Healthcare: CRM 2.0 within E-Health

CRM 2.0 within E-Health Systems: Towards Achieving Health Literacy & Customer Satisfaction.

The term e-health is an emerging field at the intersection of healthcare, Information Communication Technology, and business process, referring to health services and information delivered or enhanced through the Internet and related technologies.
Keywords: Healthcare: CRM 2.0 within E-Health, CRM 2.0; HIS; Social CRM; EHR, Customer Satisfaction; Healthcare Organisation, Aged Care, NDIS

In a broader sense, the term characterises not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. Defining e-health as an application of Internet and other related technologies in the healthcare industry to improve access, efficiency, effectiveness, and quality of clinical and business processes utilised by healthcare organisations, practitioners, patients, and consumers in an effort to improve the health status of patients. E-health can provide patient with opportunities to interact with their healthcare systems online and can provide new forms of patient-physician interaction.

The most interesting aspects in e-health is how to manage the relationship between healthcare providers and patients or clients. As in nature, fostering relationship leads to maintain loyal customer, greater mutual understanding, trust, patient satisfaction, and patient involvement in decision making. Furthermore, effective communication is often associated with improved physical health, more effective chronic disease management, and better health-related quality of life. On the other hand, failure in managing the relationship will affect the patient dissatisfaction, distrust towards systems, and jeopardise business survivability in the future.

CRM 2.0 within e-Health: Adopting CRM can be viewed as strategy to attract new customers

Adopting CRM within e-health can be viewed as a strategy to attract new customers coming to an organisation, retaining them throughout the entire lifetime of a relationship, and extending other services or products to the existing customers. In the healthcare environment, healthcare providers are challenged to acquire potential customers for the healthcare services, retaining them to use the services, and extending various services in the future. To take the challenges, a healthcare provider must consider establishing the close of a relationship with their patients offer the convenience of services, and provide transparency in services through information sharing.

Today, every healthcare organisation depends on ICT in every level of activities. The use of web technology, database management systems and internetwork infrastructure are part of the ICT initiative that will affect healthcare practice and administration. We propose our conceptual idea CRM 2.0 or Social CRM as an extension of CRM with the Web 2.0 capabilities in healthcare organisations. The idea operates in the area of a healthcare provider-patient/provider-client and patient-patient/client-client relationships inclusive with social networks interaction, and how they possibly shared information to achieve health outcomes. It offers a starting point for identifying possible theoretical mechanisms that might account for ways in which CRM 2.0 provides an alternative for building an active relationship between healthcare provider, patients, and the community at large.

CRM initiatives as a strategy for significant improvement in services by solidifying satisfaction

In practice, many see CRM as merely a technology for improving customer service which may lead to a failure when implementing it. CRM initiatives must be seen as a strategy for significant improvement in services by solidifying satisfaction, loyalty and advocacy through information and communication technology. As such, matters pertaining related to people such as customer behaviours, culture transformation, personal agendas, and new interactions between individuals and group must be incorporated into CRM initiatives. The organisation need to understand that behaviours and expectations of customers (patients in healthcare organisations, participants in NDIS, people living in aged care facilities are residents) which continue to change over time. Consequently, CRM must address the dynamic nature of patients’ needs and hence adjustments strategies embedded in CRM are required.

Greenberg (2009) defined CRM as a philosophy and a business strategy supported by a system and a technology designed to improve human interactions in a business environment. It is an operational, transactional approach to customer management focusing around the customer-facing departments, sales, marketing and customer service.

CRM has evolved people, processes, and contents which transform from customer management to customer engagement. That is more focused on the conversation that is going on between healthcare-patient and patients-others. Web 2.0, which play a significant part in the CRM transformation drives social change that impacts all institution including business and healthcare organisations. It is a revolution on how people communicate. It facilitates peer-to-peer collaboration and easy access to real-time communication. Because much of the communication transition is organised around web-based technologies, it is called Web 2.0. Patients participate in this social network can share information about their diagnoses, medications, healthcare experiences, and other information. It is often in the form of unstructured communication which can provide new insights for people involved in the management of health status and chronic care conditions.

The term of Social CRM and CRM 2.0 is used interchangeably. Both share new special capabilities of social media and social networks that provide powerful new approaches to surpass traditional CRM. Greenberg (2009) defined Social CRM as a philosophy and a business strategy, supported by a technology platform, business rules, processes, and social characteristics, designed to engage the customer in a collaborative conversation in order to provide mutually beneficial value in a trusted and transparent business environment. It’s the company’s response to the customer’s ownership of the conversation. Described the fundamental changes that Social CRM is introducing to the current, traditional CRM in term of landscape.

Risk Management Impact EHR Aged CareHealthcare: CRM 2.0 within E-Health

E-Health shifting from healthcare-institution cantered care to the patient-centred care

The vision of a paperless organisation is delineated as the embodiment of the future health information systems with the hope is that brings an improvement with promise of to be more reliable effective and efficient. The current status of HIS varies among countries with 193 countries being a member of World Health Organisation (WHO) in 2009; 114 of them participated in the global survey on e-health. Most developed countries have fully utilised HIS in their systems as they have the resources, expertise, and capital to implement them while in the developing countries, HIS have not been fully utilised yet.

One such trend in HIS is the slow adoption of e-health systems toward the use of EMR. The systems move patient information from paper to electronic file formats so they can be easily and effectively managed. However, an interesting fact to be noted that the tendency of people to know more and actively participate in the health promotion, prevention, and care together with the rights that will become a standard legislature guide the development of information systems that support these tendencies. Thus, the trend is towards more patients centred or involvement of patients in receiving information, in decision making and in responsibility for their own health.

The main feature of this trend is the shifting from healthcare-institution cantered care to the patient-centred care emphasising on continuity of care from prevention to rehabilitation. This objective can be achieved through shared care process which builds on health telematics networks and services, linking health providers, laboratories, pharmacies, insurance company and social centres offering to individuals a ‘virtual healthcare centre with a single point of entry. Furthermore, this vision implies the provision of health services to homes with innovative services such as personal health monitoring and support systems and user-friendly information systems for supporting health education and awareness.

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A leading example that has implemented HIS is Australia it has released personally controlled electronic health records (PCEHR) on July 2012. The system will enable better access to important health information held in dispersed records across the country. For the first time all Australians who choose to participate will be able to see their important health information when and where they need it, and they will be able to share this information with trusted healthcare providers.

An emerging trend in HIS is the use of web technologies. The benefits of web services include ease of integration and ease of accessibility. There are a number of health information systems demonstrating applications of computer networks that tap into the vast array of health information available on the web. These systems are designed for patients with a health crisis or medical concern and for primary care providers.

From technological perspective, there are various emerging tools and technologies in creating and managing HIS. Semantic Web is an extension of the World Wide Web, offers a united approach to knowledge management and information processing by using standards to represent machine- interpretable information. Semantic Web technology helps computers and people to work better together by giving the contents well-defined meanings. The semantic Web has also drawn attention in the medical research communities. Semantic web services can support a service description language that can be used to enable an intelligent agent to behave more like a human user in locating suitable Web services. While, Web services are software components or applications, which interact using open XML and Internet technologies. These technologies are used for expressing application logic and information, and for transporting information as messages. They have significantly increased interest in Service oriented architectures (SOAs).

Point Intervention e-health’s features enable to
Point Intervention e-health’s features enable to
Culture & Society 1. Discuss about health services in social network
2. Discuss about health status with friends in social networks
3. Online support/sharing with other patient who have similar condition
4. Use social networks/online support group provided by healthcare provider
Health System 1. Make appointment online
2. View medical records online
3. Request refills prescriptions online
4. Control with whom I share my online medical records
Education System 1. Level of education
2. Age composition
3. Internet Access
4. Interact with online health promotion program
5. Use ICT to consult with health educator

Recent development in ubiquitous computing is a paradigm shift since technology becomes virtually invisible in our lives. The ubiquitous computing environment will make possible new forms of organising, communicating, working and living. However, ubiquitous computing systems create new risks to security and privacy. To organise the u-healthcare infrastructure, it is necessary to establish a context-aware framework appropriate for the wearable computer or small- sized portable personal computer in ubiquitous environment. The mobile health (m-health) a form of ubiquitous computing can be defined as mobile communications network technologies for healthcare. This concept represents the evolution of “traditional” e-health systems from desktop platforms and wired connections to the use of more compact devices and wireless connections in e-health systems.

The next emerging trend in HIS is to use Web 2.0 technologies, such as Facebook, Twitter, Myspace, Friendster, Linkedln, etc. have grown rapidly facilitating peer-to-peer collaboration, ease of participation, and ease of networking. The use of Web 2.0 in HIS system is equivalent to bringing patient expectation aligned with fashion of ICT in actual healthcare services. It offers new outlook either from patient or healthcare organisation, and how they structure inter-relation between three distinct domains of objects; customer’ s expectation, advancement of ICT , and healthcare services. Web 2.0 affects healthcare business processes like relationship between patients and healthcare providers as it is about engaging relationships, sharing experience and information, and collaboration.

Web 2.0 technologies has brought a possibility to extend the service of HIS by enabling patients, patient’s families, and community at large to participate more actively in the process of health promotion and education through social networking process. We proposes integrated HIS which includes holistic approach of personal habit, physical activities, spiritual and emotional activities, and social support as well as social networks to be part of the systems. It is significant to improve customer satisfaction and health literacy in healthcare service in order to accommodate components and features of social networking capabilities, empowering patients, and availability of online health educator.

Customer Service & Customer Satisfaction in Healthcare

As a business, healthcare organisation stands in need of the same standards of customer service as other industries or business organisations. The fact that customer service expectations in a healthcare organisation are high poses a serious challenge for healthcare providers as they have to make an exceptional impression on every customer. In the competitive commercial healthcare market, poor service leads customers to switch healthcare providers because poor service indicates inefficiency, higher cost and lower quality of care. Health care providers have to become “empathy engines,” that are transforming their organisations to allow frontline employees to focus on patient problems and innovate. This applies to hospitals, clinics, payers, vendors and pharmacy chains as well.

Nowadays, more patients have more choices in where they seek care and how they interact with their healthcare providers. Great customer service can lead to major improvements in the health care system. Customer service is not an “extra”— it Healthcare organisation strategies should transform customer strategies and systems to customer engagement. The one is more focused on the conversation that is going on between organisation and customer and the collaborative models that cutting edge companies are carrying out for customer engagement. Proactive strategies will improve customer services. And great customer support will increase loyalty, revenue, brand recognition, and business opportunity.

E-health offers the potential to improve efficiencies and quality in health care

E- health services will eventually make an organisation more efficient and effective in managing its resources hence leading to greater productivity. Electronic records make it easier to schedule appointments for patients, keep track of follow-ups, and ensure patients’ general practitioners are informed of the results of their referrals. In addition, the majority of people would prefer to view and deal with their own health record online. Viewing medical record online is also features that will encourage patients to be proactive with health promotion, boost healthcare awareness, and self-managed healthcare.

In terms of health systems, healthcare organisation must respond demands of patients towards e-health services such as make online appointment, give online access to their medical records, view medical payment online (if necessary), and give them empowerment with whom they want to share their medical records. Last but not least, an education system that affects health literacy, health literacy program should accommodate all level of education and ages appropriately based on their knowledge level and interest, availability of Internet access to all targeted audience, and ability to use ICT in dealing with online health education.

Therefore, the healthcare organisation should perform a reengineering process to adapt their CRM strategy and tool in order to acquire potential customer coming for the service. Though e-health is not going to replace whole existing healthcare services, it is extendable systems which features and services can improve quality of service, provide effectiveness in process, and convenience for the patient. It also will form healthcare service more comprehensive and reliable in serving patients.

From the survey, we found that expectations in healthcare services are high, which create a challenge for a healthcare organisation. In response to the expectation, it is significant to add features as the front end to tie up the interface of e-health. From the survey, it is important to improve customer satisfaction and health literacy in healthcare service to accommodate components and features of social networking capabilities, empowering patients, and availability of online health educator.

Making an appointment online, view their medical records, and consulting online with medical staffs are few examples of empowerment to patient. The authorisation to access health information will benefit both patient and healthcare organisation. From a patient perspective, their health literacy is expected to improve by the time they have a better knowledge of their own health status, and for the healthcare organisation is expected to be long-lasting relationship since they always in need to access the service. Additionally, empowerment is also believed giving them flexible time when and where they want to look upon their health-related activities.

Social networks and social support online is part of the e-health systems. It should be operated, managed, and maintained within healthcare’s infrastructure. This is more targeted to internal patients/families within the healthcare to have a conversation between patients/family within the same interest or health problem/illness. For example, a patient with diabetic would motivate to share his/her experiences, learning, and knowledge with other diabetic patients. Since patient/family who generates the contents of the Web, it can promote useful learning centre for others, not only promoting health among each other, but also it could be the best place supporting group and sharing their experiences related to all issues such as; how the healthcare does a treatment, how much it will cost them, what insurance accepted by healthcare, how is the food and nutrition provided, etc.

In a competitive commercial healthcare environment, negative experience and poor service lead customers to switch healthcare providers because poor service indicates inefficiency, higher cost and lower quality of care. The high expectation of customer service provided by healthcare organisations in the information age poses a serious challenge for healthcare providers as they have to make an exceptional impression on every customer. The adoption of CRM 2.0 features as the front end to tie up the interface of e-health is believed to boost effectiveness and efficiency customer service in healthcare organisations. From the survey, we found that expectations in healthcare services are high, which create a challenge for a healthcare organisation. Furthermore, it is significant to improve customer satisfaction and health literacy in healthcare service at least e-health systems should accommodate components and features of social networking 603 capabilities, empowering patients, and availability of online educator.


Original Article written by:
Muhammad Anshari
PhD Cand. at Universiti Brunei Darussalam, & Department of Informatics, UIN Yogyakarta
Mohammad Nabil Almunawar
FBEPS-UBD, Jl.Tungku Link Gadong, BE 1410 Brunei Darussalam
Patrick Kim Cheng Low
FBEPS-UBD, Jl.Tungku Link Gadong, BE 1410 Brunei Darussalam

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