By: Christina P. O'Neill
UMass Memorial Health Care said in June that it would invest $700 million to upgrade its electronic health records (EHR) system to improve the accuracy and availability of patient data. It chose privately-held Verona, Wis.-based Epic Systems Corp.
At stake for UMass Memorial and other health systems is not only efficient use of staff and better patient outcomes. Those factors are now tied to reimbursement from the federal Centers for Medicare & Medicaid Services (CMS), the nation's largest single health-care payer, which is pressing for pay for performance. Where CMS goes, private insurers, and ultimately, health-savvy consumers, may be expected to follow.
In a July 20 blog post, UMass Memorial CEO Eric Dickson cited the move as "one of the most important contracts" he had signed since taking office in 2013, citing Epic's industry standing and the support of UMass Memorial staff for choosing Epic.
Other Massachusetts-based health systems using Epic include Partners Healthcare, which is spending a reported $1.2 billion on its upgrade. Lahey Clinic has spent $160 million; Boston Medical Center, $100 million. Nationally, Kaiser Permanente went with Epic as far back as 2003.
The direct cost of the system from the vendor is only part of the total cost of an EHR upgrade. It also includes integrating existing legacy information systems, and the training of medical and support staff in how to use the new technology.
Earlier this year, UMass Memorial administration elected to reallocate overhead expenses across its multi-campus system, with IT being a major overhead component that drove up non-operating expenses in some of its facilities.
In 2012, MeHI, the eHealth institute of the Massachusetts Technology Collaborative, based in Westborough, documented the EHR vendors and found more than 90 of them in the state. About a quarter of them had significant market share – about 80 percent of the market at the time.
One of those is Westborough-based eClinicalWorks, which led with community health-care organizations, pediatric practice and non-hospital employed medical and general in the 2012 MeHI study. The privately-held company recently said it's second in market share in the ambulatory space, with 100,000 doctors using its software.
Another Massachusetts-based EHR provider showing up high in the MeHI study is Framingham-based Meditech, which has developed a web-based EHR that can run on tablet computers.
Laurance Stuntz, MeHI's director, says there are many cost-effective EHR systems, and that his organization's role is to help providers understand their options. MeHI focuses on interoperability, which is required by CMS and by the federal government to get providers certified. They must demonstrate ability to transfer records in a standardized format and monitor continuity of care. "Every vendor has to build a system capable of sending that format," he says.
A program MeHI developed with Worcester-based Reliant Medical Group makes it possible for the patient of a Reliant-connected physician who arrives at the emergency department to have records sent directly to the patient's physician to obtain and convey patient information available to the emergency room physician or triage nurse.
Smaller community hospitals have also found what they regard as satisfactory alternatives to big systems. Heywood Healthcare, based in Gardner, is an independent community-owned hospital system in North Central Massachusetts with two hospitals, a medical group and four satellite facilities. Carol Roosa, Heywood's vice president of information services and chief information officer, notes that EHR maintenance can be more of a challenge for community hospitals, since they typically have fewer resources – both staff and finances – to implement them.
Roosa says that after extensive research, Heywood concluded that there's no perfect EHR solution for everyone. The value of any system is its ability to capture essential data in a way that empowers the health-care team and the patient, helping doctors make informed patient decisions more quickly and effectively and allowing the secure sharing of patient data in all care settings while providing the patient with online access to their personal health information.