Assembling the puzzle of a patient’s health profile in CRM


Some providers still question the use of CRM in healthcare, as they doubt that it is appropriate to use the vendor reference tool in providing care. However, the concept of healthcare CRM is far from sales automation – it’s about getting to know your patients and their needs. In adopting Healthcare CRM, caregivers can leverage the advanced health profile and segmentation of patients.

Because the efficiency of the patient’s health profile depends largely on the information that CRM must process, its integration with EHR is essential. The integration will also allow you to automatically keep the segmentation up to date.

Key criteria for patient segmentation in CRM

Patient targeting helps define small groups based on established rules and use a healthcare CRM to send personalized information to patients.

Note: In our concept, all groups of criteria they are the same. They can be used together or separately, and in different combinations. In this way, providers can go with wider segments or reduce their target patient group. Now, let’s review the suggested groups.

Health groups

We constructed the following patient taxonomy from the idea of ​​3 risk-based patient groups (high risk, low risk, and increasing risk). It allows providers to decide on a target patient segment and then detail it to highlight opportunities for advanced care delivery.

First group

This group includes 2 types of patients:

  • individuals without chronic diseases (pathological conditions) and risk factors for developing any of them
  • patients without chronic diseases (pathological conditions) but with low or medium risk factors to develop any

These patients need to receive preventive care in outpatient conditions to address risk factors.

Second group

Patients in this segment do not yet have any chronic disease or pathology. However, they do high risk factors develop any disease or primary symptoms of a pathology.

These patients may need to receive preventive care in the outpatient or inpatient setting, including medication treatment. Systematic medical supervision and screening are desirable in the future.

Third group

The following types of patients fall into the 3rd category:

  • patients diagnosed with any of the chronic diseases (conditions) that require systematic supervision and specialized medical care
  • people with a suspected chronic illness (condition) that requires additional examination (once the diagnosis is determined, the group of this patient can be changed)

These two types have the highest risk of developing complications leading to disabilities and premature deaths. Consequently, it is very likely that these patients will need hospital care, including medication-supported treatment plans and rehabilitative care. Systematic medical supervision and screening are also possible.

Sex / Age

The following basic demographic structure is constructed by reviewing Piaget’s stages of intellectual development, Erikson’s stages of human development, as well as the theories of Carl Jung and Daniel Levinson. We have used various sources to create criteria that will not only reflect psychological and physical development, but will also allow caregivers to narrow down the patient segments they work with.

Children and adolescents:

Girl / Boy:


Woman / Man:

Appointment frequency

This classification is created to achieve a number of patient analysis goals, such as

  1. highlighting satisfied and dissatisfied patients, i
  2. identifying only patients with acute cases, who stopped using the services of a particular provider after the end of the care cycle.

Other following criteria also contribute to some extent to this segmentation. However, only the ‘frequency of appointments’ allows us to find those patients who were not engaged during the care process and act to retain them.

  • Rare: A single appointment can range from a single appointment in the last 6 months to a single appointment in the last 12 or 36 months, depending on the caregiver.
  • Acute cases: 2-5 acute appointments related to a primary condition / illness in the last 6 months, 12 months or 36 months, depending on the caregiver
  • Regular: 2-5 appointments related to a chronic illness / pathology / condition during the last month, 3 months or 6 months depending on a particular caregiver)

Health risks

Risks to children’s health

We target this ranking to providers who focus on improving their prenatal and childbirth care. The criteria are based CDC and the PRB’s maternal and child health materials that highlight the importance of addressing the problem of perinatal and infant mortality.

  • intranatal
  • Perinatal
  • Neonatal
  • Newborn development: it is possible to introduce a range of 1 to 10 depending on the development of the baby in the following areas:
    • Food / nutrition
    • Physical development
    • Psychomotor development

Health risks for children, adolescents and adults

This classification addresses caregivers ’focus on preventive care and the strong need to control their patients with certain health risks. We used the Global Health Risk Report and the CDC Prevention status reports as a reference and guidance.

  • High blood pressure
  • High cholesterol
  • To smoke
  • High blood glucose
  • Physical inactivity
  • Overweight and obesity
  • Alcohol consumption
  • Sexual preferences
  • Genetics
  • Professional (stress, depression)
  • Natural environment
  • Risks of cardiovascular events according to WHO prediction graphs:
    • Low (<10%; 10% to <20%)
    • Medium (20% to <30%; 30% to <40%)
    • Alt (> 40%)


These criteria consist of common allergies, which allows providers to identify patients with one or multiple allergies.

  • Food
  • Pollen
  • Medications
  • Pols
  • Pets
  • Insect bite
  • Mold
  • Latex and more

Therapeutic departments

This is just a sample of the therapeutic departments within a healthcare organization to accommodate private caregivers. The patient segment can be filtered up to a certain department or a number of departments at once. If, for example, there is a need to guide patients with diabetes and visual impairment, endocrinology and ophthalmology are chosen for analysis.

These criteria are not addressed to patients who are fully recovered, for example, people with a healed broken leg.

  • Endocrinology
  • Gastroenterology
  • Nephrology
  • Neurology
  • ENT
  • Ophthalmology
  • Cardiology and more

State of the disease

Providers can combine the “disease status” with the “therapeutic departments” criteria sets or use them separately. This particular set consists of multiple dimensions. To create it, we have used general qualities that are not necessarily sufficient for clinical purpose, but allow for fairly narrow segmentation of patients ’health profiles.

Disease status:

  • acute
  • subacute
  • chronic (each section can be detailed to specific conditions, pathologies, disorders, etc.)


  • yes (can be filtered to a list of particular diseases)
  • no


  • complications / exacerbations (can be filtered to a particular negative result)


  • yes (can be filtered to a specific disability)
  • no

Need for systematic monitoring:

  • yes (then the list of exact types of supervision can be provided, for example, regular follow-up appointments or home care)
  • no

Postsegmentation: use cases

For example, a healthcare organization wants to offer a personalized discount for its one-off and rare patients from the ophthalmology department. They will only have to:

  • select the dating history (rare and possible to filter in the last 6 months)
  • choose the department (ophthalmology)

Healthcare professionals can then send an email to segmented patients, a push notification within their mHealth patient app, a text message, or a call to offer them a discount.

A caregiver then discovers that he has a significant number of patients with pollen allergy. As spring approaches, the provider can pick out all of their allergy patients, remind them to take care during this period, and refill their prescription if necessary. Undoubtedly, this will help this caregiver to earn a few patient loyalty bonus points.

Another provider focuses on maternity care services. They can work with a set of “child health risks” criteria to define expectant mothers who need a special focus. Because pregnant women with medium and high health risks need to see their doctor more often, the provider can send them a personalized follow-up message. It can be a delicate concern for your well-being backed up with brief tips on nutrition and activity. Of course, a discount on a prenatal massage or special yoga classes can also help you effectively reach this group of patients.

Assembling the puzzle

Having tons of data is a questionable benefit if it is not structured. To identify the levers to pull for more effective results in communicating with patients, each piece of information must provide insights.

While EHR helps to leverage individual patient data, an CRM built into EHR allows all patient details to be incorporated into this versatile puzzle (click here to see how it works). By rotating and rotating the criteria, as well as dividing and combining segments, caregivers can highlight one, two, and more patient groups that can and should be targeted with relevant services.

And after the segmentation algorithm is up and running, CRM is again useful for providers to have access to all channels of communication with the patient at once. Thus, once a caregiver decides the target segments, he or she can act immediately.

Healthcare CRM software by ScienceSoft

Are you ready to enter the patient-centered era with a dedicated CRM by your side? Take a closer look at its capabilities and practical benefits for you.

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