I served on a panel recently, and one of the program directors asked whether healthcare could really handle the changes that will be necessary under healthcare-reform legislation. I assured her that Pennsylvania has already experienced significant change.

Today, more than 500,000 patietns' records are electronic, and more than 4,000 healthcare providers are demonstrating meaningful use in ambulatory settings, according to statistics provided by the state's regional extension centers.

We are particularly fortunate in central Pennsylvania because all of the hospitals in the area committed to automating clinical records even before the CMS offered incentives to do so. The benefits to patients are immediate and continue to grow as more applications are implemented and as they mature to support continued practitioner workflow and process refinement. Automation offers more safeguards and is quicker than our old manual processes.

Holy Spirit Health System has been rolling out phases of clinical automation since 2005. Our home healthcare agency was our first corporation to implement an electronic health record. The next live event occurred in the hospital, laying the foundation for all subsequent acute-care implementations. By 2009, we were implementing our ambulatory solutions.

I shared with the program director that early in the hospital rollout, we consciously implemented only a few real-time alerts and messages. These messages alerted providers in instances where duplicate laboratory tests are ordered within the same 24 hours, the medication ordered would exacerbate an already high or low potassium blood level, the same medication or a therapeutic alternative was already ordered, or whether an echocardiogram from the previous six months was available for review in the patient's electronic record.

These simple alerts and messages were powerful. For example, out-of-balance potassium levels can be life-threatening. We had all the data we needed to simply cross-check active medication orders against a patient's recent potassium laboratory levels. In addition to cross-checking our databases, we embedded real-time access to the most current medical evidence available worldwide within our electronic ordering process. As powerful as this automation was in 2007, we were still years away from achieving the first stage of meaningful use, as defined by CMS regulations.

In December, we upgraded the hospital's clinical information system to the certified version required by the CMS to qualify for meaningful-use incentive payments. We prepared for a 24- to 32-hour system outage and successfully survived a 26-hour outage. Now that this significant upgrade is complete, we are refining existing applications and processes as we implement the remaining Stage 1 applications—the final steps in our efforts to become eligible for EHR incentives.

By November, we had completed the technical implementation on the required certified release in our ambulatory corporation. The heavy lifting now falls to leadership to continue to drive and monitor the provider adoption required by Medicare. In previous implementations, laggards eventually caught up with early adapters. However, Medicare now determines the time frame required for the percent adoption of a prescribed functionality. Even early adapters find it difficult to focus narrowly on the CMS meaningful-use criteria when the opportunities for improved patient care and communication seem limitless.

In addition to the efforts under way within each provider organization, Gov. Tom Corbett issued Executive Order 2011-04 on July 27, 2011, establishing the Pennsylvania eHealth Collaborative to provide leadership to actively engage more than 140 subject-matter experts and stakeholders from across the state in developing a statewide health information exchange using the Direct Project technology. During stakeholder meeting discussions, several recommendations for changes were made, including changes to the state legislative and purchasing process. Many stakeholders believe also that to avoid patient confusion it is necessary to "normalize" existing consent documents from providers across the state. After documents are normalized, perhaps so should the compliance office practices in all covered entities, some reasoned.

When I heard the suggestions to change state laws and normalize statewide consent documents, it struck me that we were making history. One day it will seem impossible that we ever operated the way we do today. In the future, we will take for granted the timely access to relevant clinical information, automated personalized safety checks and the elimination of redundant processes.

This is only the beginning. We still have a long way to go, but even our small steps provide direct benefits in terms of patient outcomes and cost containment.

Edith Dees

Chief information officer

Holy Spirit Health System

Camp Hill, Pa.