A little more than one year ago, Cleveland-based University Hospitals completed its transition to Epic, a process that converted 5.6 million patient records and scheduling systems into one EHR.
UH leaders decided to make the change around five years ago after determining that the health system's previous EHR landscape was unsustainable, but had to justify the cost of such a large project and present a business case for change to the board.
"We were working with around 12 different products across two regions, including Allscripts and Cerner, which was not viable long term. We had to make a proactive decision on our timeline and terms, or risk the market forcing our hand," University Hospitals CIO Robert Eardley said during an Oct. 4 panel discussion at Becker's Health IT + Digital Health + Revenue Cycle Conference in Chicago.
Mr. Eardley worked closely with Michael Szubski, who retired as UH CFO in February, to build a business case for changing the EHR system.
"The key slide that sold the project to our senior leaders and the board was the payback period," Mr. Eardley said. "We showed two scenarios: one where we reached conservative benefits in about 4.9 years, and another where we hit them in just 2.5 years. When the board saw that implementing a new EHR could deliver around $120 million in benefits, the conversation shifted. Suddenly, it was all about how fast we could get started."
Mr. Eardley said UH was leaving money on the table by sticking with its previous EHR system and moving to the new platform would help the 18-hospital system capture more revenue and reduce software expenses.
"Ultimately, it was a classic business case for change. We had to prove to ourselves that an integrated EHR would deliver financial benefits," he said.
UH leaders began building the business case for change in early 2020 and evaluated all three major vendors — Allscripts, Cerner and Epic — through two days of sessions, totaling 36 meetings.
"We developed the business case around 15 different benefit categories. A key part of this process was having operational owners on a weekly 9 a.m. Friday call. Each week, they explained how their departments could capture benefits," Mr. Eardley said. "For example, the revenue cycle owner would describe how they could increase collections, surgical services would explain how they could reduce cancellations and delays by using a unified electronic consent process, and physician services outlined how they could drive more clinic volume with an integrated system."
Having operational leaders articulate how the new EHR could help their departments achieve tangible results helped ensure buy-in from the CFO, chief physician executive and other leaders because the plan was "clear and grounded in real-world benefits," according to Mr. Eardley, who noted that implementing an integrated EHR typically costs about 10% of an organization's net revenues.
UH's Epic install cost about $400 million, a significant drop from the $600 million the health system had initially budgeted,
"Installing a new EHR is a multi-year implementation, so it's important to put in the work during the business case and pre-initiate stage in order to build a plan that can stay relatively consistent. At UH, for example, we had to manage five budgets — one capital throughout as well as four annual operating budgets," UH CIO Robert Eardley told Becker's, "Also, make sure that in addition to the Epic implementation team, you find and contract with a trusted labor agency for certified trainers and for activation support. This will likely be one of your largest expenses. It's important to really understand your split between capital and operating expense — more than 35% of our total budget was operating expense."
The project kicked off in fall 2021 and converted 5.6 million patient records and scheduling systems into one EHR. The first of two "go-lives" was in March 2023, with the second and larger "go-live" taking place on Sept. 30, 2023.