When David Lafferty arrived at Tidewell Hospice two years ago as the care provider's first CIO, customer relationship management was a bit of what he calls a "milk crate" operation.
"Our liaisons were going from account to account with their own little binders, spreadsheets and rolodexes. We had a typical offline, manual, decentralized, zero-visibility situation," he recalls.
Now, Tidewell, which serves 8,000 families annually in four Florida counties, has one of the most sophisticated CRM implementations in the hospice industry. Tidewell uses Salesforce's SaaS-based CRM, integrated with its internal electronic medical record (EMR) system.
The `aha' moment for Tidewell was the realization that it didn't need a high-priced, hospice-oriented package - a longstanding misconception, Lafferty says.
"Our CRM needs are really almost the same as those in any other industry, just called different things," he says. "We build relationships with physician practices. We educate and develop those relationships into leads. We get referrals. We admit those referrals as patients, and then administer care to them. When a patient dies, we facilitate grief and bereavement counseling and, should the family wish, take advantage of philanthropic or donation opportunity.
"That sounds an awful lot like opportunity, contact, quote, order, fulfill, ship," the typical components of a CRM-based workflow, he says.
Once Tidewell decided to adopt generic CRM, the next decision was on premises, a CRM add-on from its existing EMR provider, or SAAS.
Salesforce.com won out, and cost had a lot to do with the decision, Lafferty says.
"While I can't talk in hard, fast dollars, I can tell you that the cost to run Salesforce for a year, with about 70 or so users today, is probably a little over a third the cost of some of the typical hardware/software solutions we had quotes on," he says.
However, there is a caveat, he says: "Salesforce provides us with beneficial pricing because we're a nonprofit organization. If that had not been the case, those economics would have been very different."
Of course, Tidewell must comply with Health Insurance Portability and Accountability Act privacy rules - and the cloud computing concept gave folks pause, Lafferty says.
"Historically, all the data we cared about, so to speak, was in one system - our EMR system - on one database, in one data center, in one building. Conceptually it was easy for our IT and compliance teams to own, manage and protect that data. So at first, when we talked about keeping our information in the cloud, we needed to do a lot of education on Salesforce.com's approach to security, disaster recovery and so on," he says.
Unidentified cloud-based objects
In addition, Tidewell has implemented CRM so that when liaisons create patient information in Salesforce no unique identifiers get attached to those records. "Clinical info stays in the EMR, the system of record for that data. We bring over patient activity, I'll call it, just so we have the benefit of that census data from a reporting standpoint. But that's all there is in the CRM," he says.
Tidewall uses role-based security controls in Salesforce to ensure that only certain limited individuals even have access to patient information, Lafferty adds. "Casual users, like administrative back-office staff, have visibility into accounts and contacts, but they don't see patient objects when they pull up information on a particular physician, for example."
Tidewell uses an Informatica data integration tool to achieve real-time integration between the EMR system and the Salesforce cloud, Lafferty says. The tool plugs into the EMR database and, multiple times daily, sends patient activity updates directly into Salesforce CRM. Moving forward, when the capability becomes available from the EMR system vendor, Lafferty says he'd like to make that interface bidirectional so data entered into Salesforce CRM would automatically populate in the EMR system.
Creating the patient object, Lafferty says, was the only significant customization Tidewell needed for its initial implementation. "If you look at Salesforce, you've got accounts, contacts, events and tasks - vanilla CRM. But with the patient object, when I meet with Dr. Joe Smith, as a liaison I can look at Dr. Joe's account and see, 'Oh, Dr. Joe has referred 20 patients in the last month, and we're currently caring for four, one of whom is in a hospice and the three others are at home."
For the customization and other deployment guidance, Tidewell relied on the expertise of Model Metrics, a Salesforce partner that counted a hospice among its diverse clientele. That earlier project established the industry knowledge Model Metrics would need for Tidewell's project, even though the hospice organization's core CRM needs alone were pretty much the same as anybody else's, Lafferty says.
"It gets down to the analytics," he says.
"In a hospice, we measure everything in terms of patient census. What's our census today? What's our average length of stay? What's our cost per patient and our revenue per patient or per service line? The metrics we use to measure our business are different from those used by a public company that's going to be looking at gross sales, net sales, orders shipped, days of supply, etc., and we've got a number of dashboards that provide an instant pulse of those metrics for us," Lafferty says. "Model had already been through that drill so ... that whole portion of the development process was accelerated."
Rapid deployment, centralized visibility
Rapid deployment and change support are among the biggest benefits of the SaaS model, says Lafferty, recalling a recent quarterly meeting between IT and the liaisons. A couple of liaisons had suggested a change and within five minutes his certified Salesforce administrator already had done the update and refreshed the screen on the presentation to show everybody.
"That just doesn't happen with a premises-based implementation where you submit a wish list and hope that what you want is in the next release - and then worry whether you're going to be able to apply it on your own or call your contractor back in," he says.
Just one year into its Salesforce CRM deployment and Tidewell already is self-sufficient, relying on Model only in an advanced adviser capacity, Lafferty notes. Besides the liaison project, Tidewell is now using Salesforce CRM for IT project portfolio management, facilities management and maintenance and expects to work on projects for philanthropy and funds development and human resources within the next two years, he says.
"It fits a lot of niches for us at Tidewell," Lafferty says.
And as it fills those niches, it's bringing the benefit of centralized visibility of relationships across the enterprise, he adds. "We're moving down a path, and not that gradually, that'll bring us to one source of truth for all of Tidewell's account, contacts and contracts. The benefits of that will continue to yield themselves day after day," he says.
"That central visibility makes us more efficient but it also makes us smarter. I like to call us the high-tech hospice now," Lafferty says. "What we're doing in the cloud space is leading the charge for other hospice providers around the country."