On his “Life as a Healthcare CIO” blog, Dr. John Halamka, the CIO of Beth Israel Deaconess Medical Center talks about the market pressures that are leading many healthcare organizations to look to merge or acquire with other providers.

Many healthcare organizations are discovering that accountable care reimbursed via global capitated risk contracts requires more primary care physicians and a more tightly coupled delivery network including suburban hospitals, home care, and long term care. Affiliations, mergers, and acquisitions are accelerating to meet these needs.

This is not news to many in the industry, but Dr. Halamka goes on to identify an important issue that results from this trend that hasn’t been widely discussed.

From an IT perspective how are (we) to respond to this organizational change with agility and efficacy?

We could rip and replace everything everywhere and mandate a single vendor solution for every workflow at every new location.

That would create standardization, but it would also consume more capital than we have at time when Meaningful Use Stage 2, ICD10, and compliance requirements have already committed all available IT resources. (emphasis added)

The drive to meet Meaningful Use requirements has resulted in an industry focus on implementing EHRs to capture the government incentives available. Unfortunately, many EHR vendors are providing notoriously closed environments. They’ve further cemented themselves within Providers’ HIT ecosystems by extending their services beyond the management of health records and into other HIT functions. Providers that put all their HIT eggs into their EHR vendor’s basket may find they’ve painted their organization into a corner in the future. Interestingly, even having EHRs from the same vendor is no guarantee of interoperability (see comments in this article on Forbes).

So what can a provider do to avoid being cornered where a rip and replace strategy is the only HIT option to handle acquisitions? The key is utilizing 3rd-party HIT solutions at key technology intersections that provide an organization with the flexibility to integrate other EHR vendors, as well as other critical IT systems, and ultimately bring together the people and processes of multiple organizations. There are three critical technologies that can give Providers the flexibility to do just that:

  1. Interface Engine
  2. Master Patient Index, and
  3. Healthcare Portal.

Interface engines are at the core of systems integration for HIT. Where EHR vendors may be reticent to interface directly with other EHR vendors, 3rd-party interface engines are designed from the start to integrate with multiple EHR vendors. Some solutions, such as IBM’s Integration Bus, also enable the integration of non-HL7 messaging. This facilitates the integration of non-medical applications needed in a merger or acquisition as well, such as billing, payroll, HR and data warehousing environments.



Next, a master patient index provides the flexibility to get a complete view of patient data, regardless of which backend EHR the source record is stored in. IBM Initiate Patient Hub uses sophisticated algorithms to identify matches and enable the linking of records. This can improve data within a single EHR as well as across multiple systems. Not only does this give care providers a complete picture of the patient at the point of care, but it also enables accurate data for analytics and reporting which is crucial with the shift in focus to population health and accountable care.

This challenge was recently well articulated by Frank Richards, the CIO of Geisinger Health System, in an article in HealthLeaders magazine. Richards said,

You have to be able to identify the patient across all the venues of care in order to be able to do analytics on the information to make sure that … the care is being delivered, and people are getting the care, and that they’re getting only the care that they need in a cost-effective manner

He later explains why their EHR alone was not sufficient to resolve this problem.

But when Geisinger first installed Epic, it didn’t reconcile Epic medical record numbers effectively with other external systems in use, not only within its provider system but now increasingly with its health information exchange. So let’s say that we purchase a hospital that has another billing system or another lab system or something. Epic, at least as we installed it originally, was not capable of taking calls from an external system, reconciling the numbers in its database, and interacting with that system

Lastly, I’ve blogged before about the benefits of a 3rd-party patient portal solution such as IBM’s WebSphere Portal. The importance of this piece cannot be overstated since this is where patients directly touch a provider’s HIT infrastructure. Providers can develop a consistent brand and set of patient services across multiple patient touch points, regardless of the EHR systems involved on the backend. And they can provide an exceptional experience to patients on mobile devices as well as from a PC.

But it isn’t only patients that can benefit from a healthcare portal, and here is where a multi-audience portal can truly provide value to deliver services to physicians and the broader employee community as well. An internally-focused portal makes it far easier to integrate staff from another provider, and in so doing, quickly develop a unified culture which is key to a successful merger.

Can your organization afford a rip-and-replace strategy to EHRs and mergers and acquisitions? If not, reach out to your CDW account manager. We’re happy to provide you alternatives.