The Wireless Cure

In April, President Bush issued an executive order calling for widespread deployment of health-care technology, setting a 10-year goal for ensuring EMRs for all Americans; Kerry has countered with a proposal for universal EMRs by 2008. To encourage the adoption of technology in this area, both candidates are also calling for incentives and rewards to help drive the technology forward.

At the same time, many hospitals and health-care facilities are already embarking on the path toward automating patient records, as well as patient care. That includes Centra Health, a regional nonprofit health-care provider based in Lynchburg, Va., which is on track to transform itself into a hospital of the future by going paperless.

Centra Health's facilities include Lynchburg General Hospital and Virginia Baptist Hospital. Over the next three years, Centra will move to an electronic environment for just about every aspect of patient care at its facilities, transitioning from a legacy mainframe environment to a client-server and Web-based system. To accomplish this task, Centra is building on its existing relationship with San Francisco-based McKesson Information Solutions, the $1.1 billion solution-provider arm of McKesson.

Centra already had several McKesson technologies in place, including the Horizon Medical Imaging product for digital radiology images, Horizon Surgical Manager, Pathways Financial Management and Pathways Materials Management. Under the new contract, Centra has purchased a suite of some 24 different applications, which will run on various platforms, says Ben Clark, CIO at Centra Health.

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Moving forward, Centra will be working very closely with McKesson beyond the financial and materials-management areas and into the clinical area.

"As part of the agreement, we will be working hand-in-hand with Centra's technical services group and providing on-site support management, as well as a full schedule of education for users," says Paul Tharp, regional vice president of McKesson Information Solutions, who adds that McKesson will be on hand to manage the clinical implementation project.

Phase I of the project, which will be up and running in 18 months, will include laying the foundation of the electronic environment, Clark says. This stage will include implementing applications to automate and centralize the pharmacy-information systems onto Horizon Meds Manager to receive, verify and send drug orders for dispensing and documenting care electronically. In addition, McKesson's Horizon Admin RX will be implemented for bar-code scanning at the bedside for identification and medication administration.

The core also will include McKesson's Horizon Patient Folder application for electronic patient records.

"With medical records online, the patient chart is complete and always available," Tharp says. "Physicians can access, review and complete charts online." Doctors also will have mobile anytime access to patient information through the Horizon MobileCare Rounding application. Clark says the foundation applications all will go live in October.

Phase II, which will run another 18 to 24 months after the October date, will involve more advanced applications for computerized physician order entry (CPOE) and clinical decision support and the implementation of McKesson's Horizon Expert Orders application.

"We want to get the core infrastructure up and running before we start the advanced features like CPOE, which is still a pretty immature product, so we can wait 18 months for that to mature a little more, and we'll all be better off," Clark says.

Behind the Scenes

When Centra first embarked on this project, it began the search for the ultimate partner. In January 2003, Centra came up with 13 criteria it would use to evaluate the solution-provider community and ultimately select its partner (see "Partner Criteria," page 69). The initial vendor list included Cerner, Eclipsys, Epic, IDX, McKesson, Meditech and Siemens, Clark says. Centra narrowed the field to four, then to two, and finally selected McKesson as its partner on the path to paperless health care. Of note, Centra had a previous relationship with McKesson and had a good working history with it, Clark says.

"They are a big [solution provider], and they are going to be around so we can have a long-term relationship," Clark says. "They presented a vision we felt was right for Centra--a vision of the future, including technology and patient safety and the productivity improvements we hope to see with this."

As for cost, Clark says McKesson offered a competitive price; overall, he was amazed by how close all of the vendors came as far as pricing. McKesson came in at approximately $23 million during a five-year period, which includes two project leaders who will be on-site at Centra for the duration of the project. A financial project leader will be present for 18 months, while a clinical project leader will stay on for 36 months.

"Other support people will be coming in and working with us as well, and we feel good about that," Clark says. "They came through with a very good support plan."

Clark also was impressed by McKesson's acknowledgement of the cultural and process-improvement changes that would ultimately determine the success of Centra's paperless goal.

"It's not the hardware or software that's the challenge," Clark says. "We are spending a lot of our efforts on developing a team of internal people, along with our McKesson partners, to build a successful implementation. The software will work fine, but not if we don't have the people."

Eric Brown, vice president of health-care and life-science research at Forrester, echoes those sentiments. He points to two general rules of thumb when it comes to technology investment and adoption in the health-care industry: One, things happen much slower than in other industries, and two, the impact of change is much greater. Thus, spending in the health-care vertical will not only be focused on the actual technology installed, but on improving processes and workflow, something solution providers should be focusing on.

Adds David Garets, president and CEO of Healthcare Information and Management Systems Society Analytics: "It's not just information technology where the money is being spent. The money also is being spent on redesigning the processes of clinical care and medication administration to accommodate the technology," he says.

Partner Criteria

Here's what Centra looks for when choosing a VAR partner: