Boston Medical Center CIO Arthur Harvey talks Epic go-live, EHR costs and the end of MU

In May 2015, Boston Medical Center completed its go-live of Epic's EHR. The hospital's ambulatory go-live was the last department to start using the new platform, which the hospital named eMERGE. After a $100 million investment, Arthur Harvey, vice president and CIO of Boston Medical Center, says the first nine months of using Epic are moving along "quite well."

Here, Mr. Harvey discusses the EHR selection process, the EHR market for Boston and academic medical centers, and health IT's biggest challenge.

Note: Answers have been lightly edited for style and clarity.

Question: What was your selection process like when deciding to switch EHRs? Did you gather request for information/proposals from multiple vendors? Why did you decide to switch vendors? Why did you ultimately decide to go with Epic?

arthur harveyArthur Harvey: We were formerly a best of breed shop and were looking for a way to improve interoperability between our various clinical systems as well as to replace a couple of products that we felt we had outgrown. We decided that we wanted to go with a single vendor solution where that vendor could provide inpatient, outpatient, emergency department, perioperative and revenue cycle management with the caveat that we would not implement everything at once. 

IT performed an initial pass to determine which vendors could support an institution like ours and provided the selection committee with three finalists to choose from. The actual selection committee was very heavy on clinical and operational leaders and had very few IT people on it.  After evaluating the three finalists we decided that Epic was the best fit for our organization due to experience with academic medical centers, feature set and robust infrastructure.

Q: Many key hospitals in Boston — like Lahey Health and Partners HealthCare — use or are switching to Epic's EHR. Did the fact other major hospitals and health systems also use Epic play a role in Boston Medical Center's decision to adopt Epic?

AH: Not really. We were the first ones of that group to implement Epic, although we knew what was going on around town. The fact that Epic did have a lot of AMC customers across the country that were satisfied was certainly a factor in our decision.

Q: Boston Globe reports Boston Medical Center's Epic upgrade cost $100 million. Can you comment on if the implementation was on budget, under budget, over budget, etc. How would you defend this investment to outsiders looking in?

AH: We were on budget after taking into account some scope changes that we decided to implement during the project. The real question about doing a project of this size is where will the value come from when you are done? We felt that our project would provide for a better clinician experience, better consistency in our workflows and clinical care, and a platform that better enabled us to analyze data to improve care and operations.

Q: Why do you suspect some hospitals' and health systems' implementations go over budget?

AH: There are lots of possible reasons for this, although probably the biggest two are difficulty in controlling scope and over-customization. We were fortunate to have very supportive clinical leadership who we involved early and often. This helped us get to a scope and level of customization that we could handle within our budget but still ensured that what we built would take care of the clinicians' key needs.

Q: Since May's final go-live, how has the adoption gone? What lingering issues or complaints remain? What benefits have you already started seeing?

AH: The adoption of Epic has gone quite well. We have more requests for enhancements than we anticipated, but we have dealt with the majority of the actual defects at this point. In hindsight, we should have been a bit more transparent on our governance on these items so that there was more clarity around what we planned to do next.

One of the easiest benefits to see is improved uptime and scalability. We have almost no unplanned downtime at this point, and the system performance is better than many of the solutions that have been replaced. In addition, we are seeing an improvement in the consistency of our data from patient to patient.

Q: What are your thoughts/reactions on the end of the meaningful use program?

AH: I am mostly interested in what they are going to replace it with. While there were certainly challenges with the actual implementation of MU, it did generate a lot of activity around computerization and standardization. It did put a fairly heavy burden on both health IT vendors and hospital IT staffs. Hopefully we will see changes going forward that encourage meaningful improvements and take into account the difficulty in implementing the changes.

Q: Any other thoughts or comments you'd like to share about Boston Medical Center, Epic or health IT?

AH: The most important thing in health IT is the people you have doing the job, both the technical folks and the clinicians we work with. We are lucky to have a good, dedicated team here at BMC. The challenge that all of us in health IT face is that there is more demand than supply for these people, turnover is high, and we are struggling to create new health IT professionals.

More articles on health IT:

CMS' Andy Slavitt hints at the end of MU: 6 things to know
athenahealth CEO Jonathan Bush administers CPR to man suffering heart attack
The new MU: What's next for providers and EHRs

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