Why big health systems are moving to Epic

Two large health systems — Atlanta-based Emory Healthcare and Houston-based Memorial Hermann — recently switched their EHRs from Oracle Cerner to Epic, continuing a trend of bigger hospital groups moving to the Verona, Wis.-based software giant.

Several health system CIOs and other IT leaders told Becker's the reasons for this include the desire to consolidate to one EHR from multiple vendors, with Epic being the most dominant player, while others said not to put too much stock in the name of the companies as the EHRs are fairly similar and depend on what your patients and clinicians are looking for.

"When you've seen one health system, you've seen one health system," said Aaron Miri, senior vice president and chief digital and information officer of Jacksonville, Fla.-based Baptist Health.

But he said Baptist Health went to Epic, a transition completed July 30, to integrate into a single EHR.

"While I can't speak for other health system's reasons, I do think that healthcare is becoming so complicated with so many intersecting levels of care that all health systems must be asking themselves how to simplify the equation and make care delivery a much more seamless experience for providers and patients alike," he said. 

Still research bears out this trend. KLAS Research, which studies EHR use among hospitals, has found bigger systems going to Epic in recent years and Oracle Cerner gaining smaller facilities.

"KLAS is still collecting, tabulating and verifying data for 2022, but the trend of Epic gains, especially among large hospitals and IDNs, appears to be continuing. Cerner's trend of winning several small hospitals also appears to be holding," said Coray Tate, vice president of core solutions and interoperability at KLAS.

Epic is also typically the EHR used by academic medical centers, said Lisa Nelson, PharmD, vice president of IT applications for University of Rochester (N.Y.) Medical Center.

"It is the platform used in training a generation of providers, nurses and pharmacists as students and residents," she said.

While Epic dominates the U.S. market, Oracle Cerner is the leader by hospital market share worldwide. Oracle said it could help Cerner expand its global reach after it bought the EHR vendor in June for $28.4 billion.

Even though New York City-based Weill Cornell Medicine uses Epic, its biggest affiliates in the Middle East have opted for Oracle Cerner, said CIO Curtis Cole, MD. He said Oracle Cerner provides better support internationally and is more accommodating of local laws and customs.

"In the U.S., Epic is especially compelling in large systems," he said. "It simply solves more problems and scales better. Epic's strict implementation practices mean you will end up with a functional system, even if it isn't fabulous."

Dr. Cole said some former customers of EHR vendor Allscripts, which also has had a bigger share of academic medical centers, miss its flexibility and innovation potential compared to Epic.

"Epic makes it really hard to be exceptional — exceptionally good or exceptionally bad," he said.

"But with the Oracle takeover, I expect more systems will move to Epic," he added. "Epic's dictatorship is at least benevolent."

Other CIOs pointed to the Oracle deal as a reason for the recent switches. 

"The healthcare industry is risk-averse and does not like uncertainty," said Michael Saad, senior vice president and CIO of Knoxville-based University of Tennessee Medical Center. "For health systems already contemplating a move from Cerner to Epic, the acquisition of Cerner by Oracle has accelerated some of these conversations."

He said one of Oracle Cerner's challenges is a lack of a robust, clinically integrated revenue cycle platform, though he noted that the company plans to implement the beta version of its RevElate solution starting later this year.

"Until Cerner can successfully address this gap and convince health systems that they have an integrated revenue cycle solution, we will continue to see health systems move to Epic," Mr. Saad said.

An Epic spokesperson said the company's gains have been consistent, averaging about 26 large healthcare system pickups a year. The spokesperson pointed to Epic being an integrated system that is built around the patient and preferred by physicians, better financial returns among health systems, high patient satisfaction with MyChart, interoperability among Epic customers, and organizations wanting to collaborate with the Epic peer group. Oracle Cerner didn't respond to requests for comment for this story. 

"I am not surprised as we have seen this shift occur over the past decade as health systems move away from best-of-breed strategies, instead focusing on a high level of integration, not only with respect to their internal software systems but additionally integration with other health systems leveraging [Epic programs like] CareEverywhere and Cosmos," said Josh Glandorf, CIO of University of California San Diego Health.

In an era of hospital consolidation, health systems may buy other hospitals or groups that are on different EHR vendors, then decide to integrate them all into one.

"In these situations, there is a 'you can't go wrong with Epic' sentiment that often prevails," said Joyce Oh, CIO of Tampa, Fla.-based Moffitt Cancer Center. "Epic is a perfectly fine and expected choice."

But she said Oracle Cerner is a better fit for Moffitt. She embraces the vision of Oracle Health Chair David Feinberg, MD, to move the company from "technologically driven" to "clinically driven," which could help boost oncology care delivery and research support. She hopes Oracle employs its data expertise to help Cerner customers find better insights for value-based care.

"A race is not a race with only one participant," Ms. Oh said. "Competition keeps participants pushing to improve, excel, and move further than ever before. The Epic-Cerner 'race' is not only healthy but I am certain will improve EHR technology, data, and (ultimately) patient outcomes for the health systems that utilize these platforms."

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