Nashville, Tenn.-based HCA Healthcare recently expanded its new Meditech EHR to 43 hospitals, with a leader emphasizing that “interoperability is not optional.”
The 190-hospital network is continuing a multiyear project to move the enterprise to Meditech’s Expanse platform, with more go-lives expected in the coming months. HCA has worked with the EHR vendor for over 30 years.
“We view EHR optimization as an ongoing discipline, not a one-time implementation milestone,” said Jake O’Shea, MD, vice president and chief health information officer at HCA and the EHR rollout’s executive sponsor. “Measuring value is central to that mindset.”
In this Becker’s Q&A, Dr. O’Shea discusses how the publicly traded health system monitors that return on investment and why HCA decided to deepen its relationship with Meditech.
Question: HCA has now gone live with Meditech Expanse at 43 hospitals as the first large-scale wave of its enterprise EHR rollout. What were the key strategic drivers behind choosing Expanse, and what outcomes are you most focused on achieving in the first six to 12 months?
Dr. Jake O’Shea: Our decision to move forward with Meditech Expanse reflects HCA Healthcare’s long-standing belief that technology should be a force multiplier for strong systems of care. At our scale, the EHR is not simply a documentation tool — it is a foundational clinical platform that must support safe, consistent care delivery, enable innovation and scale reliably across diverse care settings.
Expanse allows us to modernize our EHR environment while building on a deep strategic partnership with Meditech. It gives us the ability to thoughtfully standardize, improving safety and quality while preserving flexibility for how care teams actually work. In the first months following go-live, our priorities deliberately focused on fundamentals: platform stability, clinician confidence and operational reliability. Establishing that strong foundation is essential to sustaining performance today and enabling future innovation.
Q: One of the touted benefits of Expanse is enhanced clinical decision support and personalized clinician workflows. How are you measuring improvements in clinical efficiency, patient safety, and quality of care since go-live?
JO: At HCA Healthcare, we view EHR optimization as an ongoing discipline, not a one-time implementation milestone. Measuring value is central to that mindset. Within our Expanse program, a dedicated process engineering and patient safety team focuses on evaluating how the technology is performing within real clinical workflows and how it contributes to safer, more effective care.
We use detailed time-and-motion studies that assess clicks, task duration and workflow efficiency, complemented by qualitative feedback gathered directly from clinicians through interviews, surveys and focus groups. Those insights are shared across clinical informatics, our Expanse clinical content and product teams, and other partners to drive continuous improvement. Capabilities like Expanse Surveillance illustrate this approach — bringing critical real-time, actionable data into clinician workflows and refining it iteratively based on front-line feedback.
Q: Moving to a cloud-based EHR at this scale presents both opportunities and challenges. How is HCA handling interoperability and data integration across the broader enterprise, especially with legacy systems and partner organizations?
JO: At HCA Healthcare’s scale, interoperability is not optional. This has been among our core focal points for many years, and historically we relied on systems outside of the EHR to aggregate information across multiple platforms.
With Expanse, we are advancing a more integrated approach by standardizing key data components and enabling API-based integration directly within the EHR. This helps clinicians stay within a single system whenever possible, while still accessing the full breadth of information needed to support clinical decision-making. Over time, this strengthens care continuity across HCA Healthcare’s network.
Q: The rollout announcement mentions plans to collaborate with Meditech and others on clinician-focused AI tools. Can you share specific AI use cases you’re prioritizing and how you balance innovation with clinician trust and usability?
JO: HCA Healthcare’s approach to AI is grounded in a goal to strengthen patient safety, support our clinicians and ultimately improve the care our communities receive. Our Expanse program sits within HCA Healthcare’s department of Digital Transformation and Innovation, which helps ensure we stay focused on delivering meaningful innovation through the platform.
We are prioritizing AI use cases that address real clinical challenges, ease cognitive load and reduce administrative burden. One example is ambient clinical documentation, which we were able to deploy alongside Expanse for select provider groups rather than treating it as a downstream add-on. At an enterprise level, our robust responsible AI program provides governance to ensure that AI is used and deployed thoughtfully, transparently, ethically and with appropriate oversight. That balance allows us to innovate while maintaining clinician confidence and patient trust.
Q: Large EHR implementations often require significant change management. What strategies has HCA Healthcare employed to support clinician adoption, minimize workflow disruption, and sustain long-term engagement with the new Expanse platform?
JO: Large-scale EHR implementation is as much about people as it is about technology. At HCA Healthcare, change management is a critical component of our Expanse implementation, supported by a dedicated change management team that is fully embedded within the program. It is a core capability that supports long-term adoption and performance.
Ahead of each go-live, we invest heavily in preparing key sponsors and front-line change champions within our hospitals to lead their colleagues through change. Targeted education, clear communication and visible leadership engagement at the hospital and division levels promote transparency and accountability. Their leadership and participation are essential in helping teams navigate change and ensure Expanse becomes a durable platform that clinicians can trust and rely on to improve patient care.
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