When a health system decides to implement a new electronic record system (EHR), normally the process involves purchasing the vendor’s foundation package and then building it internally within the organization. But after careful consideration, IT leaders at University of California, Irvine Health (UCI) decided they would take a different approach to their installation of the Epic Systems (Verona, Wis.) EHR.
Indeed, for the past year-and-a-half, UC Irvine Health has been working on a project that involves the health system linking up with UC San Diego Health, another academic health system, about 120 miles away, so that the two patient care organizations would be on the same instance of Epic, rather than on separate ones. Says Charles “Chuck” Podesta, CIO, UC Irvine Health, “This is the first time that two academic medical centers in the U.S. have [collaborated] to be on one instance of Epic.” He adds, “Clearly, we went about this in a different way compared to most [other] health systems.” According to officials, the shared platform also involves a transition to a cloud-hosted environment for its medical records at Epic.
In California, there are several integrated health systems connected to major University of California organizations—the University of California, San Francisco (UCSF), the University of California, Davis (UCD), the University of California, Los Angeles (UCLA), to go along with UCI and the University of California, San Diego (UCSD). Podesta notes that each of these organizations is currently on Epic, so rather than have the fifth separate instance of Epic in the region, why not partner with one of the others? He says that they looked at UCSF, UCLA and UC Davis, but UC San Diego made the most sense based on its size and geography, being in Southern California with UC Irvine. Podesta has plenty of reasons why it makes so much sense to have a common EHR solution with another area health system, but more broadly he attests, “A lot of this is cost-based. There is just no reason in the world we should have five different IT shops among [University of California organizations] with five different instances of Epic all doing their own thing. That truly makes no sense.”
To this point, Podesta and other C-suite leaders at UC Irvine ran a cost savings analysis after looking at UCSD’s EHR system build and found that if they could align on 80 percent of UCSD’s existing build, and change 20 percent of it, “we can save a whole lot of money.” And, the implementation timeline would also be shorter, not to mention the savings with support and training, so coupled all together, Podesta says his team calculated a near $40 million cost avoidance by going with this collaborated approach. “So there was a big value proposition. But you still need to prove its [worth],” he says. “Currently we are actually at 87 percent alignment with UCSD’s build, and we have more to go post go-live, so we have met that goal.”
Agreeing on Commonalities
Of course, when one health system decides to join another’s existing EHR build, a whole new array of challenges arise that clinical and IT senior leaders need to sort out. For one, notes Podesta, there is the shared governance aspect. “You are putting the teams together, so COOs, CEOs and CFOs across both organizations to work on governance, and to work on which [system] has the particular best practice, whatever that might be, and the best workflows, and then adopting those,” he explains. “In some cases,” he continues, “That best practice was ours, even though we were on [a different vendor’s EHR system], so UCSD would adopt it and put it into Epic, and in some cases vice versa. You can imagine how complex this is, considering how complex it is just doing this within your own organization. But now it’s across two academic medical centers, two medical schools, research departments, faculties, etc.,” he says.
One key strategy for UCSD and UC Irvine was to create a set of guiding principles, with one of them being that UCI would align on UCSD’s build except if it were a regulatory or patient care issue. They also agreed that the organizations would accept the best practice of each other, or of another University of California organization, such as UCSF, who UC Irvine reached out to for some of its workflows that ended up getting adopted. “Those guiding principles were front and center for every single meeting and presentation,” says Podesta. “And that’s interesting because usually they go by the wayside real quickly once you run into your first conflict or problem, or you just never bring them out at all. But we had them front and center at all times. It was so important for us to align at over 80 percent, otherwise that value proposition would be gone,” he says.
Another sign of collaboration is in the form of UCI and UCSD combining information systems (IS) support teams. Podesta says that this specific progression is in wave one of three right now, which was completed in August, and involved all of the infrastructure teams being under a single management structure across both organizations, along with security and the PMO (project management office) service desk. Wave two, which will be next spring, will be the applications part, which involves bringing in both UCI and UCSD application groups under a single leadership structure, he adds.
If those two phases go well, the third piece will be “everything else we do,” which will then lead to the two patient care systems essentially becoming one IT shop, Podesta says. “We’re a few years away from that, but by next spring we will have about 80 percent of our support structure under a single leadership structure. And we have already worked out the savings model and how the savings will be spread out across both organizations. The CEOs are excited about that,” he says.
Podesta adds that for many EHR go-lives, six months down the road, the health system will have issues, such as billing problems, and will have to bring in consultants from the outside for assistance. That, of course, leads to additional resources being spent. But in this case, “We’re talking about a savings rather than adding more resources post go-live,” he says. “My whole team has been working on Epic for over a year, so now they’re part of the implementation and support, along with UCSD.”
Christopher Longhurst, M.D., CIO, UC San Diego Health, added in a prepared statement, “This groundbreaking collaboration aligns with the broader strategic goals of UC Health to share services and generate efficiencies across campuses through shared implementation and maintenance of technology platforms. Through this process, we’ve aligned our clinical pathways and practices to leverage the best of both organizations.”
Adapting in the Era of the Pressured CIO
Podesta points out this type of collaboration project would be unheard of even just three or four years ago, but with new pressures on CIOs to save money while also thinking about next-level population health strategies, it became something of a no-brainer for UC Irvine. “We are teaming up on some population health [initiatives] where having a single EHR will benefit us greatly when we hit those populations. So it’s morphed into a strategic imperative rather than an EHR go-live, and that’s how the CEOs view it,” he says.
Podesta notes that when he talks to his peers about this, most don’t think that they can do a collaboration of this significance in their region with the next-door neighbor health system. “But I tell them that they have to; costs will simply get too high.”
And then there’s also the competitive standpoint. Podesta points out that CIOs are saying that their jobs are hard enough in their own organizations, so they can’t imaging sticking their necks out proposing something where shared governance and the complexity around that will need to be created, and also the relationships that will need to be built across two organizations. “It’s just very difficult,” he attests. “Even with M&As happening, they struggle with being able to put this all together, and in those cases, one organization actually owns the other. And they still struggle!”
Nontheless, Podesta thinks that for many regions, this type of partnership “is the model of the future.” And the idea is for this to be scalable and in time, if UCI and UCSD indeed “pull it off,” there will be pressure on the other university health systems in the area to do something similar. “I think it will happen over time, but it will take a while. We have to show the cost savings first,” he says.