All In One Place

Seven years ago, the health care system of Newfoundland and Labrador recognized it had a serious data management problem. For starters, it lacked an accurate and accessible central registry of citizens eligible for service under the Newfoundland Medical Care Plan (MCP), the provincial health insurance system. As a result, it frequently had to pay for services provided to Newfoundlanders who continued to present their MCP cards at hospitals and clinics when living, and paying taxes, in other parts of Canada.“The health care system in this country is funded on a per capita basis,” notes Mike Barron, a director at the Newfoundland and Labrador Centre for Health Information (NLCHI). “We found ourselves in a position where our population was decreasing, which meant health care transfer payments [from the federal government] were decreasing. But we were not necessarily paying less for care.”
That was just the most obvious, fiscal problem. Health care in Newfoundland is administered by semi-autonomous regional health authorities — nine originally, soon to be four. Each keeps separate patient records. When Newfoundlanders moved from one region to another, or travelled to receive specialized care — a common occurrence in a province with a population of less than a million where specialized care is necessarily centralized — their health records wouldn’t follow, or not immediately. Result: duplication of records, duplication of expensive tests, and care givers working without full information.
Barron’s organization, an arm’s-length government agency with representation from stakeholder groups throughout the provincial health care community, found the solution in a technology that was then just beginning to be talked about: customer data integration or CDI. NLCHI wanted a system that would maintain what Barron calls “a centralized source of truth” – a master database of citizen-patients with always up-to-date, always accurate data. The regional health authorities would feed into it – and also feed from it. That’s what CDI promised.
If yours is a complex enterprise that frequently deals with the same customer on different matters in different places, you almost certainly have the same problem the NLCHI did. Multiple departments, operating divisions and offices create records for the same customer or contact, often on different, incompatible systems. The data is slightly different in each record – often both syntactically and in terms of details captured – and always incomplete.
The problem comes to light when you decide to implement a centralized customer relationship management (CRM) or enterprise resource planning (ERP) system. How do you now gain a comprehensive view of your customer? This is after all one of the points of CRM. CDI systems can integrate customer data scattered about the enterprise to create a unified record.
Advanced systems such as those from DWL Inc. also let users develop complex business services based on “events” related to customer data. If a customer changes his address at a Web self-service page, for example, the system might analyze the postal code to determine if it’s likely the customer has moved into a new income bracket. In a bank or insurance company, that in turn might trigger an interaction with a marketing system that initiates a call or mailing to the client to offer increased house insurance.
Besides all the soft CRM-related benefits, CDI offers some hard benefits as well, related to cost savings, risk avoidance and regulatory compliance. “You can find a lot of cost reductions if you manage data centrally,” notes Karen Jay, director of marketing at DWL. “It’s not just the systems, it’s the people and processes attached to managing those systems that are replicated.”
CDI also solves numerous problems related to quality of data. Many large organizations waste hundreds of thousands of dollars sending out marketing and other materials to customers who are deceased, have changed names or no longer live or work there. Or they market to existing customers – pitching them on a credit card, for example, when they’re already card holders.
Integrating customer data helps companies manage risks more effectively in many cases. Jay cites the example of a large bank with different operating units marketing multiple credit card products. A customer who is a bad debt risk, who has exceeded his limit on one card and hasn’t paid his bill, is now applying for a second credit card from the same company but a different brand. An effective CDI solution automatically flags the application based on the client’s overall profile.
Finally, more and more companies are implementing CDI systems as a way to ensure they can comply with privacy, financial disclosure and other regulations. The impetus to deploy CDI frequently comes now from senior managers worried about the sometimes dire consequences of non-compliance, says UK-based Gartner Inc. analyst John Radcliffe. “These people are very interested in staying out of jail,” Radcliffe notes dryly.
Gartner has been following the CDI market over the last several years. “It’s still very small compared to, say, business intelligence or middleware, but it’s growing quickly and gaining a lot of attention,” Radcliffe says. “There are a lot of companies that could use products like this. Some see the value and are ready for it, others are not.”
Newfoundland was ready early. After a rigorous selection process, the NLCHI ended up partnering with Quovadx Identity Services and CDI software developer Initiate Systems. Over a period of three years, culminating in 2004, they built the province’s Unique Personal Identifier/Client Registry System which runs on the Initiate Identity Hub EMPI (Enterprise Master Person Index) software.
A 1998 Benefits Driven Business Case developed by NLCHI calculated that the province could save $1.2 million a year just by implementing the first phase of the project, the Unique Personal Identifier system. Given estimated capital costs of $2.9 million and operational and management costs of $343,000 a year, the pay-back period would be less than five years. Those early calculations have been borne out.
“We’ve seen significant decreases in MCP outlays for out-of-province billings,” Barron says. “[The overall savings] are within the range of what we discovered in 1998. We’re easily saving $600,000 to $1 million a year just from better MCP management.”
And that’s just the beginning. The NLCHI is now in the process of tying in the province’s new medical imaging (PACS or Picture Archiving and Communication System) and pharmacy systems.
The pharma system will create a single authoritative drug profile for each patient, ensuring prescribing physicians know exactly which drugs a patient is already taking. This will help eliminate over medication and adverse interactions between drugs.
It’s these applications that will deliver the big medical pay-offs, and some of the financial returns as well. “It’s all underway now, but we won’t be in position to tell what the benefits truly are on the health side until those systems are in place,” Barron says. “The client registry serves as the basic building block for all the rest.”
“There’s a lot of change management involved. It takes really high-level organizational backing to make it work,” Radcliffe says. “As with CRM, you may need to bang a lot of heads together to get the kind of co-operation you need. You are potentially heading into some very dangerous political waters.”

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