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Are We Going About Population Health The Wrong Way?

Posted on March 29, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For most of us, the essence population health management is focusing on patients who have already experienced serious adverse health events. But what if that doesn’t work? At least one writer suggests that though it may seem counterintuitive, the best way to reduce needless admissions and other costly problems is to focus on patients identified by predictive health data rather than “gut feelings” or chasing frequent flyers.

Shantanu Phatakwala, managing director of research and development for Evolent Health, argues that focusing on particularly sick patients won’t reduce costs nearly as much as hospital leaders expect, as their assumptions don’t withstand statistical scrutiny.

Today, physicians and care management teams typically target patients with a standard set of characteristics, including recent acute events, signs of health and stability such as recent inpatient admissions and chronic conditions such as diabetes, COPD and heart disease. These metrics come from a treatment mindset rather than a predictive one, according to Phatakwala.

This approach may make sense intellectually, but in reality, it may not have the desired effect. “The reality is that patients who have already had major acute events tend to stabilize, and their future utilization is not as high,” he writes. Meanwhile, health leaders are missing the chance to prevent serious illness in an almost completely different cohort of patients.

To illustrate his point, he tells the story of a commercial entity managing 19,000 lives which began a population health management project. In the beginning, health leaders worked with the data science team, which identified 353 people whose behavior suggested that they were headed for trouble.

The entity then focused its efforts on 253 of the targeted cohort for short-term personal attention, including both personal goals (such as walking their daughter down the aisle at her wedding later that year) and health goals (such as losing 25 pounds). Care managers and nurses helped them develop plans to achieve these goals through self-management.

Meanwhile, the care team overrode data analytics recommendations regarding the remaining 100 patients and did not offer them specialized care interventions during the six-month program.  Lo and behold, care for the patients who didn’t get enrolled in health management programs cost 75% more than for patients who were targeted, at a total cost of $1.4 million. Whew!

None of this is to suggest that intuition is useless. However, this case illustrates the need for trusting data over intuition in some situations. As Phatakwala notes, this can call for a leap of faith, as on the surface it makes more sense to focus on patients who are already sick. But until clinicians feel comfortable working with predictive analytics data, health systems may never achieve the population health management results they seek, he contends. And he seems to have a good point.

Intermountain Creates Virtual Hospital

Posted on March 16, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of years ago, I wrote an item describing the Mercy Virtual Care Center, a four-story, $54 million venture which describes itself as a “hospital without beds.” The Center, which launched in October 2015, has more than 300 staffers. After one year of operation, the Virtual Care program had cut emergency department visits and hospitalizations by an impressive 33%.

Now, Intermountain Healthcare is following in Mercy’s footsteps. Last month, Intermountain announced a launch of its virtual hospital service, Connect Care Pro, which brings together 35 telehealth programs and more than 500 clinicians. Its goals are to supplement existing staff and provide specialized services in rural communities where some types of care are not available.

Unlike Mercy’s offering, Connect Care Pro’s services aren’t located in a single building, but according to Intermountain, it can still provide much of the care that you find at a large, sophisticated hospital. It describes its approach as clinically integrated and digitally enabled. (I’m not sure what clinical integration looks like in telehealth, so I’d love to hear more about that in the future.)

In explaining why Connect Care Pro matters, Intermountain tells the story of an infant admitted to a southern Utah hospital which needed intensive services. Because the infant was supported via Connect Care Pro, it received a remote critical care consultation rather than having to be transferred to a different ICU in Salt Lake City. Avoiding the transfer saved over $18,000 and allowed the baby’s parents to remain in their community.

Now, all Intermountain Healthcare hospitals, including 10 of its rural hospitals, use the virtual hospital’s services to build on their existing offerings. Also, nine hospitals outside of the Intermountain system have signed up to use Connect Care Pro.

While I might’ve missed something in my searches, from what I can tell few hospitals systems have gone to the trouble of creating a fully-fledged virtual hospital service, though many are offering telemedicine options to support rural hospitals and clinics.

Part of the reason may be financial. After all, as noted above, Mercy did spend more than $50 million to create its hospital without walls. However, I’d argue that the main reason for hospitals haven’t created similar centers is that they simply don’t understand their benefits, and to some extent may be in denial about the extent to which medical care is becoming decentralized.

Despite the costs and effort involved, I do think we’ll see more virtual hospitals emerge over the next few years. I just don’t think most hospital systems are ready to move ahead just yet.

E-Patient Update:  Patients And Families Need Reassurance During EMR Rollouts

Posted on March 5, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Sure, EMR rollouts are stressful for hospital staffers and clinicians. No matter how well you plan, there will still be some gritted teeth and slammed keyboards as they get used to the new system. Some will afraid that they can’t get their job done right and live in fear of making a clinical mistake. All that said, if your rollout is gradual and careful, and your training process is thorough, it’s likely everyone will adjust to the new platform quickly.

The thing is, these preparations leave out two very important groups: patients and their families. What’s more, the problem is widespread. As a chronically ill patient, I visit more hospitals than most people, and I’ve never seen any effective communication that educates patients about the role of the EMR in their care. I particularly remember one otherwise excellent hospital that decorated its walls with asinine posters reading “Epic is here!” I can’t see how that could possibly help staff members make the transition, much less patients and family members.

This has got to change. Hospital IT will always be evolving, but when patients are swept up in and confused by these changes, it distorts everything that’s important in healthcare.

Needless fear

A recent experience my mother had exemplifies this problem. She has been keeping watch over my brother Joseph, who is critically ill with the flu and in an induced coma. For the first few days, as my brother gradually improved, my mother felt very satisfied with the way the clinical staff was handling his case.

Not long after, however, someone informed her that the hospital’s new Epic system was being deployed that day. Apparently, nobody explained what that really meant for her or my brother, and she felt that the ICU nurses and doctors were moving a bit more slowly during the first day or two of the launch. I wasn’t there, but I suspect that she was right.

Of course, if things go well, over the long run the Epic system will fade into the background and have no importance to patients and their families. But that day or two when the rollout came and staff seemed a bit preoccupied, it scared the heck out of her.

Keeping patients in the loop

Don’t get me wrong: I understand why this hospital didn’t do more to educate and reassure my mother. I suspect administrators wouldn’t know how to go about it, and probably feel they don’t they have time to do it. The idea is foreign. After all, communicating with patients about enterprise health IT certainly isn’t standard operating procedure.

But isn’t it time to involve patients in the game? I’m not just talking about consumer-facing technology, but any technology that could reasonably affect their experience and sense of comfort with the care they’re receiving.

Yes, educating patients and families about enterprise IT changes that affect them is probably out of most health IT leaders’ comfort zones. But truthfully, that’s no excuse for inaction. Launching an Epic system isn’t inside-baseball process — it affects everyone who visits the hospital. Come on, folks, let’s get this right.

Are Biometrics Tools Practical For Hospital Use?

Posted on February 21, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In theory, using biometrics tools could solve some of the hospitals’ biggest data management problems.

For example, if the patient had to register for treatment when seeking care at a hospital emergency department (something I saw in place at my local hospital), it would presumably cut down medical identity fraud substantially. Also, doing patient matching using biometric data could make the process far more precise and far less error-ridden. When implemented correct it can achieve these goals.

In addition, requiring hospital employees to use biometric data to access patient records would lock down those records more tightly, and would certainly make credential sharing between employees far more difficult.

Unfortunately, hospitals that want to use biometric technology have to overcome some major obstacles. According to an article by Dan Cidon, CTO of NextGate, those obstacles include the following:

  • Biometric solutions need to be integrated with primary hospital systems, and that process can be difficult.
  • Most biometric solutions can only manage a subset of patients, which makes it difficult to scale biometrics at an enterprise level.
  • Standard biometric solutions like palm vein and iris scanners demand highly-specialized standalone hardware.
  • Bringing biometrics in-house demands significant server-side hardware and internal infrastructure, bringing the total cost to one that even major health systems might balk at.

On the other hand, Cidon notes, some of these issues can be minimized.

Take the problem of acquiring and maintaining specialized devices. To bypass this issue, Cidon recommends that hospitals try using lower-impact solutions like facial recognition, commodity technology built into patient smartphones. By relying on patient smartphones, hospitals can offload enrollment and registration to patient-owned devices, which not only simplifies deployment but also increases user comfort levels.

He also notes that by using a cloud-based approach, hospitals can avoid allocating a high level of server-side hardware and infrastructure to biometrics, as well as getting added flexibility and affordability, especially if they leverage commodity hardware to do the job.

Even if hospitals act on Cidon’s recommendations, going biometric for patient matching, security and medical identity theft protection will be a major project. After all, hospitals’ existing IT infrastructure almost certainly wasn’t designed to support these solutions and putting them in place effectively will probably take a few iterations.

Still, if putting biometric solutions in place can address critical safety and operational issues, especially dangerous patient record mismatches, it’s probably worth a try.

Pilot Effort Improves EHR Documentation

Posted on February 9, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Though EHRs were intended to improve medical documentation, in many cases they seem to have made documentation quality worse. Despite their best intentions, bogged-down physicians may resort to practices — notably excessive copy-and-paste usage — that turn patient records into bloated, unfocused data masses that don’t help their peers much.

However, a pilot program conducted by a group of academic medical centers suggests using a set of best practice guidelines and templates for progress notes can improve note quality dramatically. The pilot involved intern physicians on inpatient internal medicine rotations at UCLA, the University of California San Francisco, the University of California San Diego and the University of Iowa.

According to a related story in HealthData Management, researchers rated the quality of the notes created by the participating interns using a competency questionnaire, a general impression score and the validated Physician Documentation Quality Instrument 9-item version (PDQI-9).

The researchers behind the study, which was published in the Journal of Hospital Medicine, found that the interns’ documentation quality improved substantially over the course of the pilot. “Significant improvements were seen in the general impression score, all domains of the PDQI-9, and multiple competency items, including documentation of only relevant data, discussion of a discharge plan, and being concise while adequately complete,” the authors reported. Even better, researchers said notes generated by the participating interns had about 25% fewer lines and were signed 1.3 hours earlier in the day on average.

One side note: despite the encouragement provided by the pilot, the extent to which interns used templates varied dramatically between institutions. For example, 92% of interns at UCSF used the templates, compared to 90% at UCLA, 79% at Iowa and only 21% at UCSD. Nonetheless, UCSD intern notes still seemed to improve during the study period, the research report concluded. (All four institutions were using an Epic EHR.)

It’s hard to tell how generalizable these results are. After all, it’s one thing to try and train interns in a certain manner, and another entirely to try and bring experienced clinicians into the fold. It’s just common sense that physicians in training are more likely to absorb guidance on how they should document care than active clinicians with existing habits in place. And unfortunately, to make a real dent in documentation improvement we’ll need to bring those experienced clinicians on board with schemes such as this.

Regardless, it’s certainly a good idea to look at ways to standardize documentation improvement. Let’s hope more research and experimentation in this area is underway.

Yale New Haven Hospital Partners With Epic On Centralized Operations Center

Posted on February 5, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Info, info, all around, and not a place to manage it all. That’s the dilemma faced by most hospitals as they work to leverage the massive data stores they’re accumulating in their health IT systems.

Yale New Haven Hospital’s solution to the problem is to create a centralized operations center which connects the right people to real-time data analytics. Its Capacity Command Center (nifty alliteration, folks!) was created by YNHH, Epic and the YNHH Clinical Redesign Initiative.

The Command Center project comes five years into YNHH’s long-term High Reliability project, which is designed to prepare the institution for future challenges. These efforts are focused not only on care quality and patient safety but also managing what YNHH says are the highest patient volumes in Connecticut. Its statement also notes that with transfers from other hospitals increasing, the hospital is seeing a growth in patient acuity, which is obviously another challenge it must address.

The Capacity Command Center’s functions are fairly straightforward, though they have to have been a beast to develop.

On the one hand, the Center offers technology which sorts through the flood of operational data generated by and stored in its Epic system, generating dashboards which change in real time and drive process changes. These dashboards present real-time metrics such as bed capacity, delays for procedures and tests and ambulatory utilization, which are made available on Center screens as well as within Epic.

In addition, YNHH has brought representatives from all of the relevant operational areas into a single physical location, including bed management, the Emergency Department, nursing staffing, environmental services and patient transport. Not only is this a good approach overall, it’s particularly helpful when patient admissions levels climb precipitously, the hospital notes.

This model is already having a positive impact on the care process, according to YNHH’s statement. For example, it notes, infection prevention staffers can now identify all patients with Foley catheters and review their charts. With this knowledge in hand, these staffers can discuss whether the patient is ready to have the catheter removed and avoid related urinary tract infections associated with prolonged use.

I don’t know about you, but I was excited to read about this initiative. It sounds like YNHH is doing exactly what it should do to get more out of patient data. For example, I was glad to read that the dashboard offered real-time analytics options rather than one-off projections from old data. Bringing key operational players together in one place makes great sense as well.

Of course, not all hospitals will have the resources to pull something off something like this. YNHH is a 1,541-bed giant which had the cash to take on a command center project. Few community hospitals would have the staff or money to make such a thing happen. Still, it’s good to see somebody at the cutting edge.

How Mobile Computer Carts Reduce Errors and Increase Efficiency

Posted on February 2, 2018 I Written By

The following is a guest blog post by Andy Lurie, Director of Marketing and Partner Relations at Add On Data.

Mobile computing carts have been a mainstay in the hospital environment since the electronic medical records (EMR) mandate took effect in the United States. To show meaningful use of electronic health records in the healthcare environment, facilities across the nation have adopted mobile computing carts as the primary means of addressing EMR at the point-of-care. Mobile carts offer better ergonomics and productivity than tablets or mobile devices.

Mobile computer carts aren’t just a means of satisfying the new meaningful use requirements for EMR however, they’re becoming vital aspects of workflow optimization and error reduction strategies at healthcare facilities everywhere. Hospitals that initially overlooked the practical benefits of satisfying the EMR mandate are now benefiting from fewer recording errors in patient records, more accurate medication administration, and enhanced worker productivity. Keep reading to find out how!

Mobile Computer Carts Help Care Providers Get More Done

It’s easy to imagine how the introduction of mobile workstations to the healthcare environment has enhanced productivity, especially for the nurses and physicians that use this equipment daily. Here’s what a workflow for patient visits might have looked like before the introduction of mobile workstations:

  1. The nurse visits the patient’s room.
  2. The nurse interviews the patient and conducts any relevant assessments (blood pressure, vitals, etc.)
  3. The nurse visits the medication/equipment room to get materials needed by the patient.
  4. The nurse returns to the patient and administers treatments.
  5. The nurse returns to the stationary workstation located at the nurse’s station.
  6. The nurse records the patient’s condition and documents the treatment provided.
  7. The nurse is ready to visit a new patient.

With mobile computer carts, nurses can reduce many of the walking steps in this process. Basic medical supplies and medications can be stored securely in the drawers of a mobile computing cart, reducing the need for trips to supply rooms. The nurse can also update patient records at the bedside, eliminating the need to repeatedly return to a stationary workstation throughout their shift. A 10-20% reduction in the time taken for a patient visit represents massive productivity gains for an organization.

Mobile Computer Carts Reduce Errors in EMR Recording

EMR recording errors are an insidious and completely unnecessary cause of adverse outcomes for the patient, but they’re a sad reality of an inefficient workflow that separates the processes of patient care from the process of documentation.

We all trust our healthcare providers to provide attentive and conscientious care for each patient, but it’s easy to imagine how documentation errors can occur. Nurses who routine to a stationary workstation between patient visits may sometimes find that computer occupied, meaning they have to wait before documenting the most recent interaction. Sometimes nurses encounter distractions on their way to document a patient interaction – it could be a medical emergency, an urgent request from another staff member, a disruptive patient or visitor, or anything else.

Nurses and physicians need to be accountable for accurately documenting every interaction they have with patients, and this is best achieved with mobile computer carts. Mobile carts ensure the presence of an available workstation at the point of care, ensuring that patient care is documented as it happens and without delay. This reduces data entry errors and enhances patient safety.

Mobile Computer Carts Help Ensure Secure and Accurate Medicine Administration

Mobile computer carts have been used effectively to ensure the security, accuracy, and timeliness of medication administration in hospitals. Carts can be customized with secure drawers for holding medication, as well as bar-code scanners that nurses use to correctly identify patients and match them with the appropriate medications. The combination of medication verification software and organized storage of patient medications virtually eliminates the possibility of patient medication errors.

A study that assessed adverse drug events (ADEs) found that each hospital experiences a medication error every 22.7 hours and every 19.73 admissions. Miscommunication and “Human Factors” have been identified as leading factors contributing to these mistakes, along with similar labeling on medications and patient name confusion. Using bar-code scanners and software to match patients with their proper medications reduces these errors and ultimately saves lives by addressing sources of error that are inherent to the manual administration of medicines in the hospital setting.

Conclusion

While the implementation of mobile computer carts in the healthcare environment is important for satisfying the EMR mandate, hospitals should not overlook the real opportunities to generate and capitalize on the other benefits of mobile carts. Effective usage of mobile computing carts reduces errors and increases hospital efficiency, helping facilities reduce their costs and improve patient safety and health outcomes.

Hospital Mobile Strategy Still In Flux

Posted on January 8, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The following is a look at how hospitals’ use of communication devices has changed since 2011, and what the patterns are now.  You might be surprised to read some of these data points since in some cases they defy conventional wisdom.

The researchers behind the study, communications tech provider Spok, Inc. surveyed about 300 healthcare professionals this year, and have tracked such issues since 2011. The report captures data on the major transitions in hospital mobile communications that have taken place since then.

For example, the report noted that in 2011, 84% of staffers received job-related alerts on pagers. Sixty-two percent are using wireless in-house phones, 61% desk phones, 77% email on their computers, 44% cell phones and 5% other devices.

Since then, mobile device usage in hospitals has changed significantly. For example, 77% of respondents said that their hospital supports smartphone use. The popularity of some devices has come and gone over time, including tablets and Wi-Fi phones (which are nonetheless used by 63% of facilities).

Perhaps the reason this popularity has risen and fallen is that hospitals are still finding it tricky to support mobile devices. The issues include supporting needed infrastructure for Wi-Fi coverage (45%), managing cellular coverage infrastructure (30%), maintaining data security (31%) and offering IT support for users (about 30%). Only 11% of respondents said they were not facing any of these concerns at present.

When the researchers asked the survey panel which channels were best for sharing clinical information in a hospital, not all cited contemporary mobile devices. Yes, smartphones did get the highest reliability rating, at 3.66 out of five points, but pagers, including encrypted pagers, were in second place with a rating of 3.20. Overhead announcements came in third at 2.91 and EHR apps at 2.39.

The data on hospitals and BYOD policies seemed counterintuitive as well. According to Spok, 88% of facilities supported some form of BYOD in 2014, or in other words, roughly 9 out of 10.  That percentage has fallen drastically, however, BYOD support hitting 59% this year.

Not surprisingly, clinicians are getting the most leeway when it comes to using their own devices on campus. In 2017, 90% of respondents said they allowed their clinicians to bring their own devices with them. Another 69% supported BYOD for administrators, 57% for nurses and 56% for IT staffers. Clearly, hospital leaders aren’t thrilled about supporting mobility unless it keeps clinical staff aligned with the facility.

To control this cacophony of devices, 30% said they were using enterprise mobility management solutions, 40% said they were evaluating such solutions and 30% said they had no plans to do so. Apparently, despite some changes in the devices being used, hospitals still aren’t sure who should have mobile tools, how to support them and what infrastructure they need to keep those devices lit up and useful.

Hospitals Puts Off Patient Billing For Several Months During EMR Rollout

Posted on January 6, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s something you don’t see every day. A New Hampshire hospital apparently delayed mailing out roughly 10,000 patient bills going back as far as 11 months ago while it rolled out its new EMR.

According to a report in the Foster’s Daily Democrat,  members of Frisbie Memorial Hospital’s medical staff recently went public with concerns about the hospital’s financial state. Then a flood of delayed patient bills followed, some requesting thousands of dollars, the paper reported.

Hospital officials, for their part, said the delay was planned. Hospital president John Marzinzik said Frisbie needed time to implement its new Meditech EMR and didn’t want to send out incorrect bills during the rollout.

In fact, Marzinzik told Foster’s, under the previous system, records generated during doctor visits weren’t compatible with forms for hospital billing.

Rather than relying further on this patchwork of incompatible systems, Marzinzik and his staff decided to wait until the process was “absolutely clean” for patients. The hospital decided to have a staff member validate every balance shown on a statement before sending them out, he says.

Previously, in December of last year, anonymous Frisbie medical staff members sent Foster’s a letter to share concerns about the hospital and its administrators. The criticisms included skepticism about the over-budget implementation of the $13.5 million Meditech system, which they named as one of the reasons they lack confidence in the hospital administration. The staff members said that this cost overrun, as well as other problems, have undermined the hospital’s financial position.

As is always the case in such situations, hospital leaders took the stage to deny these allegations. Frisbie Senior VP Joe Shields told the paper that the hospital is in sound financial condition, and also said that the only reason why the Meditech project went over budget by $1.5 million was that the administrators delayed the implementation by seven weeks to give the staff holiday time off.

Hmmm. I don’t know about you, but to me, some parts of this story look a little bit bogus. For example:

* I appreciate accurate hospital bills as much as anybody, but the staff was going to check them manually anyway, why did it take 10 or 11 months for them to do so?

* The holidays take place at the same time every year.  Did administrators actually forget they were coming to an event that necessitated an almost 10% cost overrun?

Of course, only a small number of people know the answers to these questions, and I’m certainly not one of them. But the whole picture is a little bit odd.

Merged Health Systems Face Major EHR Integration Issues

Posted on January 2, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Pity the IT departments of Advocate Health Care and Aurora Health Care. When the two health systems complete their merger, IT leaders face a lengthy integration process cutting across systems from three different EHR vendors or a forklift upgrade of at least one.

It’s tough enough to integrate different instances of systems from the same vendor, which, despite the common origin are often configured in significantly different ways. In this case, the task is exponentially more difficult. According to Fierce Healthcare, when the two organizations come together, they’ll have to integrate Aurora’s Epic EHR with the Cerner and Allscripts systems used by Advocate.

As part of his research, the reporter asked an Aurora spokesperson whether health systems attempt to pull together three platforms into a single EHR. Of course, as we know, that is unlikely to ever happen. While full interoperability is obviously an elusive thing, getting some decent data flow between two affiliated organizations is probably far more realistic.

Instead, depending on what happens, the new CIO might or might not decide to migrate all three EHRs onto one from a single vendor. While this could turn out to be a hellish job, it certainly is the ideal situation if you can afford to get there. However, that doesn’t mean it’s always the best option. Especially as health system mergers and acquisitions get bigger and bigger.

To me, however, the big question around all of this is how much the two organizations would spend to bring the same platforms to everyone. As we know, acquiring and rolling out Epic for even one health system is fiendishly expensive, to the point where some have been forced to report losses or have had ratings on the bond reduced.

My guess is that the leaders of the two organizations are counting often-cited merger benefits such as organizational synergies, improved efficiency and staff attrition to meet the cost of health IT investments like these. If this academic studies prove this will work, please feel free to slap me with a dead fish, but as for now I doubt it will happen.

No, to me this offers an object lesson in how mergers in the health IT-centered world can be more costly, take longer to achieve, and possibly have a negative impact on patient care if things aren’t done right (which often seems to be the case).

Given the other pressures health systems face, I doubt these new expenses will hold them back from striking merger deals. Generally speaking, most health systems face little choice but to partner and merge as they can. But there’s no point minimizing how much complexity and expense EHRs bring to such agreements today.