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.
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