Why big health systems keep switching to Epic

When UPMC and Intermountain Health both said in early September they would be switching to Epic, they continued a trend of the biggest U.S. health systems opting for the nation's largest EHR vendor. Hospital CIOs told Becker's they don't see this changing anytime soon.

"It is not a coincidence many big health systems are moving to Epic," said Scott Arnold, executive vice president and CIO of Tampa (Fla.) General Hospital. "The scale and interoperability available with Epic make it attractive to big systems that may struggle with those elements. Exchanging information between Epic sites is remarkably easy."

UPMC, a 40-hospital system based in Pittsburgh, said Sept. 5 it plans to consolidate its nine EHRs to Epic over the next three years. Salt Lake City-based Intermountain Health said Sept. 11 it will switch all 33 of its hospitals from Oracle Cerner to Epic. They joined New Hyde Park, N.Y.-based Northwell Health, which said in March it would be moving its 21 hospitals from Allscripts to Epic.

These dwarfed Epic's biggest wins last year, which included Houston-based Memorial Hermann Health System, which has 14 hospitals, and Emory Healthcare, an 11-hospital system based in Atlanta. Both switched from Oracle Cerner. The only other EHR vendor that gained any big system hospitals in 2022 was Oracle Cerner, with eight, according to KLAS Research (KLAS defines large systems as having more than 10 hospitals).

Epic is the choice for mammoth systems because of its integration across products, interoperability with critical partners, ability to standardize healthcare workflows, and constant technological development, said KLAS analyst Paul Warburton.

"Until other vendors better address these challenges, we expect the trend to Epic will continue," he said.

The market is ripe for more movement. In 2022, about a fifth of the nearly 2,300 hospitals that are part of big health systems still use legacy EHRs from various vendors, KLAS reported.

Epic has "made a concerted effort to focus on interoperability, social determinants of health and — important to health system vitality — a strong financial platform," said William Hudson, CIO of Oklahoma City-based Integris Health (himself a former Cerner executive). "As long as Epic continues to focus on aligning caregivers and patients and transforming care, while Oracle remains focused on integrating Cerner into their portfolio, Epic will continue to pull away."

Software giant Oracle acquired Cerner, the nation's second-largest EHR vendor, in 2022 for $28.4 billion. "We're basically rewriting that software a piece at a time," Larry Ellison, Oracle's co-founder and chief technology officer, said in a Sept. 11 earnings call, referring to the Cerner Millennium EHR.

That doesn't mean Epic works for everyone. "Epic tends to be more expensive than most of their competition, can require a larger amount of resources to have and maintain (between things like application analysts and IT infrastructure), and does not mold itself as much to the customer organization," said Saad Chaudhry, chief digital and information officer of Annapolis, Md.-based Luminis Health.

However, he said, "Epic has fine-tuned the art of implementing an EHR into a science."

He also said the company has successfully reined in nonstandard configurations and is tightly integrated. That's because Epic hasn't grown through acquisitions — it's remained privately held since its founding in CEO Judy Faulkner's basement apartment in 1979 and has never bought or invested in another company — so it has built all of its dozens of modules in house.

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