At one point, Cleveland-based University Hospitals was running as many as 36 different systems to support critical functions, including billing, prescriptions and scheduling.
Finally, in the fall of 2023, the health system consolidated on Epic, bringing the bulk of its operations under the umbrella of the electronic health records system.
It wasn’t a fast, easy or inexpensive process, but it was worth it, says Senior Vice President and CIO Robert Eardley.
“Our providers love being in one system,” he says. “Everybody within the University Hospitals system at every point of care is referencing a single patient record to coordinate care for that patient. That’s been one of the biggest wins.”
Since the Health Information Technology for Economic and Clinical Health Act of 2009 pushed the adoption and use of EHRs, nearly all U.S. healthcare organizations have transitioned away from paper-based records. Supporting multiple systems can lead to problems, including a lack of interoperability and clinician burnout, but it is still relatively rare for hospital systems to be standardized on one EHR.
“Some larger organizations with the budget and human resources have taken the leap to consolidation over the past five to 10 years,” says ChristinaGrimes, digital health strategist at the Healthcare Information and Management Systems Society. “It is still an incredibly small number of health systems, but we are at a point where leaders know they need to move in this direction.”
The Costs and Benefits of EHR Consolidation
Consolidated EHR systems can lead to insights that save hospitals money, Grimes says, and patient portals provide one-stop access to lab results, billing, appointment scheduling and clinician messaging. “Patients are demanding this,” she adds.
Before the Epic rollout at University Hospitals, Eardley says, providers had to toggle between systems to find patient information, and login routines took up to 30 seconds. Now, login time is down to about 5 seconds, and clinicians can access all patient data through one common portal.
“We always strive to deliver the highest-quality care,” Eardley says. “Having to click around and hop to other systems makes it less likely that you’re going to have everything in front of you to make the best clinical judgment.”
The organization budgeted more than $600 million for its Epic rollout, which included the purchase of new HP PCs, new monitors, licensing costs and more than 2,000 temporary contract workers to train the organization’s 34,000 users.
Eardley anticipates that the rollout will yield more than $100 million in annual benefits, including increased productivity for clinicians, more efficient billing practices, reduced no-show rates and fewer surgery cancellations.
“We have a very thin margin, and we didn’t want this to be an added cost,” he says. “The benefits allowed us to be confident in this investment to deliver the best care for our patients.”
DIVE DEEPER: How does EHR optimization improve clinical workflows?
How EHR Consolidation Improves Clinical Efficiency
Nashville General Hospital, which operates a 150-bed facility and more than 20 outpatient locations, actually had a consolidated EHR system at one time, but another company bought the platform and sold it off for parts.
“What was formerly a connected system became much more disconnected,” CIO Melanie Thomas says. “It was fairly straightforward at the beginning, but maybe a year later, there were more complications, so we opened up a search for a new vendor.”
Thomas says she cast a wide net at first, but one large vendor would support Nashville General Hospital only under the umbrella of a larger healthcare partner, and smaller vendors didn’t offer the “one-stop shopping” that she was looking for.
“A vendor might have had a strong clinical platform but a weak financial platform,” Thomas says. “Others might have a strong inpatient platform but no ambulatory platform.”
Ultimately, the organization opted for Oracle Health CommunityWorks (formerly Cerner CommunityWorks), which allows smaller hospitals to access the Oracle Health EHR. Nashville General Hospital is part of a cohort of about 40 healthcare providers that together access a standard EHR platform, with some ability to customize the hospital’s own platform build.
Thomas and her team are in the process of transitioning to Oracle, with a planned go-live date in December.
“Our existing EHR has been extremely slow, and our providers are looking forward to faster processing time,” she says. “With an integrated system, clinicians won’t have to switch between interfaces, so we’re looking at a much more efficient way of doing our clinical business.”
The move to a single system will also improve IT troubleshooting and support, Thomas says. “Currently, I have to spend an hour trying to get beyond the finger-pointing to see which vendor is responsible for an issue,” she says. “Now, I’ll have one person I can go to and say, ‘I need you to solve this.’”
READ MORE: Healthcare organizations can extend the reach of the EHRs.
An Ongoing Journey of Improvement
At Denver Health, Associate Chief Medical Information Officer Daniel Kortsch likens the organization’s transition to Epic to a “big bang.”
“We turned off around 120 other systems when we turned on Epic, so there was a remarkable consolidation,” Kortsch says. “We did that because it created a lot of feature-rich functionality for us. The integration that we’ve seen with Epic has been really beneficial to our patients and to our providers, improving efficiency and allowing us to drive clinical utility in all sorts of unexpected ways.”
In particular, Kortsch says, the ability to seamlessly share patient data within and outside of the institution has helped clinicians provide personalized care. For instance, if a patient with dementia is seen in the emergency room at a partner hospital and then comes to Denver Health for a later appointment, the person’s doctor can pull up the lab results and imaging from the ER visit, even if the patient can’t remember why they were in the hospital.
“There’s real value in that type of integration and data sharing,” Kortsch says.
Clinicians at Denver Health have also begun to use the artificial intelligence features in MyChart, Epic’s patient portal, which Kortsch says may be key in helping organizations battle the burnout that affects many doctors and nurses.
In some clinical locations, providers have the option to select message responses generated by ChatGPT, and internal survey data shows that 61 percent of the organization’s nurses feel that the feature makes handling MyChart messages more manageable.
Denver Health continues to fine-tune its use of Epic, Kortsch says. For instance, his team is working to purge low-value “clutter” from patient records, allowing clinicians to focus on more important diagnostic information.
“When you turn on an EHR, it’s never a once-and-done thing,” he says. “You need to be in a state of constant improvement.”
Ways EHRs Can Improve Patient Care
Federal agencies such as the Centers for Medicare & Medicaid Services and the Department of Health and Human Services say EHRs can improve patient care in a number of ways:
- A reduction in medical errors is one of the top benefits. Digital systems can improve the accuracy and clarity of medical records.
- EHRs include information about medications, so it’s less likely that a provider will prescribe medications that interact poorly with patients’ existing prescriptions.
- Centralized EHR data can eliminate duplication of testing, reduce treatment delays and help provide patients the information they need to make better decisions about their care.
- Because EHRs are backed up, patient records can be retrieved even if a hospital is affected by a natural disaster.
