Banner Health goes for one EHR for all

Migration of two acquired hospitals from Epic to Cerner slated for 2018
By Bernie Monegain
08:41 AM
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It may seem counter-intuitive to pull the plug on a new and expensive – reportedly $115 million – EHR system that was recently rolled out at two hospitals in favor of another brand.

But that's exactly what Banner Health has decided to do in the case of the two hospitals they recently acquired from the University of Arizona.

Banner, a 28-hospital integrated healthcare system with a Cerner EHR, will by 2018 migrate the two UA hospitals from their Epic EHRs to the Cerner platform.

To Banner Health executives, it makes perfect sense. As they figure it, the move will, in the end, save them money. But most important it will ensure better quality of care, said Banner Chief Information Officer Ryan Smith.

"There's significant cost savings by consolidating these two systems down to our single system," Smith said. "Even taking into account the sizable investment that the former organization had made in that Epic environment, the structure of our relationship with Cerner is actually very cost effective for us to make this migration."

He pointed out there would be significant operating cost around system support and disparate staff to support a system like that's different from what the rest of the organization is using.

"From the cost side of the equation, it makes really good business sense for us to do this migration," he said.

[See also: Banner Health, Cerner tackle big change.]

Having all hospitals on the same EHR will also benefit a key component of Banner Health's approach to care, he added.

"Part of our operating success really entails driving as much standardization as possible to operate most efficiently, safely with the highest quality possible," Smith explained. "You can't do that if you're doing things in a lot of different ways across your various care sites."

Over the years, he says, Banner has devoted a lot of time and attention to standardizing care.

"In essence, our whole IT organization is built around support of a highly centralized, highly consolidated, highly integrated business and clinical operations of the company," he says. "And, therein really lies the answer to why we really wanted integrated electronic health record systems."

When Banner acquired the two Tucson hospitals, they had been operating with their Epic system for about two years. There had been reports of cost overruns mostly attributed to delays in implementation.

The UA board of directors reported in April 2014 $6.8 million loss, which it attributed to physicians devoting time learning how to use the new system and also a decrease in patient volumes.

Steve Lynn, former chair of the UA Health Network Board of Directors was quoted in the Arizona Daily Star as saying the migration to Cerner would be easier than installing the Epic EHR had been.

"Obviously there was pain and suffering. But the good news is that there's enough similarity between the two," Lynn told the Arizona newspaper. "It is much more difficult to go from non-electronic to electronic than from one electronic system to another."

But, the decision for Banner, a Cerner shop, did not boil down to whether Epic was better than Cerner or vice-versa.

As Smith put it, it was all about standardization. It was vital for the organization to have everyone on the same platform.

"Part of our operating success really entails driving as much standardization as possible to operate most efficiently, safely with the highest quality possible, and you can't do that if you're doing things in a lot of different ways across your various care sites," he said. "In essence, our whole IT organization is built around support of a highly centralized, highly consolidated, highly integrated business and clinical operations of the company."

[See also:  Banner Health earns Stage 7 recognition and Banner Health targets chronically ill]

Another critical factor to care at Banner Health, Smith said, is clinical decision support.

"We have implemented within our server system vast decision support rules that assist our clinicians and physicians in providing really highest quality care," he said.

At the Tucson hospitals there had been little clinical decision support implemented. It had been in the plan to add it over time, but it had not yet been implemented.

"That's another opportunity for us to highly leverage those many thousands of clinical decision support rules in that care setting as well," Smith said.

Ultimately, the decision to move the two Tucson hospitals to the Cerner EHR was a C-suite decision.

There was a lot of early discussion and debate around it because the former organization had made significant investment in that Epic implementation, and they were relatively new on that implementation, Smith said.

"As we went through and really did the analysis and challenged ourselves around what would it mean to have significant variance in what had historically been a very strong operating model in Banner, we pretty quickly concluded conceptually and philosophically that this migration would make sense," he said.

Even after thorough discussion and analysis, Banner executives took several months to go through the due diligence process, he said, to really build the case of why exactly it made sense.

"We've largely concluded that analysis," Smith said, and all arrows point in the same direction – that it does make sense."