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Pam Pure of McKesson addresses members of the Nashville Health Care Council on April 17

“Everyone in this room knows we are going to change,” stated Pamela Pure, executive vice president of McKesson, the largest healthcare services company in the United States.

Her comment came in a recent address to members of the Nashville Health Care Council. Pure, who also serves as president of McKesson Technology Solutions, has more than 20 years of operating and executive experience in the healthcare information technology industry and is responsible for the strategic direction of the company’s information and automation solutions for hospitals, physician offices and home health.

Pure predicted that any dramatic change in the way the country’s healthcare system is organized and managed must result in more value for patients, hospitals and physicians.

Pure recently received what she called a “mini MBA” in the way healthcare systems around the world work and the unique challenges and similar problems in relation to those faced by American providers during a three-week circumnavigation of the globe with stops to study healthcare in England, Dubai, India and China.

In England, she found that although physicians’ offices are automated and care is provided and managed in a very electronic manner, hospitals are struggling with issues of capacity and delivery under the single-payer system. Providers are seeking technological solutions to route patients in the most cost-effective way, especially as they struggle to manage chronic disease.

Dubai has created the ultimate consumer experience in a high-tech world. Everything is geared to please the customer shopping for the best in luxury goods or healthcare, whether he is shopping for Gucci loafers or the best in “cash only/high tech” care from “named providers” such as Mayo or the Cleveland Clinic and other prestigious names from around the world.

In India, a country of 1.3 billion people, Pure discovered that 65 percent of the population would never see a healthcare provider in their lives. There is tremendous disparity between the private and public hospitals, in terms of both care and facilities. In the private hospitals, statistically, deaths result from the same three causes - heart disease, cancer and stroke - as they do in U.S. hospitals. In the public hospitals, where the average length of stay is 21 days, deaths are caused by malaria, typhoid and dengue fever.

In China, also a country of 1.3 billion, there are hospitals in Shanghai and Beijing with advanced technologies more sophisticated than in 95 percent of hospitals in the United States, but everywhere patient volumes are staggeringly high — some facilities see up to 7,000 outpatients a day. Physicians in China are hospital employees, and “they are begging for technology to help them deal with overwhelming numbers of patients,” Pure said.

No matter how different the healthcare structures in each country, Pure said that everywhere she visited there was an urgency to develop technologies to produce better levels of care and to reduce the escalating costs, which are universally spiraling out of control.

“Reinvention of healthcare can’t proceed without technology,” Pure said, adding that technological change should focus on patient safety, improved satisfaction with the healthcare experience for both patient and physician, strategies to manage economics of care, and population-based programs to improve care and prevention programs in the community.

“We have to fix the system and reinvent the patient experience from the inside rather than waiting for someone else to fix it,” she stated. “Fundamentally, the problem is how to give people the care they want and deserve with limited resources. We have the technology to make a huge difference and have a global impact — we need to start using it on a larger scale.”

Pure pointed out that fewer than 25 percent of U.S. hospitals scan patient medications at beside (a procedure known to be able to prevent the 700,000 clinical medical errors of significance annually), and less than 10 percent of U.S. physicians’ offices are fully electronic, a number predicted to be at 30 percent by 2010.

Before we start driving care and patients online, she stressed that there must be a demand for the universal use of electronic medical records (EMRs) and for physicians’ offices to be automated to take advantage of the technology that is already in place.

Pure touted the emergence of e-visits — online physician consultations — as one of the most important of the new generation of tools focused on using technology to help provide better care to increasing numbers of patients.

She predicted that the use of new tools would enable physicians to get paid more realistically for patient care, including e-visits, adding that these new tools will identify and maximize payment before care is delivered.

Pure added that healthcare can’t look like it looks now to the upcoming generation of high-tech consumers who are used to interacting with computers for everything from boarding passes to expensive purchases.

She contended that we could — and should — invent a healthcare infrastructure that could go global.

Closer to home, Pure has worked with Nashville’s Metropolitan Hospital Board to build a single technological platform at Metro General Hospital, a publicly supported, academically affiliated, community-based hospital.

Dr. J. Reginald Coopwood, CEO of Metropolitan General Hospital at Meharry, said that five years ago when Metro General was trying to tie together disparate old technology systems that couldn’t communicate with each other, Pure was gracious enough to bring McKesson Technology to partner with the hospital to install a coordinated system so the labs, pharmacy, radiology, ER, OR, nursing documentation and more can communicate on the same platform.

“Now, five years later, we have a system that has eliminated paper charts and is a source of pride for everyone in the hospital,” Coopwood said.

“Our bedside scanning computers allow nurses to check before administering medications by scanning the medication and the patient’s armband to eliminate errors,” he continued. “We are one of the few public hospitals in the country and one of only 25 percent of (all) hospitals in the country with this capability.”

Coopwood said that the RelayHealth system, a McKesson product, allows staff members to communicate via email on a secure site to develop a sophisticated system to prevent patient harm.

Although Metro General is not yet ready to put e-visits in place, Coopwood feels that, as their populations become motivated and accustomed to interacting electronically, the hospital will add this tool to their system.

Dr. William W. Stead, associate vice chancellor for strategy/transformation and chief information officer for Vanderbilt University Medical Center, sees e-visits as part of the premise that informatics/information is a major component in transforming the healthcare system and that the world’s information resources are moving more and more toward being all digital.

“In essence, at Vanderbilt there is work around personal health records and work around e-visits,” he said, adding that electronic communication between patient and provider is a way to provide more continuous and personal care without face-to-face access.

Stead likened the relationship between EMRs and the patient to the way Quicken software connects to financial institutions but keeps information in the user’s computer records.

Vanderbilt has had an electronic portal for several years, during which time patient and provider messages back and forth have become a routine part of patient administration data. Stead said they now see several thousand visits a month to My Health at Vanderbilt with more than 2,000 individual log-ins by patients.

He said, “What we are doing right now is connecting in a way that makes communication less episodic and makes the patient part of quality assurance … and in essence creates a different kind of patient.”

He added, “Our next step is to see how to connect the healthcare system in to the patient’s support community of family, school, church. That’s going to be the way the patient’s values and resources for their condition change to family and support. E-visits are a very important step that begins to help a provider find where the center is.”



June 2008

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