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By Michelle Freed
Vice President
Achieve HIT/ARRA Program Office
McKesson Provider Technologies
The 1999 Institute of Medicine (IOM) report To Err is Human was a landmark "wake up" call for healthcare. The report brought national attention to the patient injuries and deaths that occur due to human error and the lack of safety checks in the care process. The report identified the effective use of health information technology (IT) – such as electronic health records (EHRs), barcode medication administration, and computerized physician order entry (CPOE) – as one of the keys to improving the safety, efficiency and effectiveness of care. Unfortunately, too many hospitals and physician practices saw the call for health IT as optional and delayed implementing EHRs and CPOE for more than a decade.
ARRA Changes the Game
But the game has changed with the American Recovery and Reinvestment Act (ARRA). To create greater efficiencies, higher quality and improved access to care, the federal government is offering significant financial incentives to those that adopt EHRs and other health IT — and will financially penalize those that do not. In the near future, it will become increasingly difficult to maintain a sustainable clinical and financial model for care without an EHR.
The good news is that McKesson and its customers are well-positioned to achieve the goals of ARRA. Once the stimulus legislation became law, McKesson put the needed infrastructure in place to support customer readiness and collaborated with the federal agencies charged with ARRA compliance.
It All Comes Down to Meaningful Use
Hospitals and physicians can get their share of $19 billion in incentives by meaningful use of a certified EHR. However, installing a certified EHR system will not automatically qualify an organization for incentives. Providers must go beyond achieving government-defined "meaningful use" — they also have to prove it.
Practice and Process Changes — To achieve adoption and success, leaders must consider the practice and process changes that go along with an EHR deployment, and get started immediately. Leaders must establish a strong oversight program and governance model that enables stakeholders from across the enterprise to participate and invest in the change process.
A Cultural Shift — A fully electronic care environment requires a cultural shift. Governance and change management are required in order to retrain caregivers, manage workflow consistency, and identify where, when and how to collect the measures to report on meaningful use. At a time when caregivers are already stretched thin, leadership will need diligent planning and potentially creative approaches to deploy meaningful use processes.
Staff Support through the Change — Leadership committees should support pilot implementations and enable clinicians to address problems in small groups. Leaders should acknowledge the time and effort required to transition the organization to a complete electronic workflow. In addition, regular education and communication are essential to readying clinicians and staff for change — and to get them to embrace the technology.
Analytics for Reporting — Leaders must build an infrastructure that will enable them to gather, analyze and report verifiable data and evidence that shows they are using the technology as prescribed. Workflow and clinical content must be aligned so the right data flows seamlessly to the EHR and to performance analytics – for analysis and scrutiny – to track and manage the needed improvements and efficiencies. McKesson's prescriptive approach enables you to not only aggregate the right quality data for reporting, but to empower your organization to understand and improve performance in context of meaningful use.
Enabling 21st Century Care
The change required to certify and successfully adopt EHRs will take considerable effort, time and commitment — for both providers and vendors. But EHRs will be the cornerstone of a redesigned 21st century healthcare system that harnesses information to empower patients and care providers.
 For hospitals, McKesson's depth of solutions and evidence-based content approach creates a
strong foundation to support clinical connectivity for collaborative care.
For physicians, our EHRs support delivery of advanced and actionable knowledge at the
point-of-care, enabling a new level of excellence in care delivery.
For patients, EHRs and connectivity solutions enable true partnership and collaboration with
their healthcare team.
Finally, the pace of the upcoming changes expected from health reform could not take place without the foundation built by ARRA as demonstrated in the five objectives adopted by the Office of National Coordinator for Health Information Technology (ONCHIT) related to the meaningful use of EHRs:
Improve quality, safety and efficiency; reduce health disparities
Engage patients and families
Improve care coordination
Improve population and public health
Ensure adequate privacy and security
With McKesson's focus on customer success and the quality of our proven solutions, we're prepared and confident of supporting your journey to achieving meaningful use for Stage 1 and beyond.
Michelle S. Freed is vice president of McKesson's ARRA/Achieve HIT Program Office. She is charged with leading company-wide activities relative to ARRA and the broader healthcare reform activities. She is directing the: interpretation and influence of policy; assessment of business impacts and opportunities; and optimizing delivery of solutions to our customers. Freed has more than 25 years of experience in the healthcare industry. Over her career at McKesson, Freed has led the planning office, marketing organization, customer management and development activities, sales and sales support. Prior to joining McKesson, Freed was director of patient accounting at a large Midwestern hospital.
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Adopting health IT does not automatically translate to better outcomes. Better outcomes are achieved when physicians can make better informed clinical decisions at the point of care because they have complete patient health information. Exchange of data among participants in the care process requires interoperability and health information exchange (HIE).
The growth of HIE is being accelerated by the financial incentives available in the American Recovery and Reinvestment Act (ARRA) of 2009. As the stages for meaningful use are defined, the importance of the exchange of information through regional, state and national exchanges will increase dramatically.
By linking together caregivers and data sources electronically, an HIE facilitates faster, more effective health data exchange. The exchange enables sharing of more complete patient information by healthcare participants — from the patient to the primary care physician to specialists and any other authorized professionals. Shared information can help improve care, reduce errors, eliminate redundancies and engage patients in their healthcare decisions.
McKesson's RelayHealth business provides a comprehensive, Web-based connectivity platform that links numerous health systems, reference laboratories, pharmacies, payors and physicians across the country. This platform processes billions of clinical and financial transactions annually. Connectivity services enable:
Online consultation of physicians by patients
Electronic prescribing
Point-of-service pharmacy claims resolution by payors
Pre-visit patient financial clearance by providers
Post-visit provider bill settlement by payors and patients
Health information exchange (HIE)
RelayHealth enables access and exchange of actionable health information in local communities, across the state, regionally or throughout the nation. For more information, visit www.mckesson.com/AchieveHIT.
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