPT codes.
Features of the Operation Theater module
• Accurate scheduling of the operations with flexibility in managing bookings.

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 • Comprehensive checklists for monitoring the patients.
• Detailed preoperative assessment.
• Multilingual consent forms provided.
• Inventory and stock management of the OT.
• Sterilization schedules, checks and audits.
• Anesthesia details monitoring and recording.
• Alerts on abnormal reading.
• Provision for interface with the monitoring devices.
Nursing & Ward Management:
The ward management module provides the facility for nursing or Ward staffs
to manage the floors. This module manages special units like ICU, OT activity and
tracks the services given to the patient in their respective wards. Nursing workbench
is a comprehensive module that provides the facility for nurses to administer and
maintain throughout patient care. It works in conjunction with doctor's workbench and
other modules and departmental functions of the clinical and administrative systems
of the HIS.
Features of Nursing and Wards Management module
• Ability to access Patient Administration system for user defined data items.
• Ability to link in with the order communications
• Ability to include notification of patient's pending arrival, current status, etc.
• Real time test, procedure and medication ordering to the concerned
departments.
• For surgery, the theatre schedule is notified, together with any preparation
required.
• Ability to record admissions, discharge and transfers at the wards to update the
bed census.
• Confirm location of the patient and to notify ancillary departments such as
dietary.
• Communicating with departments such as housekeeping, maintenance,
security, etc.
•:• Comprehensive charts to monitor the patient's condition.

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Blood Bank Management:
Blood Bank Management module supports all the functionalities of Blood
Bank such as receiving requisitions for blood and issuing blood and blood products. It
also helps monitor the blood collection and blood transfusion process and records the
details of the process. It provides provision to record the donor or recipient reactions.
This module helps you manages the storage of blood and blood items and also helps
you maintain the stock.
Features of Blood Bank Management Software
• Generating reports on Stocks-Blood Group wise, Area wise and Expiry date
wise.
• Donor Database-Blood Group wise and Area wise
• Maintain and update Unique Donor Identifications.
• Complete Key Consumables Inventory Management.
• Track and maintain all the Donor Types-Voluntary, Exchange and Directed
• Improve the Effectiveness and efficiency of Blood Bank-Faster Response
Time and Better Control
• Accurate database/Record Management.
• Blood Cross Match and Result Storage Facility.
• Digital Record archival backup and restoring facility-Better House keeping
and Record Maintenance.
• Rejected Donor Database for Donor Control and Identification-Blood
Transfusion related disease control and prevention
• Searched Facility for Destroyed and Expired Blood
• Comprehensive Donor database with Search Facility.
• Unique Donor Id and Patient record Id for managing future list.
• Improve Blood Bank processes by providing efficient and continuous software
support.
Service Order Processing:
The Service Order Processing and Billing module is used to process the
orders prescribed by the clinicians or other staff in real time. This is called
e-prescribing of services or e-prescription. These orders are populated in their
concerned departments after passing the process of billing. These services are billed

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on the concerned billing counters depending upon the category of the patient, (i.e.
General, Insured, Guest, Staff, etc.). CPT codes are used to denote the services
provided within the Healthcare Organization.
Features of service order processing
• Generation of Service Orders by service points like Clinics, Wards, OT, etc.
• Electronic processing of orders.
• Real time updates.
• Service Order Tracking
• Service Point account for material consumption against Service Order
• Detection of material wastage and loss of revenue at service point.
• Provision for ensuring billing payment before the processing of order to the
concerned department.
• Provision for giving discounts for services subject to authorization..
• Provision for providing healthcare packages and billing collectively for
services provided in these packages.
Ambulance Services Management:
This module helps to manage the ambulance services provided by the
Healthcare Organization. This module keeps track of the ambulances available for
service and also manages ambulances services ordered from external vendors. This
module helps you manage the Scheduled as well as the emergency services of the
ambulance. It also helps you maintain the basic life support facilities provided in the
ambulance if any. The availability of ambulances and drivers are better managed
using this module.
Features of Ambulance Module
• Normal Care/ Critical Care ambulance services.
• Scheduling of Ambulances/vehicles.
• Driver Duty roster.
•:• Accompanying Doctor's duty roster.
• Tariff management.
• Daily running statistics of ambulances.
• Scheduling maintenance of the vehicles.
• Managing emergency facilities provided in the ambulance.

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 • Provision for communication facilities within the Ambulance.
Bed Census Management:
The Bed census management module maintains the record of bed occupancy
status at all times. It facilitates the estimation of appropriate waiting times for patients
and avoids unnecessary empty beds. It helps the Healthcare organization in reducing
the bed turnover time which is very essential for optimization of the revenues. It also
provides statistical information regarding the occupancy status of a bed over a period
of time.
Features of the Bed Census Management Module
• Current bed allocation status overview
• Monitoring and reducing the bed turnover time
• Recognizing the staff involved in the turnover process of a bed
• Statistical analysis of utilization per ward, consultant and specialty
• Scheduling the housekeeping and maintenance activities
• Calculation of revenue generated from each type of bed
Quality Assurance:
This module is used to monitor and control the quality of care provided to the
patients. It is used to manage the infection control practices. It is used to record the
number of incidences that exploit the healthcare quality and helps to employ methods
to control such incidences. It helps in deploying methods to improve the quality of
care provided to the patients. It helps in setting up the policies and procedures to
check the quality of processes in the hospital.
Features of the Quality Assurance Module
• Statistic of total hours that the nurse has spent with the patient, with
procedures been made containing the nursing and medical diagnosis of the
patient.
• Provide diagnostic control on reducing operational errors and minimize
incident (needle stick injury, drug error etc.)
• Infection Control (Nursing Services)
• Ability to record extra clinical details against a patient record for infection
control purpose like (HEP: A, B, C, HIV and other infectious diseases.

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 • Ability to access user defined patient data from Patient Administration data
items.
• Ability to receive automatic notification of certain specific hospital defined
organisms growing from culture.
• Facilities to access patient clinical data (CBC, CRP etc) date of operation, etc.
• Ability to access date of admission and discharge of selective Patients.
• Ability to gather statistics according to international standards for infection
control.
Stores and Inventory Management:
The stores and inventory management helps you keep track of each and every
item consumed within the healthcare organization. It keeps track of the sales and
purchases taking place within the healthcare organization. The consumable as well as
non consumable items are identified and accounted for Provision for FIFO and LIFO
management of the inventory items. Online purchase requests from various stores in
the healthcare organization to the warehouse of the Healthcare Organization.
Receiving quotations and issuing purchase orders to various vendors.
Features of stores and inventory management module
• Real time request of stock by the stores to the warehouse.
• Automatic alerts when minimum stock level is reached.
• Stock consumption with provision for FIFO and LIFO.
• Purchase request generation by stores.
• Issue of purchase order by purchase department to the vendors.
• Vendor management.
•> Negotiations management.
•:• Provision for defining specific items to stores.
• Alerts for items nearing expiry.
• Racking and shelving of the store items.
• Cold storage room management.
Billing and Financial Accounting:
The financial accounting module caters the entire gamut of accounting
practices that is conducted in a typical healthcare setup/environment. This financial
accounting system manages all the balance sheets, Income statements, petty cash,

78
sales, purchases, revenues, expenses, ledgers and other books of accounts. It provides
statistical tools for graphical representation of financial data related to the
organization.
Features of the flnancial accounting module
• Balance Sheet
• Statement of income
• Cash flow statement
• Statement of Owner's equity.
• Petty Cash book.
• Bank book.
• Purchase book.
• Daily, weekly, quarterly and monthly financial statements.
• Statistical tools for analysis.
• Compatible with GAAP(Generally Accepted Accounting Principles)
Features of the TPA and Insurance Module
•:• Provision to record the TPA and Insurance details of a patient.
• Instant verification of eligibility of the patient.
• Online submission of claims forms.
• Provision for follow up with the TPA's and Insurance companies.
•:• Status enquiry of the submitted claims.
• Integration with other modules for discharge summary and other details.
• Provision to bill the patient separately for the services provided by the hospital
that are not covered by the TPA and Insurance companies.
• Provision for cashless hospitalization.
TPA and Insurance Management:
The TPA and Insurance Management module facilitates the process of
settlement of the bills of a patient insured or covered by a third party. It records the
details of third party payers and insurance companies. It helps to verify the eligibility
of the patient for reimbursement by the third party or the insurance company. This
module helps the hospital file online claims on behalf of the patient in a prescribed
format along with the discharge summary and various bills of the services provided to

79
the patient. It also helps to track the status of the claims and provides a provision for
follow up to these TPA and Insurance companies.
Features of Patient Referral System Module
• List of Hospitals with their specialties
• Communication of Clinical Information of the system using HL7 messages
• Sending the patient details by email
• Records the details of transportation of the patient.
• Ensures patient billing before transfer.
Patient Referral System:
The patient referral system facilitates the referral of a patient to other
Healthcare Organizations for further management. This module identifies the need for
referral and provides a list of Healthcare Organizations to which the patient can be
referred. The Clinical details of the patients can be communicated to those hospitals
by using the HL7 messages. It also manages the means of transportation of the patient
to those hospitals and identifies revenue generation for referral if applicable.
Features of Payroll and HR Management module
• Daily attendance entry
• Leave accounting
• Substitute management
• Salary calculations
• Pay slips
• Payroll reports
• Performance indicators
• Recruitment activities
• PF, TDS management
• Final settlement processing
•:• Bonus and Incentives management.
HR and Payroll Management:
HR and Payroll Management module is primarily responsible to track and
manage all the human resourcing activities with respect to the personnel and payroll
functions. This includes management of the daily attendance and duty and shift
timings of the Hospital staff. It also helps in managing the leaves of the staff and

80
arrangement of substitutes for those absent. Recording and keeping track of the
Human Resources Development activities like seminars and trainings.
Features of Payroll and HR Management module
• Daily attendance entry
• Leave accounting
• Substitute management
• Salary calculations
• Pay slips
• Payroll reports
• Performance indicators
• Recruitment activities
• PF, TDS management
• Final settlement processing
• Bonus and Incentives management.

Duty Roster Management:

The duty roster management module is used for scheduling of working hours
for the staff of various departments, including doctors and nurses which work round
the clock. It maintains shift rotation of doctors and nurses, analyze the workload and
skills of the nurses. This module is used to assign various timings to different shifts,
assign shifts to various employees department wise. It also helps manage substitutions
for absent employees.
Features of Duty Roster Management module
• Easy management of the Duty Shifts of the employees.
• Appointment scheduling wrt to shift timings of the consultant.
• Manipulation of substitutes in case of absent employees.
• Provision for scheduling overtime.
Physiotherapy and Rehabilitation:
The Physiotherapy and rehabilitation Module provides the physiotherapist to
maintain the physiotherapy schedules of the patient manage the physiotherapy
sessions and keep record of the therapies provided to a particular patient. It also helps
in estimating the relevant progress of the patient's health status and has the ability to

81
chart the improvement of a patient over a period of time. It provides the schedule of
exercises to be performed at home by the patient.
Features of the Physiotherapy and Rehabilitation Module
• Maintains a schedule for the patient's Physiotherapy sessions
• Provides automatic reminders to the patients as per their schedule
• Tracks the pattern of improvement of the patients
• Provides a schedule of exercises to be performed a home
• Helps collect detailed description of a physiotherapy session
• Manages the referrals by a surgeon for post operative rehabilitation
Dietary Management:
The dietary management module provides assistance to the hospital kitchen in
providing meals to inpatients as per the instructions of the dietician. The module
facilitates the dietician to prescribe a diet as instructed by the physician to any given
patient. The module also allows the maintenance of meal scheduling, customizing
meals as per patient meals and recording of individual meal orders.
Features of the dietary management module
• Allows the user to create the food items groups and food items available in the
hospital kitchen.
• Captures the calorie count as well as the nutritional information of all food
items.
• Facilitates capturing of recipes that are made up of food items or other recipes
and their proportionate quantities. The steps for preparation can also be
mentioned.
• Charts for maintaining the nutritive information of different food stuffs.
• Creation of a meal plan for the kitchen by the dietician in the system for
breakfast, lunch and dinner for any given period of time as per the
requirements of patients.
• Generates an order for the kitchen providing a list of items to be prepared for
each day, based on the requirements of the patient.

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CSSD (Central Sterile and Supply Department):
The Central Sterile Supply Department's (CSSD) main function is to provide
sterile items, linen, equipment to ward's and OT's. The CSSD receives reusable
equipment; linen from various OT's and ward's for sterilization and performs the
sterilization of these equipment, linen, etc. Further it stores these equipment, linen, etc
and dispenses it as and when required by various departments. The Central Sterile
Supply Department (CSSD) module records and facilitates all these functions carried
out by the department.
Features of the Central Sterile Supply Department module
• Records the daily instruments, linen, etc received by various departments for
sterilization.
• Classification of the instruments, linen, etc based on the type of sterilization
technique.
• Locating various items in the CSSD.
• Tagging the items with the date of sterilization.
• Online receipt of requirements from the Operation Theater and wards.
• Scheduling maintenance of the equipment used for sterilization.
• Monitoring the quality of sterilization.
Housekeeping and Laundry Management:
The Housekeeping and Laundry management module provides the facility to
manage and monitor the housekeeping activities in a hospital. This module facilities
and keeps track of the housekeeping activities like patient room preparation,
sweeping/mopping floors, dusting furniture, cleaning fixtures/ walls/ windows/
ceiling/ bathrooms, etc. A schedule is maintained which alerts the Housekeeping and
laundry department of the activities that are to be performed. The housekeeping and
laundry module helps the healthcare organization to reduce the waiting time of the
patients requiring admission to the inpatients department.
Features of the Housekeeping and Laundry Module
• Scheduling the cleaning of various areas of a hospital.
• Appointing staff for specific housekeeping activities.
• Integrated with the stores department to maintain the required stock.
• Scheduling the changing of linen used by the In-patient department.

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 • Maintaining the count of incoming and outgoing laundry items
• Scheduling maintenance activities of cleaning equipments.
• Quality indicators provided for cleanliness.
• Real time updates of cleaning orders from various departments.
Bio-Medical Waste Management:
The Bio-Medical waste management protocol module keeps track of the
collection and disposal of Bio-medical waste produced in the Healthcare
Organization. This module helps in defining, identifying and categorizing the waste
produced within the healthcare organization into different categories including the
radioactive waste materials. This module identifies the areas within the organization
where the waste is actually generated and finally disposed off. It also manages the
time frames within which the waste has to be disposed off and provides a checklist for
the same. It also helps to schedule and keep track of the staff responsible for the
Bio-medical Waste Disposal.
Features of Biomedical Waste Management Module
• Categorization of waste into different types.
• Keeps track of the Generation of Waste.
• Schedules and identifies the Collection of waste
• Tracks and records the transportation of waste.
• Acknowledgement of the safe disposal of waste.
• Scheduling of the timely disposal of waste.
• Radioactive waste disposal management.
• Color codes for different types of waste.
Telemedicine:
Telemedicine is a field of healthcare IT which deals with the communication
of health related information of a patient between two or more remote healthcare
entities. This health related information of a patient may be communicated in the form
of online video chatting, simple text messages, digital or DICOM images, audiovisual
films or any other digital form of data. To send and receive such information to and
from remote systems via the internet or satellite communications, telemedicine
compatibility becomes highly essential. Our systems are fully compatible for such
communications used in Healthcare.

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Features of Telemedicine compatibility
•:• Ability to provide unique Identification numbers to the patients.
• Ability to make appointments over the telemedicine network.
• Ability to have voice and video connectivity.
•:• Provision to attach the medical data transmitted to be part of the patient EMR.
•:• Ability for the remote doctor (client) to access patient's EMR.
• Storage of information of all the interactions within the network.
•:• Provision to use the telemedicine network to possibly support tele-education.
• Comprehensive GUI to create, retrieve and update a patient's Information.

1.43 Current statue of health information technology

Majority of the hospitals in the country are rooted in manual processes, which
are unable to cope with the volume of data generated. In the larger hospitals, patient
records remain difficult to access and these adversely affect quality of health delivery.
The demands of the insurance sector for more efficient information storage and
retrieval are also going to add to the pressure on hospitals and health providers.
According to industry analysts, any hospital with a minimum capacity of 100 beds is a
potential IT buyer. It is estimated that there are over 1,000 hospitals in that category
in the country. National Association of Software manufacturers are services
Companies (NASSCOM) believes that healthcare organizations in India will spend
around INR 100 million on IT in the current year. The major component of this will
be hospital management systems and networking hardware required for processes like
telemedicine. Even with such a small scale of operations, some significant changes
are being made nationwide that will strengthen telemedicine initiatives and the
healthcare industry as a whole. The most important initiative being the
standardization of exchange of health information between different entities within
the healthcare sector.
Information Technology are jointly creating a national health information
infrastructure, for easy capture and dissemination of health information! To support
this infrastructure, necessary steps are also being taken in creating a legally safe
environment that will protect the privacy and confidentiality of health information

85
.Steps are also being taken to educate various stakeholders of the healthcare industry
about the need for complying with health information standards.
Although a large number of products are available in the market, the major
players in this field are CDAC, Wipro, TCS and Siemens Information Systems Ltd
(SISL). CDAC, an autonomous government IT organization, was a pioneer in
developing HIS solution in India. The degree of IT use varies by health care setting:
Pharmacies are generally advanced users, while other settings such as physician
offices or nursing homes are further behind. The kind of technology used also varies
by setting. For example, in home health, the use of technology that allows patients to
monitor their own vital signs from their home and communicate results to the agency
could increase the ability to address a problem before a patient requires acute care. In
both home health and nursing home settings, use of handheld computers to complete
documentation and capture patient assessment information can increase efficiency and
provide more information to care givers. IT and the Internet have also had a
significant impact on consumers. Numerous websites have made health information
more available to patients, thereby strengthening their role in care decisions. E-health
services are being adopted by healthcare provider organizations in India gradually.
The growth of e-health services has given rise to the need for a new breed of
healthcare professionals, healthcare administrators and healthcare technologists. This
industry needs people who can understand any two of healthcare, business and
technology.
Government Policy

Currently, official HIT adoption or implementation policies are almost

nonexistent. However, HIT is on the government's radar and serious exploratory
initiatives are underway to explore coordination of a national health IT infrastructure
and network.
Framework for Information Technology Infrastructure for Health:
In consultation with Apollo Health Street Limited, the Department of
Technology (within the Ministry of Communication and Information Technology)
created the ITIH Framework in 2003. The Framework is a guideline document and
comprehensive roadmap that prescribes IT standards and guidelines for each

86
stakeholder across diverse healthcare settings in India with the goal of building an
Integrated Healthcare Information Network.
National Knowledge Commission (NKC):
Established in 2005 with a three-year mandate, the NKC is a high-level
advisory body to the Prime Minister of India, with the objective of transforming India
into a knowledge society. It covers sectors ranging from education to e-govemance,
with a working group focused on health information technology.With a maturing
private healthcare sector, the private hospital chains have become the primary
consumers and financiers of HIT. The aggressive IT sector in India is slowly
managing to move large government hospitals toward HIT adoption.
Challenges:
Policy Absence of clear, coordinated government policy to promote HIT
adoption
Government funding:
Almost non-existent government funding for HIT has resulted in lack of HIT
adoption in government health facilities and a lack of trained medical informatics
professionals
Computer literacy:
Low computer literacy among the government staff, and to a large extent in
the private provider community
Infrastructure and coordination:
Lack of supporting infrastructure and coordination between public and private
sector.
Legacy systems:
Except for a very few privately owned large hospitals, most patient records are
paper based and very difficult to convert to electronic format.
Standards:
Local HIT systems that do not adhere to standards for information
representation and exchange . This could be further complicated because of the use of
multiple local languages by patients and some health workers

87
Privacy:
Patient confidentiality is an open area. The Supreme Court of India has not
addressed the specific right of privacy issue with respect to health information.
Private Sector
• The private sector has seen the entry of established HIT vendors like GE and
Siemens, and homegrown vendors have begun implementing IT solutions in
private healthcare facilities such as Wockhardt Hospitals, a tertiary care
hospital group throughout India.
• The Apollo Hospitals group, the leading private hospital group in India, plans
to integrate all its systems across 42 hospitals with a common platform. It is
introducing HIPAA standards across all its EMR implementations and has a
core IT team of 30 people and a growing IT budget that makes up about 4.5%
of its operational budget.
Government
• The central government has announced projects to build a national disease
surveillance system called the Integrated Disease Surveillance Project (IDSP)
sponsored by the World Bank, making it the largest such project in the nation.
Two of the authors (SK, VK) directed the design of an informatics engine
behind a shortlisted proposal for IDSP.
• The Indian Space Research Organization (ISRO) has taken the initiative to
establish telemedicine centers across India.
• Efforts are underway by the Ministry of Health and Family to computerize
basic information systems at the top public tertiary hospitals.
••• The privatization of medical insurance will become a major driver of HIT
adoption in the future, which will create a big push for comprehensive patient
information and consequently the use of HIT.

1.44 Informational Role

Informational role pertains to receiving and transmitting information from
staff members. Mintzberg observed that a large part of the manager's job is devoted
to informational roles, in which the manager acquires processes and communicates
information

88
The informational role includes - monitor role, disseminator role, spokesperson role
1.44.1 Monitor Role:
In monitor role, manager monitors or scans the source of information
environment. Manager collects internal and external information about issued that can
affect organization. They also talk with people they meet in their liaison roles. This
information, gathering roles in the monitor role.
1.44.2 Disseminator Role:
In disseminator role, manager passes certain information to peers and
subordinates that is obtained from either internal or external sources.
1.44.3 Spokesperson Role:
In spokesperson role, manager provides information about the organization to
external community such as press, TV, suppliers and to government officials. For top
managers, this information role is a key part of their regular management duties as
they interact with government officials, consumer groups, and other people who have
an influence on or interact in the organization.
1.45 Types of Health Information Technology
Although HIT has many uses throughout healthcare system, three important
types of health IT may affect healthcare industry in the near future as more consumers
use personal health records (PHRs) and more physicians use electronic health records
(EHRs) and electronic prescribing (e-Rx).
1.45.1 Personal Health Records
Patient's personal health record (PHR) is an online document with information
about his health (and the health of family members) that he keep up to date for easy
reference. Using PHR, patient can keep track of his family's health information, such
as the date of his children's immunizations, last physical exam, major illnesses and
operations, allergies, or a list of family medicines.
Many PHRs are easy to use and may be provided free from patient's health
plan, the government, his doctor's office, and private companies. Some PHR
companies charge a monthly or annual fee. Since PHR is online, patient can get into
and manage his health information from anywhere that he has access to the internet.
Since patient can collect, view, manage, and share his health information

89
electronically, having a PHR will allow him to take a more active role in managing
his own health care.

1.45.2 Electronic Health Records

An electronic health record (EHR) is computer-based document that is used by
doctor, doctor's staff, or a hospital. An EHR (similar to old paper medical chart)
contains health information from doctor and other health care providers. A typical
EHR has information about patient's health conditions, allergies, treatments, tests, and
medications. Many EHRs can connect with health care providers outside doctor's
office such as specialists, labs, imaging facilities (X-rays, CT Scans, MRIs), and the
local hospital. This allows doctor to share up-to-date information with other providers
as well as getting quick and easy access to tests and hospital information.
Since everyone involved in health care can share accurate information, EHR
can help lower the chances of medical errors and may help improve the quality of
health care. Some EHRs have warning systems built in to let doctor knows about drug
allergies or potential problems with drug interactions. Also, some EHRs have medical
alerts to remind doctor to perform certain tests or procedures. For example, if patient
has diabetes, your doctor's EHR may remind your doctor to check your feet at every
visit or order a blood sugar test.
Depending on the EHR used by doctor, patient may be able to link his
personal health record with doctor's electronic health record and share information
back and forth.
1.45.3 Electronic Prescribing (Computerized Provider (Physician) Order Entry
(CPOE))
Electronic prescribing or e-prescribing (eRx) is a way for doctor and other
health care providers to send patient's prescriptions to pharmacy electronically.
Instead of writing out a prescription and having patient take it to drugstore, doctor
orders medication through his office computer, which then sends a secure electronic
prescription to pharmacist. It can reduce total medication error rates by 80%, and
adverse (serious with harm to patient) errors by 55%. In addition to electronic
prescribing, a standardized bar code system for dispensing drugs could prevent a
quarter of drug errors. Consumer information about the risks of the drugs and

90
improved drug packaging (clear labels, avoiding similar drug names and dosage
reminders) are other error-proofing measures. Further applications for dispensing to
include bar-coding at medication dispensing (BarD), robot for medication dispensing
(ROBOT), and automated dispensing machines (ADM) are defined.
Electronic prescribing helps to:
• avoid mistakes due to doctor's handwriting or pharmacist's misreading of
doctor's prescription abbreviations
• avoid harmful drug interactions by letting doctor know that the drugs being
ordered may interact with a medication patient is already taking
• Allows doctor to see what medications are on patient health plan's drug
formulary to make sure the drug being ordered is covered.
1.45.4 Telemedicine technology
The term telemedicine refers to the use of information technology to exchange
medical data to deliver consultations, procedures, exams or monitoring services over
geographic distances. It typically refers to the delivery of clinical services, while the
terms telehealth and e-health are often used more broadly to include nonclinical
activities, such as research, education and administration. The term e-care is
sometimes used as a synonym for telemedicine, but in the federal government it
includes technologies to aid in advanced analytics, as well as clinical services.There
are three main categories of telemedicine, each of which is being used in some
capacity in nearly every medical field.
1.45.5 Remote patient monitoring
Is a rapidly growing telemedicine technology, and it is championed as a way
to save vast sums of money in health care costs. Patients with chronic diseases can be
monitored in their homes through the use of devices that collect data about blood
sugar levels, blood pressure or other vital signs, and the data can be reviewed instantly
by remote caregivers. Store and forward technology stores clinical data, as well as X-
rays and other images, and forwards it to other locations for evaluation.
1.45.6 Interactive telemedicine
Let's physicians and patients communicate in real time. Such sessions can be
conducted in the patient's home or in a nearby medical facility. Typical activities for
these sessions include medical history review, psychiatric evaluations, ophthalmology

91
assessments and other activities that do not require direct physical contact. Psychiatric
evaluations, particularly in children and young adults, may actually be more effective
with the use of telemedicine; because the physician conducting the interview is not in
the same room as the patient, the evaluation process can be less intimidating.

1.46 Type of information chart

Example of health information technology for hospitals

Type of information technology Applications

Billing
General ledger
Cost accounting systems
Hospitals Administrative and financial
Patient registration
Personnel and payroll
Electronic materials management
Computerized provider order entry for
drugs, lab tests, procedures
Electronic health record
Picture archiving and communication
systems for filmless imaging
Results reporting of laboratory and other
Clinical tests
Clinical decision support systems
Prescription drug fulfillment, error-alert,
transcriptions
Electronic monitoring of patients in
intensive care units
Desktop, laptop, cart-based, and tablet
computers
Servers and networks
Wireless networks
Voice recognition systems for
Infrastructure transcription,
physician orders, and medical records
Bar-coding technology for drugs, medical
devices,
and inventory control
Information security systems
Billing
and financial Accounting
Physicians Administrative and financial
Scheduling
Personnel and payroll /d^3^^—-^^
' ^-^—^^ A5r ^NrfrS

92
=PU,
 Online references (drug compendia and
clinical
guidelines)
Receiving lab results and other clinical
information
Clinical online
Electronic prescribing
Computerized provider order entry
Clinical decision support systems
Electronic health record
E-mail communication with patients
Desktop and laptop computers
Infrastructure Handheld technology
Servers and network

The following technologies and terms are often included in discussions of

information technology in health care:

• Electronic health record (EHR):

From various sources (eventually integrating text, voice, images, handwritten
notes, etc.). Now they are generally viewed as part of an automated order-
entry and patient-tracking system providing real-time access to patient data, as
well as a continuous longitudinal record of their care.
• Computerized provider order entry (CPOE):
CPOE in its basic form is typically a medication ordering and fulfillment
system. More advanced CPOE will also include lab orders, radiology studies,
procedures, discharges, transfers, and referrals.
• Clinical decision support system (CDSS):
CDSS provides physicians and nurses with real-time diagnostic and treatment
recommendations. The term covers a variety of technologies ranging from
simple alerts and prescription drug interaction warnings to full clinical
pathways and protocols. CDSS may be used as part of CPOE and EHR.
• Picture archiving and communications system (PACS):
This technology captures and integrates diagnostic and radiological images
from various devices (e.g., x-ray, MRI, computed tomography scan), stores
them, and disseminates them to a medical record, a clinical data repository, or
other points of care.

93
*l* Bar coding:
Bar coding in a health care environment is similar to bar-code scanning in
other environments: An optical scanner is used to electronically capture
information encoded on a product. Initially, it will be used for medication (for
example, matching drugs to patients by using bar codes on both the
medications and patients' arm bracelets), but other applications may be
pursued, such as medical devices, lab, and radiology.
*** Radio frequency identification (RFID):
This technology tracks patients throughout the hospital, and links lab and
medication tracking through a wireless communications system. It is neither
mature nor widely available, but may be an alternative to bar coding.
*l* Automated dispensing machines (ADMs):
This technology distributes medication doses.
•> Electronic materials management (EMM):
Health care organizations use EMM to track and manage inventory of medical
supplies, pharmaceuticals, and other materials. This technology is similar to
enterprise resource planning systems used outside of health care.
• Interoperability:
This concept refers to electronic communication among organizations so that
the data in one IT system can be incorporated into another. Discussions of
interoperability focus on development of standards for content and messaging,
among other areas, and development of adequate security and privacy
safeguards.
1.47 Quality and health information technology
The solution to better healthcare IT is not simply adding more technology.
Hospitals, physicians and other providers must create information-driven healthcare,
where technology is integrated into the healthcare ecosystem, transforming data into
knowledge. When healthcare is driven by interconnected information, the community
of care is empowered to create better patient outcomes. One of the primary motivators
for adopting much clinical health IT applications is the belief that they improve the
quality of patient care.

94
 Beyond improving care in individual settings, health IT also has the potential
to address the problems presented by a fragmented delivery system. Most patients
receive care from many disparate providers. The primary means of coordination is
often through discussion with the patients about what other services they have
received and what the other providers thought about their conditions. Information
technology used across settings could create a "virtual" integrated delivery system
without requiring formal mergers or affiliations.
In 2000, the Institute of Medicine (lOM) released a report focusing on patient
safety estimating that 44,000 to 98,000 people die in U.S. hospitals annually as a
result of medical errors. Many of these errors involve medications. In a subsequent
report, the lOM identified IT as one of the four critical forces that could significantly
improve health care quality and safety (lOM 2001). Partly in response to these
reports, the Leapfrog Group, a group of large employers committed to patient safety
improvements, made hospital adoption of CPOE a major goal for large employers and
health plans. These influential external forces linking IT to improved quality and
patient safety have contributed to a widespread belief that adoption of IT in health
care will improve quality and safety.
Health IT implementation issues such as work flow disruption, physician
involvement, and ease of use have tremendous impact on whether health IT is
effective.
CPOE improved quality and safety through one of the following actions:
<• reducing medication errors, including adverse drug events;
• decreasing dosage errors;
• prescribing certain medicines more precisely; or
• Prescribing with improved accuracy by faculty and residents (Oren et al.
2003).
Although more limited in the types of errors it can prevent, bar coding is
probably the most proven technology of those we discuss. Bar coding prevents errors
at the patient's bedside by averting the administration of the wrong drug when other
levels of review have failed.
Studies document that bar coding reduced ambulatory and inpatient
medication error and the number of adverse drug events (Oren et al. 2003, Bates and

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Gawande 2003, GAO 2003). One study at a Department of Veterans Affairs hospital
showed that bar coding of medications could prevent from medical error by 85percent
(McVicar and Valdes 2003).
In a review of the evidence on CPOE, researchers found that one important
issue in ensuring successful implementation of CPOE is that the threshold for alerts
must be set so that physicians do not receive so many "false alarms" that the
information is ignored (Kaushal and Bates 2001).
Electronic health records are often implemented with CPOE and decision
support efforts; therefore, it is difficult to evaluate separately their impact on quality.
However, an electronic health record has the potential to make health information
more available to providers and patients when they need it. The availability of lab and
radiology reports, patient-specific histories, and clinical reminders, along with other
functions such as CPOE and bar coding, have the potential to improve quality.
A recent study of the effect of computerized guidelines for managing heart
disease in primary care found that sophisticated reminders from an EHR (Electronic
Health Records) failed to improve adherence to accepted practice guidelines or
outcomes for patients with heart disease (Tierney et al. 2003). A Department of
Veterans Affairs hospital that is the test site for a new computer software program
recently reported surgery delays and other problems with its new computer system
(De La Garza 2004).
1.48 What Can Data Mining Do?
(Data mining aims to extract knowledge and insight through the analysis of
large amounts of data using sophisticated modeling techniques. It converts data into
knowledge and actionable information.fThe data to be analyzed any reside in well
organized data marts and data was learns or may be extracted from various instructed
data sources. A data running procedure has many stages. It typically involves
extensive data management of before the application of a statistical or machine
learning algorithm and the development of an appropriate model. Specialized
software packages have been developed data mining tools which can support the
whole data mining procedure./Data/mining models consist of a set of piles,
equipments or complex. 'TransfeNnsf^itutions' that can be used to identify useful data

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patterns. Understand and predict behaviors. They can be grouped into two main
classes according to their goal as follows:
1.49 Supervised / Predictive Models
In supervised, or predictive, directed, or targeted modeling, the goal is to
predict an e vent or estimate the values of a continuous attribute. In these models there
are input fields or attributes and an output or target filed. Input fields are also called
predictors because they are used by the model to identify a prediction function for the
output field. We can think of predictors as the A part of the function and the target
filed as the Y part the outcome. The model uses the input fields which are analyzed
with respect to their effect on the target field Pattern recognition is supervised by the
target field. Relationships are established between input and output fields. An input
output mapping funcfion is generated by the model which associates predictors with
the output and permits the prediction of the output values given the values of the input
fields. Predictive models are further categorized into classification and esUmation
models.
1.49.1 Classification or propensity models:
In these models the target groups or classes are known from the start. The goal
is to classify the cases into these predefined groups in other words, to predict an
event. The generated model can be used as scoring engine for assigning new cases to
the predefined classes. It also esUmates a propensity score for each case. The
propensity score denotes the likelihood of occurrences of the target group or event.
1.49.2 Estimation models:
In unsupervised or undirected models there are no output field just inputs. The
pattern recognition is undirected it is not guided by a specific target attribute. The
goal of such model is to uncover data patterns in the set of input fields.
1.50 Unsupervised models include
1.50.1 Cluster models
In these models the groups are not known in advance. Instead we want the
algorithms to analyze the input data patterns and identify the natural groupings of
records or cases. When new cases are scored by the generated cluster model they are
assigned to one of the revealed clusters.

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1.50.2 Association and sequence models
These models also belong to the class of unsupervised modeling. They do not
involve direct prediction of a single field. In fact, all the fields involved have a
double role, since they act as inputs and outputs at the same time. Association models
detect associations between discrete events, products, or attributes. Sequence models
detect associations over time.
1.51 Data Mining in the CRM Framework
Data mining can provide customer insight which is vital for establishing an
effective CRM strategy. It can lead to personalized interactions with customers and
hence increased satisfaction and profitable customer relationships through data
analysis. It can support an individualized and optimized customer management
throughout all the phases of the customer lifecycle form the acquisition and
establishment or a strong relationship to the prevention of attrition and the winning
back of lost customers. Marketers strive to get a greater market share and a greater
share of their customers. In plain words they are responsible for getting, developing,
and keeping the customers.
More specifically, the marketing activities that can be supported with the use of data
mining include the following topics:

1. Gathering and integrating the necessary data from different data sources.
2. Customer analysis and segmentation into distinct customer groups.
3. Development of targeted marketing campaigns by using propensity models in
order to select the right customers.
4. Campaign execution by choosing the appropriate channel, the appropriate time
and the appropriate offer for each campaigns.
5. Campaign evaluation through the use of the test and control group. The
evaluation involves the partition of the population into test and control group
and comparison of the positive responses.
6. Analysis of campaign results in order to improve the campaign for the next
round in terms of targeting, time, offer, product, communication, and so on.
Data mining can play a significant role in all these stages, particularly to
identifying the right customers to be contacted.

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1.52 Most Useful Data Mining Applications in the CRM Framework
The following list summarizes some of the most useful data mining
applications in the CRM framework.
1.52.1 Customer Segmentation
• Value - based segmentation: Customer ranking and segmentation According
to current and expected estimated customer value.
<• Behavioral segmentation: Customer segmentation based on behavioral
attributes.
*l* Value-at-risk segmentation: Customer segmentation based on value and
estimated voluntary churn propensity scores.

1.53 Information technology in hospitals

Relatively little is known about the level of diffusion of IT in hospitals and
strategies hospitals take when making IT investment decisions. Diffusion of
information technology in hospitals varies with the type of technology. Of the three
major categories shown in, diffusion is greatest in administrative and financial
applications such as patient registration, billing, and payroll. Clinical applications,
such as computerized provider order entry for drugs or other items (e.g., lab work)
and electronic health records, are less diffused. Infrastructure technologies build the
base that other technologies work from, and include both widely diffused
technologies, such as e-mail and telecommunications, and those that are less common,
such as wireless connections and voice recognition. Infrastructure investments also
include maintaining secure information systems that comply with federal security
rules.

• For each type of clinical IT, academic medical centers and large hospitals are
more likely to be advanced users.
• Providers who are part of integrated systems delivering inpatient and
outpatient services are also more likely to have the necessary financial support
and a clearer need to ensure smooth flow of information across their systems.
• Those who are part of multiple hospital systems (about half of all hospitals
according to the American Hospital Association Guide 2003-2004) probably

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 benefit from IT support offered by the larger organization. They may also be
motivated to adopt IT to facilitate information flow across system members
• For each type of clinical IT, academic medical centers and large hospitals are
more likely to be advanced users. Providers who are part of integrated systems
delivering inpatient and outpatient services are also more likely to have the
necessary financial support and a clearer need to ensure smooth flow of
information across their systems. Those who are part of multiple hospital
systems (about half of all hospitals according to the American Hospital
Association Guide 2003-2004) probably benefit from IT support offered by
the larger organization. They may also be motivated to adopt IT to facilitate
information flow across system members.
• Clinical applications, particularly CPOE and EHR, may not diffuse rapidly for
a number of reasons. They are relatively new. They are costly, complex, and
difficult to implement in stages. They require significant changes in work
processes and culture for nurses, pharmacists, other allied health professionals,
and physicians to be successfully implemented. Finally, achieving the benefits
of these technologies for improvements in quality of care appears to hinge on
the same factors that pose a risk to successful implementation. As discussed
below, the financial return to investment for these technologies is uncertain.
1.54 Significance of Information Processing In Hospitals
1.54.1 Information Processing Is an Important Quality Factor
Almost all healthcare professionals need a vast amount of information. It is
essential for the quality of patient care and for the quality of hospital management to
fulfill these information needs. When a patient is admitted to a hospital, a physician or
nurse first needs information about the reason for admission and about the history of
the patient. Later, she or he needs results from clinical, laboratory, and radiology
examinations which are some of the most frequent diagnostic procedures. In general,
clinical patient - related information should be available on time, and it should be up-
to-date and valid (e.g. the recent lab.)
If this is not the case, if it comes too late, or is old or even wrong, the quality
of patient care is at risk (e.g., an incorrect lab report may lead to erroneous and even
harmful treatment decisions). If this causes repetition of examin "^ "

100 ' * '^-i^-H™

searches for information, the costs of health care may increase. Information should be
documented adequately, enabling healthcare professionals to access the information
needed and to make sound decisions.
People working in hospital administration also must be well informed in order
to carry out their tasks. They should be informed in a timely fashion and receive
current information. If the information flow is too slow, bills are written days or even
weeks after the patient's discharge. If information is missing, payable services cannot
be billed, and the hospital's income will be reduced.
Hospital management also has an enormous information need. Up-to-date
information about costs and proceeds are necessary as a basis for controlling the
enterprise. Information about the quality of patient care is equally important, for
example, about the form and severity of patients' illnesses, about nosocomial
infections, or about complication rates of therapeutic procedures. If this information
is not accurate, not on time, or incomplete, the hospital's work cannot be controlled
adequately, increasing the risks of management errors. Thus, information processing
is an important quality factor in health care and, in particular, in hospitals.

1.54.2 Information Processing Should Offer a Holistic View Of The Patient and
Of The Hospital
Information processing in a hospital should offer a comprehensive, holistic
view of the patient and of the hospital. "Holistic" in this context means a complete
picture of the care of a patient, independent of where in the hospital the patient has
been or will be treated. This holistic view on the patient can reduce the undesired
consequences of highly specialized medicine with various departments and healthcare
professionals involved in patient care. Despite highly differentiated, diagnostics and
therapy, and the multitude of people and areas in a hospital, adequate information
processing (and a good hospital information system) can help to make information
about a patient completely available. As specialization in medicine and health care
increases, so does the fragmentation of information, which makes combining
information into such a holistic, view more and more necessary. However, it must be
clearly ensured that only authorized personnel can access patient data and data about
the hospital as an enterprise.

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1.55 Importance of Systematic Information Management
• All people and all areas of a hospital are affected by the quality of its
information system.
Nearly all people and all areas of a hospital are affected by the quality of the
information system, as most of them need various types of information ( e.g. about the
patient) in their daily work. The patient can certainly profit most from high-quality
information processing since it contributes to the quality of patient care and to
reducing costs. The professional groups working in a hospital, especially physicians,
nurses, and administrative personnel, but also others, are also directly affected by the
quality of the information system.. As they spend 25 % or even more of their time on
information handling, they directly profit from good and efficient information
processing. But they will also feel the consequences if information processing is poor.
• The amount of information processing in hospitals is considerable
The amount of information processing in hospitals, especially in larger ones,
should not be underestimated. Let us look at a typical German University medical
center. It is an enterprise encompassing a staff of approximately 6,000 people, an
annual budget of approximately 500 million E and , as a maximum care facility
numerous tasks in research, education, and patient care. It consists of up to 60
departments and up to 100 wards with approximately 1,500 beds and about 100
outpatient units. Annually, approximately 50,000 inpatients and 250,000 outpatients
are treated, and 20,000 operation reports. 250,000 discharge letters, 20,000
pathology reports, 100,000 microbiology reports, 200.000 radiology reports, and
800,000 clinical chemistry reports are written. Each year, approximately 400,000 new
patient records, summing up to approximately 8 million pieces of paper, are created.
When stored in a paper-based form, an annual record volume of approximately 1,500
meters is generated in Germany, for example, they should be archived over a period
of 30 years.
When stores digitally, the annual data volume needed is expected to be around
5 terabytes, including digital images and digital signals, and increasing. The computer
based tools of a university medical center encompass hundreds of computer - based
application components, thousands of workstations and other terminals, and up to a

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hundred servers (larger computer systems that offer services and functionaHty to other
computer systems). Which usually belong to a network?
The numbers in the majority of hospitals are much smaller. In larger ones we
will find, for example, about 10 departments with 600 beds and about 20,000
inpatients every year. In industrialized countries 1,500 staff members would work
there, and the annual budget of the hospital would be about 80 million E. Especially
in rural areas we can also find hospitals with only one department and fewer than 50
beds. In Germany, for example, some basic administrative data must be
communicated to the respective health insurance company online within 3 days after
patient admission and after discharge. In a coded form, they are the basis for
accounting. Additionally, managing and controlling a hospital is possible only if the
costs (such as consumption of materials or drugs) of the treatment can be compared to
the form and this verity of the illness, characterized by diagnosis and therapy.
• Integrated information processing is necessary to efficiently fulfill information
needs.

Information processing has to integrate the partly overlapping information

needs of the different groups and areas of a hospital. It has been shown that
systematic, integrated information processing in a hospital has advantages not only for
the patient, but also for the healthcare professionals, the health insurance companies,
and the hospital's owners. If information processing is not conducted globally across
the institutions, but locally, for example in professional groups (physicians, nurses,
administrative staff) or areas (clinical departments, institutes, administration).
This corresponds to traditional separation politics and leads to isolated
information processing groups, such as 'the administration' or 'the clinic'. In this
case, the quality of the hospital information system clearly decreases while the costs
for information processing increase due to the necessity for multiple data collection
and analysis.
Finally, this has disadvantages for the patient and, when seen from a national
economical point of view, for the whole population. For example "Dismiss a patient."
"Document a diagnosis." or "write a discharge letter"). As they are composed of
individual activities, they also have a definite beginning and end. While enterprise
functions concentrate on the "what". Business processes focus on the ^liow" of

103 ""
activities. We will refer only to enterprise functions and business processes with
respect to information processing.
Whereas enterprise functions and business processes describe what is done,
we now want to consider tools for processing data, in particular so-called application
components and physical data processing components. Both the usually referred to as
information processing tools. They describe the means used for information
processing.
1.56 Hospital Information System
With the definition of information systems in mind, a hospital information
system can be easily defined. A hospital information system is the socio-technical
subsystem of a hospital, which comprises all information processing as well as the
associated human or technical actors in their respective information processing roles.
Typical components of hospital information systems are enterprises functions,
business processes, application components, and physical data processing
components. For the sake of simplicity, we will denote the enterprise functions of a
hospital as hospital functions. As a consequence of this definition, a hospital has a
hospital information system from the beginning of its existence. Therefore, the
question is not whether a hospital should be equipped with a hospital information
system, but rather how its performance can be enhanced. For example, by using state
of the art information processing tools or by systematically managing it. All groups of
people and all areas of a hospital must be considered when looking at information
processing. The sensible integration of the different information processing tools in a
hospital information system is important. Hospital staff can be seen as part of the
hospital information system. For example, when working in the department of patient
records, or as an operator in an ICT department, staff members directly contribute to
information processing. In their role as user of the hospital information system, they
use information processing tools (e.g. a nurse may use a telephone or a computer).
Each employee may continuously switch between these two roles. The goal of a
hospital information system is to sufficiently enable the adequate execution of
hospital functions for patient care, including patient administration, taking into
account economic hospital management as well as legal and other requirements.
Legal requirements concern data protection or reimbursement aspects, for example.

104
 Other requirements can be the decision of a hospital executive's board on how to store
patent records, for decision of hospital executive board on how to store patient
records, for example, to support patient care and the associated administration, the
tasks of hospital information systems are:
1- To make information, primarily about patients, available, current information
should be provided on time, at the right location, to authorized staff, in an appropriate
and usable form. For the purpose, data must be correctly collected, stored, processed,
and systematically documented to ensure that correct, pertinent, and up - to - date
patient information can be supplied, for instance, to the physician or a nurse.

2- To makes knowledge, for example, about diseases, about side effects, and
interactions of medications, available to support diagnostics and therapy.

3- To make information about the quality of patient care and the performance and
cost situation within the hospital available.
So when these people can make the right decisions, this is also described as
information and knowledge logistics. Hospital information systems have to consider
various areas of a hospital, such as
1. Wards,
2. Outpatient units,
3. Service units diagnostic (e.g. clinical laboratory, radiological department) ,
therapeutic ( e.g. operation room ) and others ( e.g. pharmacy, patient records
archive, library, blood bank ),
4. Hospital administration areas (e.g. general administration, patient administration and
accounting, technology, economy and supply, human resources).
5. Offices and writing services for (clinical) report wiring.
6. In addition, there are the management areas, such as hospital management,
management of clinical departments and institutes, administration management, and
nursing management. These areas are related to patient care.

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1.59 Ways of Providing Information
There are different ways of processing and disseminating information. These are
basically identified by two criteria: kind of use and kind of support.
The main features of the first criterion are:
*l* User's mobility,
*l* Frequency of use,
• Degree of analysis complexity,
*l* Complexity of data,
• Available bandwidth,
<• Frequency of data modification,
••• Sharing level of applications,
• The Technical Architecture, scalability,
• Cost per user.
••• On the other hand, the main features of the second criterion concern the modes
of interaction with the system and are related to the kind of support and the
infrastructure adapted:
<• Personal computer for at least one not permanently, contacted to the Internet.)
• Client / server / ( distributed )
• Internet - based technologies (intranet, extranet)

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