J2 Interactive

How HIEs Can Leverage Salesforce To Deliver Success For Their Participants and Patients

Growth is key to the survival of today’s health information exchange.

As geographical reach expands, every HIE experiences an ever-increasing host of hospitals, IPAs, PHOs, ACOs, payers, and single-practice providers. This presents challenges in ensuring the delivery of high-quality services to participants without increasing participant management overhead and straining budgets.

HIE Collaboration With CRM

Along with an innovative organizational design, technology can help.

With vast differences among geographical markets, it is essential to begin the journey toward a technology-driven contact management approach by assessing the realities of the HIE business. A roadmap and strategic objectives are crucial to realizing the value that a Customer Relationship Management (CRM) solution like Salesforce offers.

This post will discuss some of the challenges and business needs associated with the acquisition and retention of clinical participants. We will also look at the various components of Salesforce that can be leveraged to support the goal of highly effective account management without additional human resources overhead in an expanding geography.

Finally, we’ll present a real-world example of how one HIE approached the planning and execution of a CRM implementation, the challenges they faced, and the outcomes they achieved.

Each team in an individual HIE has a different operational focus. However, across HIEs, there are many shared challenges. We are writing this because of our experience working closely with many health information exchanges worldwide.

Understanding The Business Needs of CRM

1. Engaging Prospective Participants

From the first introduction to the final sign-off and interface go-live, the participant enrollment process is a business development process. This requires a level of clinical understanding and the ability to influence and “close” the participant agreement.

Within the HIE, participant engagement teams often operate similarly to sales organizations in other fields of business. Viewing participant engagement not only as a sale but as a repeatable process to replicate success—and creating both organizational and technological structures to ensure that the process is followed—are critical factors for achieving growth. For any HIE that is proceeding with a technology-driven approach to CRM, the results of the process and adherence to the process itself should be measured over time.

These processes should also dovetail with, and extend into, other processes before and after participant engagement, such as marketing, interface implementation, and ongoing account maintenance.

This approach gives a holistic view of the overall state of the account and provides a common place for all parties within the HIE to collaborate toward a successful participant interaction

An HIE should have a standard approach to the generation of quotes and proposals, as well as a highly standardized Participant Agreement. In addition, an inventory of the technology components and interfaces that will be required to achieve success should be documented within a standard system accessible to all involved.

That system should be capable of generating metrics and reporting information that can present the overall status of the various teams working to deliver new participants to the exchange and working to support the participant long after go-live.

2. Onboarding New Participants and Delivering Technology Solutions

Although the technology products offered by an HIE are similar from one participant to the next, a large amount of information is required by all parties to achieve successful implementation.

Because of different EMR systems and their limitations, different organizational structures at participant organizations, and varying configuration requirements demand, a system for tracking implementation should provide rigid measures for success while still allowing for flexibility to customize each implementation to the needs of both the HIE and the participant.

Engaging the HIE’s technology resources should be as seamless as possible. The participant pipeline should be transparent and visible to technology leaders so that costs can be contained and load balancing can be used to maximize the effectiveness of those resources.

The Account Manager or Participant Advocate must be involved with the participant beginning with the participant agreement negotiation, and they should be engaged and serve as an active member of the integration team for the duration of any technology delivery project.

Using the technology project as an introduction to an account management professional helps to create a cohesive and seamless link between the HIE and its technology.

3. Technology Implementation

Implementation teams often face the challenge of having more work than staff capacity.

To mitigate this challenge, steps should be taken to understand and thoroughly document technical needs before engaging technology resources. In addition, implementation teams should actively report capacity to senior management and actively manage ongoing projects.

Delayed projects should be parked until participants are ready to proceed. There is often a sense of urgency when a participant agreement is first signed. Still, it is seldom true that participant technology resources will be ready to proceed during contract execution.

Formulae to calculate estimated and actual delivery timetables should be modeled and continually improved by the Integration Team. These metrics should be transparent to all parties associated with the HIE, and exceptions to standardized processes, such as an EMR upgrade or other participant-side delay, should be immediately communicated. The Implementation and Participant Engagement teams should create and understand contingency plans in the case of delays.

A standardized project plan or task punch list should be created to outline the delivery process for each technology project offered by the health information exchange. In addition, metrics should be put in place to measure how closely the process is followed and how effective the process is at delivering high-quality solutions in a timely fashion. Continuous Improvement concepts should be used to create a culture of experimentation to improve quality and participant satisfaction.

4. Retaining and Supporting Participants Post Go-Live

Communication is the lifeblood of retaining participants. A CRM-based approach to participant management must facilitate communication between teams within the HIE and with any of those teams and the customer. A unified approach where support is managed from the same system as engagement and implementation is a highly advisable strategy to achieve a holistic view of the success of each participant from one source.

In addition, when support issues arise, proper notification to responsible parties, not only for support but for management of the participant relationship, should be considered. Providing a unified front and demonstrating full and seamless integration from the end-user perspectives is key to establishing confidence and trust with the participant.

In parallel with this communication strategy, rules within the system should be created and implemented to route issues to the person or team most likely to solve the issue in the least amount of time. Reducing communication and confusion waste is critical to supporting growth without expanding headcount and overhead.

Where Does Technology Fit In?

Many HIEs have already implemented some form of CRM. In J2’s experience, Salesforce has emerged as the leader within this market. Through Salesforce.org, eligible 501(c)(3) organizations can obtain 10 cost-free user subscription licenses to the product. Salesforce offers deep discounts for additional licenses.

J2 has found that Salesforce is well-structured for supporting HIE operations. Core features within Salesforce support each of the concepts mentioned above. However, like nearly all applications, successful implementation requires careful consideration of planning, organizational impact, and change management.

With a proper plan that is developed in conjunction with an experienced resource, Salesforce implementation is achievable mainly with configuration rather than through lengthy and expensive custom code development.

HIEs might benefit from some of the following Salesforce features:

Contact Management

Contact management allows HIE staff to share details about participant staff. This includes roles, phone numbers, email addresses, notes from conversations, and other pertinent data.

Salesforce has a built-in relationship hierarchy that flows from a parent organization to each sub-organization to contacts within that organization.

Activity Management

Closely related to contact management is activity management.

Salesforce users in all operational groups can easily schedule follow-up tasks for themselves and others. Activities are often linked to specific contacts. One example of this is scheduling follow-up calls and emails to pursue new participants.

Part of each user’s daily routine can be to review the activities that should be accomplished that day.

Opportunity Management

For a prospective participant, a sales Opportunity can be created in Salesforce. Estimated close date & fees and the stage in the sales cycle can all be easily tracked.

Pipeline reports and dashboards can be viewed with the click of a button. These give management visibility to the collective efforts toward landing new participants. Reports can also be delivered by email, which is more convenient for an executive than logging into an application.

Case (a.k.a. Ticket) Management

Out of the box, Salesforce includes Case Management functionality for customer service and technical support. Questions from and issues reported by participants can be queued up and assigned to the person or group of people most qualified to respond.

Email communications about an issue can be contained within a Case, eliminating the common problem of scattered email communications among staff members.

Cases have a variety of collateral uses within an HIE. For example, a Case can be used to kick off the onboarding process for a new employee.


Collaborative, freeform discussions among HIE staff about participants, contracts, support cases, and more are all possible with Salesforce Chatter. This practical, versatile, and integrated communication tool sits on top of structured data.

Workflow & Rules

Salesforce has several ways to create workflows so users can easily follow standardized processes.

Salesforce can standardize and manage business workflows for the entire HIE participant lifecycle.

For example, a simple flow can trigger the following set up of operational steps after a salesperson or an administrator closes a sales Opportunity with a new participant.

Validation rules require the entry of specific data depending on one or more conditions. These configurable rules ensure the completeness of the information at different steps along the path.

Leveraging CRM Technology

While CRM software is designed to be simple to configure, experience with planning and implementation is essential to achieve successful implementation.

A trusted technology consulting partner is worth engaging if an HIE does not have its own internal staff with this experience.

How One HIE Leveraged CRM To Bring Their Product to The Next Level

Manifest MedEx (MX) is the largest not-for-profit health network in the state of California and facilitates the sharing of clinical and claims data across more than 400 participant organizations across the entire state. To facilitate and enhance communications between MX and its participant organizations, MX selected and implemented Salesforce as its CRM solution.  However, MX also needed assistance navigating the multitude of ways to implement Salesforce to find the right match for their needs.

MX sought to expand on its existing Salesforce implementation to accelerate growth and optimize the participant onboarding experience. Working with J2, MX used Salesforce to integrate MX’s various departments and create a unified workflow, covering the entire process from Marketing and Sales through Contracting, Implementation, and ongoing Account Management and Support.  The centralized repository of participant information, accessible to all parties, ensures accountability and transparency at every step of the onboarding process.

MX and J2 collaboratively designed a CRM strategy that would meet MX’s need to work quickly and accurately and improve the overall speed, quality, and accountability around the implementation of new participant connections.

J2 performed their work in a highly professional manner, managing timeline commitments and budget. Manifest MedEx has been delighted with our working relationship and the caliber of the J2 team across their entire organization.
–David Kates, CTO, Manifest MedEx

To solve the challenge of units of work flowing between disparate teams within MX, J2 assisted MX in the development of a detailed master plan, which coordinates the required inputs and outputs of each team. 

Alongside the master plan, J2 provided and continues to guide MX in the configuration of Salesforce to work hand-in-hand with the various departments at MX to ensure work keeps moving, is highly visible to stakeholders, and is completed per MX policies at every step of the integration.  Immediately after beginning these configuration changes, a positive net change in MX’s overall ability to deliver quickly was observed.

The core components mentioned above (Accounts, Contacts, Cases, Activities, Chatter) are leveraged to facilitate the transitions and collaboration between the teams to provide quicker sales, faster implementation, reduced operational overhead, and improved participant satisfaction.

J2 Interactive delivers solutions to HIEs for integrations and interoperability—as well as rapid delivery of automation and operational efficiencies on the Salesforce platform.

In its almost 20 years of experience, J2 has identified needs common to Health Information Exchanges, Accountable Care Organizations, and Physician Health Organizations, regardless of the technology platforms they use. Many of these organizations deploy Salesforce to optimize workflow and communications across their operational functions: Sales/Participant Acquisition, Participant Relationship Management, Implementation, and Support.

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J2 Interactive

J2 Interactive is an award-winning software development and IT consulting firm that specializes in customized solutions for healthcare and life sciences.