An it system that pulls staff together: although the manufacturing world knows it as customer relationship management (CRM), it is a portal to smarter operations by long-term care staff.

Common practice within long-term care organizations is to use standardized forms and spend countless hours updating policy and distributing procedure manual updates (i.e., building the knowledge bank)-but can you ensure that the information is truly understood by facility personnel 24 hours a day, seven days a week? If someone has a question, how does that flow through the organization and elicit an answer? Does the answer come by way of a sticky note or an e-mail obviously written with "attitude?" When a department head leaves, how long does it take for the replacement to come up to speed? In short, how is knowledge leveraged within your organizations?

The manufacturing industry struggles with these same problems. According to a 2001 survey 423 large companies conducted by the business consulting/accounting firm KPMG, 67% of respondents claimed they had too much information to manage. Although recent economic events have led to personnel reductions, productivity measures in the manufacturing sector continue to rise. There are several explanations for this, but the manufacturing sector's dissemination of company knowledge in an organized fashion, using the latest Internet technologies, is an important one.

Long-term care companies' experience with technological resources has been gained primarily through the implementation of information-management software systems. Line personnel, i.e., the individuals entering data into the software application, use this information, but the information-management needs of the "knowledge sector"--department heads and administrators running the overall operation--are not addressed. Because management's expectations are not being met by the software vendor, this often leads to conflict between the vendor and the facility.

Vendors often respond defensively, citing "user error," insufficient training, or excessive employee turnover as contributing factors to users' problems. Line personnel, the IT department, and the software vendor then appeal to the facility's upper management to resolve these issues. Although these managers are expected to make a decision and quickly resolve the problem, in long-term care this decision is frequently pushed back down to the IT department or the line personnel on the grounds that these are the employees who use the software application--not the managers. The financial impact of this "back-and for thing" over time negatively affects both the software vendor and the facility.

The manufacturing sector took a different approach. Manufacturing managers determined that they should be in control since, after all, they are held accountable for the overall operation. Therefore, they looked for tools that would foster solutions and provide them with the knowledge to make informed decisions in the process. Technology companies jumped at the opportunity to fill this vacuum, as it is the managers who place the software orders, after all.

Managers are hired for their ability to manage people and for their decision making abilities; they generally are not hired solely for their computer skills. Therefore, any technology solution has to be easy to use. It needs to include the best features of the software applications managers are already accustomed to using. It needs to be a single answer that will pull information from across all levels and areas of the organization, and it has to be affordable. For this, organizations can look to the Web and a new information technology called "customer relationship management" (CRM). CRM systems are available from LTC software vendors for as little as $500 per month; most vendors are providing free trial periods of up to 90 days. CRM can be used with any software system and any platform.

Web pages have traditionally provided static information, often serving primarily as an advertisement for the company. This is no longer the case. Most manufacturers are now using the Web as a collaborative tool, and new Web-based applications have sprung up to meet the knowledge needs of managers.

The so-called "portal technology" upon which GRM is based has become a popular solution. Enterprise portals using easily accessed icons give large workgroups or entire organizations a central Web gateway to all of a company's resources. These portals feature a formal publishing process to ensure that information is kept accurate and up to date, and that management and staff can search for information across file servers, databases, and the Internet.

Portals also offer advanced document management features that allow businesses to incorporate their business processes directly through the portal. The portal contains many different features with one access point. It is dynamic--it grows naturally, as others contribute to it from other applications.

So, how can portal technology help a long-term care facility?

One simple, affordable solution for long-term care organizations is offered by CRM: the creation of an online library to deal with their staffs' information needs. No more faxes or phone calls. An employee's question is directed to the appropriate individual; if that individual can't answer the question, it can be automatically routed to someone who can (whether or not he or she is located within the organization).

Take, for example, a software-related question routed to the software vendor. The service representative answers the question, and the response is placed back in the facility's online library, available to anyone who has a similar question in the future. If the question relates to regulation, it is routed to the appropriate facility representative, the DON, the staff development coordinator, or the administrator. Or, if a staffer wants an outside consultation from a regional QA Nurse or from an LTG professional association representative, it can be routed via the Internet and, again, the answer returned to the organization's library.

The privacy component of the Health Insurance Portability and Accountability Act (HIPAA) is another significant reason for healthcare organizations today to look into CRM. Many long-term care organizations have multiple-legacy software systems, performing disparate operations that do not talk to each other. CRM can tie together all the methods of inquiry regarding a resident that are currently used: e-mail, fax, electronic x 12 transactions (e.g., a Medicare/Medicaid eligibility check)--by attaching them to the specific resident, along with the responses to the inquiries, thereby creating a global knowledge database on each resident that (unlike paper forms) is password/encryption-protected.

Another HIPAA-related aspect of the CRM system would be a policies-and procedures resource library addressing issues in the collection and disbursement of Protected Health Information (PHI). The knowledge base also can include direct Web links for obtaining the most current information on changing HIPAA regulations.

In short, by organizing disparate information for convenient retrieval when and in the form it is needed, CRM systems help create order in a complex, chaotic environment. Convenience is the key. A portal functions much like a computer desktop icon. Users click on an icon and are connected to different functions on his or her desktop. Utilizing portal technology, the physical location of the software application is no longer important. A company's licensed business software might be on the clientserver located elsewhere in the building. Or, a user might click an icon and access software over the Internet found in a different sector of the county.

It should be noted that for purposes of confidentiality and need-to-know, the portal looks and operates differently for different individuals, based on their passwords. The portal views for line personnel are not the same as those for managers. Each view is determined by the user's preference and job function.

CRM is not exactly new to the LTC field. Leading LTC software vendors are currently employing CRM technology to determine the functionality of their software features by accumulating and analyzing questions asked by customers. If, for example, 7 out of 10 questions to customer-support personnel concern the vendor's newly released bank reconciliation function for accounts payable, the company's quality-assurance reviewers might recommend that the software engineers review and revise this function. Vendors can also use CRM to assist their new customer service reps in coming up to speed quickly, which is useful in the light of the high turnover rate for these personnel.

A regulatory agency familiar to long-term care providers uses CRM extensively: The Centers for Medicare and Medicaid Services (CMS). Through portal technology and CRM, it recently connected all the databases of the Department of Health and Human Services, to provide answers to questions from consumers and providers throughout health- care. This technology is the cornerstone in CMS Administrator Thomas Scully's "Open Door Policy."

It is time for the "heart and soul" of long-term care--facility operators--to begin experiencing the advantages of CRM in their own right. It is an option worth investigating with their LTC software vendors.

Valarie Boughman is a tong-term care information technology consultant based in Sugar Grove, North Carolina. She has been a nursing home administrator for 25 years and worked with Advanced Information Management in development of software for the industry. During the past two years she was director of customer services for CRM vendors. For further information, phone [phone] or e-mail [e-mail]. To comment on this article, please send e-mail to [e-mail]