In April, Northwell Health will begin the first phase of its transition to an Epic electronic health record system, a project costing hundreds of millions of dollars that began nearly two years ago.
For Epic, it represents another notch in its belt as it continues to break away from the competition in the acute care EHR market. In 2023, Epic increased its market share to 52% of acute care beds while every other vendor lost share, according to a KLAS Research report from May. The 2024 report will be published later this year and is likely to show more of the same.
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Epic hasn't won every major health system. HCA Healthcare, the large Nashville-based hospital chain, uses Meditech while Oracle Health has a $10 billion contract with the Veterans Affairs Department. But Epic's wins keep piling up, with Newark, Delaware-based ChristianaCare and University of Alabama Health system both committing to the EHR vendor in 2024.
The cost of Epic is high but health systems that contract with the Verona, Wisconsin-based company seem undeterred, predicting they’ll break even on their investment while improving clinician satisfaction and patient care. Executives also say the cost between different EHR vendors is not dramatic enough to go with what they perceive is a less-proven vendor, said Coray Tate, vice president of interoperability at KLAS.
“I think the reason that you've seen people kind of make that decision….they’re not scared about spending all this money," Tate said. "It’s that Epic has been really consistent in how they've delivered. There’s no evidence from your peers that it will be a bad decision. You know what you’re going to get.”
What also has benefited Epic is robust mergers and acquisitions activity among hospitals, Tate said. Many health systems are acquiring facilities that use disparate EHRs and then move to Epic once the acquisition is complete, he said.
That is the case for the University of Pittsburgh Medical Center, which operates 40 hospitals and said in September 2023 it was moving to a single EHR system through Epic. Years of acquiring other hospitals meant the Pittsburgh-based health system had nine different EHR systems, said Chief Information Officer Ed McCallister.
“I use the swan analogy,” McCallister said. “Above surface, it looked like we were calm and had everything under control, but on the IT side under the water, we were working very hard to pull everything together. The start of COVID-19 was probably the 'aha' moment to say we should do an assessment of our environment…and it became apparent that there's a better model."
UPMC selected Epic for its platform because it could create a more streamlined approach to managing applications, McCallister said. The system will go from 1,000 applications to around 200 once the Epic installation is completed by summer of 2026.
While McCallister declined to share costs, he predicted the return on investment will kick in by the end of the decade. Reducing the number of applications the IT department has to manage will be a big driver of those cost savings, he said.
Northwell's $1.2B project
At New Hyde Park, New York-based Northwell Health, the move to a new EHR was part of a digital transformation effort across the 21-hospital system, said Joseph Moscala, the health system's executive vice president of enterprise services. In March 2023, it announced it was moving from Altera Digital Health, formerly known as Allscripts, to Epic.
Along with implementing Epic as its EHR, it selected Salesforce as its customer relationship management software vendor.
The decision-making process took less than a year and much of that time was spent negotiating the level of integration between Epic's EHR and Salesforce's CRM system, Moscala said. In terms of picking the EHR, the health system went through a due diligence process but going with Epic ultimately was an "easy decision," he said.
Moscala estimated Northwell will spend $1.2 billion on the combined Epic-Salesforce solution, including implementation, support and training. Operating costs will be half of what Northwell spent on its previous EHR vendor.
Still, Moscala knew he had to get the entire leadership team on board.
“For that amount of money we're spending, we quickly organized right up to the board level and recognized that this is something we had to do if we wanted to compete and provide the level of quality that we so desired,” Moscala said.
Northwell’s doctors also played a big role in the process. Every year when the health system surveyed employees, physicians would frequently ask when they were going to move to Epic, Moscala said. When the move was announced in 2023, he said there was a standing ovation at a organization-wide meeting.
The second phase of the rollout will happen later this year and the third phase next year, Moscala said. The process hasn’t always been smooth. The timelines for rolling out the system have drifted from their original goals. He anticipates more hiccups.
“It's a journey,” Moscala said. “Not only do you have to capture everyone’s minds, but you’ve got to capture their hearts at the same time so you keep them engaged.”
Sarasota Memorial's call
Selecting an EHR vendor can be a different conversation within smaller organizations. Tate said most of Meditech and Oracle Health's wins have come from health systems that can't afford Epic or feel it's too complex.
But some smaller health systems make it work. Sarasota Memorial Health Care System, a publicly owned hospital in the Florida coastal city, announced in November it was investing $160 million to install Epic.
CEO David Verinder said the hospital underwent a three-year strategic review to determine whether it would remain with current vendor Altera Digital Health or pick another partner. Once it determined it was going to switch vendors, it took Sarasota six months to select Epic. Verinder said the project is estimated to cost around $225 million, a significant sum for the public health system, which is overseen by the elected Sarasota County Public Hospital Board.
“We looked at the cost over 10 to 20 years, not the cost over two years,” Verinder said. “What’s the cost if we stay with Altera? What’s the cost if we switch to Epic? Yes it’s going to be more expensive to switch to Epic but the numbers start to turn when you get to year 10.”
The system will not be fully live for another two years, Verinder said. He’s confident it will be a better system for its patients, including snowbirds who live in Florida during the winter and elsewhere in the summer.
“A lot of large medical centers around the country are on Epic and we have a lot of patients that are in our healthcare system who have second homes here,” Verinder said.