Who is the Customer?

In designing and running a Health Information Exchange-based service, lots of decisions large and small seem arbitrary until you ask: "Who is the customer?"

Recently, one of our accounts, a large integrated provider group, asked for provider level reports to help manage diabetes quality improvement. Usually, we send those reports, marked "Confidential," to the provider only. After all, no matter how good the providers are, one of those reports has the worst performance in the group. Publishing those results would be embarrassing and generate huge resentment that could easily torpedo any future improvement efforts. Reporting to management only is a bit better, unless the bosses use the data to reward or punish the providers. In either case, you have given the providers a big incentive to game the system and soon your data are meaningless.

So, even though the provider group is paying for the service and the managers are our "customers" for sales purposes, we have resisted giving them the provider level reports. (We do report at the group level.) The customers of our provider reports are the providers and we share them with the managers only when the providers give written permission.

Who is the customer for your data exchange?