EHR interoperability will be put to the test in the Chicago area with the large-scale merger of Advocate Health Care and NorthShore University Health System. The partnership will create a network of sixteen hospitals using four different EHR systems from some of the biggest vendors in the business, with more than 2000 employed physicians serving 3 million patients a year at more than 350 locations: a daunting challenge for health information exchange that raises questions about the impact of multiple EHRs in such a massive conglomerate.
The new Advocate NorthShore Health Partners, which still requires approval before the deal closes in early 2015, will shift the business paradigm in Illinois as it produces a $6.8 billion behemoth with more than 45,000 employees. “This is a huge win for Advocate. It’s an incredible coup to lock up NorthShore. It’s a great market and it’s a great system,” said Jordan Shields, a vice president at hospital merger advisor Juniper Advisory, to the Chicago Tribune. “[It] is going to shake people. What this does is change the gravity in the metropolitan area.”
The merger will help to secure ongoing revenues in a climate of uncertainty over the role of the inpatient setting and the long-term impact of the Affordable Care Act, which has been restructuring the way patients receive care. While the potential for employee layoffs to reduce redundancies may have support staff and administrative workers worried, clinicians might be wondering how their EHR systems will be affected by the deal. NorthShore University is an Epic shop with a single, unified platform across its care sites, but Advocate providers are split between Allscripts for its employed physician group, eClinicalWorks for “physician partners,” and Cerner as its inpatient EHR.
Dr. Wes Fisher, MD, FACC, a NorthShore cardiologist and Clinical Associate Professor of Medicine at the University of Chicago, explains in a blog post discussing the merger that Advocate wanted to allow their physicians to remain more independent by using multiple EHRs. Providers who leave the Advocate Physician Partners group are allowed to take their patient data with them and set up shop elsewhere without having to worry about losing previous records.
But that admirable flexibility on the part of Advocate may prove a challenge when butting heads with a monolithic Epic partner. “NorthShore was the metro Chicago’s first EPIC client and while its 4 hospitals are a relative minority compared to Advocate’s more geographically diverse 12-hospital system, its seamless outpatient and inpatient integration of EMR platform may threaten Cerner and Allscripts control of Advocate’s EMR solution,” Fisher writes. “While I suspect change may not come immediately, if a move to consolidate EMR systems occurs, both doctors and patients in one of the systems may see some dramatic changes going forward as a result.”
In the meantime, if the partnership is approved, all four clinical systems must find a way to work together to ensure that patient data flows appropriately across the 350 sites involved in the merger. Cerner and Allscripts are founding members of the CommonWell Alliance, a pact between EHR vendors to improve interoperability and implement data standards, but standoffish Epic has denounced the effort as a “competitive weapon” and a “distraction” for the healthcare industry.
Will the four major competitors find a way to play nice in the new health system conglomerate, or will Epic’s unified database and proven effectiveness in the hospital setting eventually muscle its way into dominance? Advocate’s CEO James Skogsbergh notes that the merger is an attempt at ramping up the scale of the health system to be more competitive in a fragmented market, and few EHR vendors are as accomplished at conquering large-scale projects as Epic Systems. It will be interesting and edifying to see how the new Advocate NorthShore partnership addresses its technology challenges as it moves forward in an evolving healthcare landscape.