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Dome - Epic: The right move at the right time

October 2011

Epic: The right move at the right time

Date: October 14, 2011

Ron Peterson
Ron Peterson

There are a lot of changes going on throughout Johns Hopkins Medicine. We are restructuring the organization to make us more efficient and responsive. We are building a clinical network that will give patients more opportunities to reach Hopkins quality care. In the not too distant future, we will be opening the doors to a $1.1 billion new clinical building. If that is not enough, we are also embarking on a major investment to develop a highly integrated electronic health record system called Epic.

You might question, with all of this activity, why we are going ahead now with spending so much time and money on Epic. In fact, it is all tied together.

The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Howard County General Hospital each took different approaches to an electronic health record system. That has served us reasonably well to a point.

But with the expansion of Hopkins Medicine to include three additional hospitals and a much larger primary care network, we have patients coming into our system through many portals and causing us to think more strategically about where and when these patients should be getting care. That means we need to move in a direction that requires more coordination and integration of the care we provide our patients and the information our providers need to accomplish that.

Epic would help us respond to Meaningful Use, the Centers for Medicare and Medicaid Services program that requires providers to use electronic health records to measure quality and quantity or face possible reduction in payments. It would help us in the mandatory, enormous enterprise-wide conversion by October 2013 to a new generation of billing codes.

Additionally, with federal and state budget issues putting more pressure on Medicare and Medicaid to reduce costs, we are entering an era when we find ourselves very constrained in the amount of funding available for health care services.

That is why we have been focusing on launching a more highly integrated clinical information system across the enterprise. This would bring together our clinical and patient billing systems and give us access to a common approach to an electronic health record.

It will standardize ways of doing business. It will make it easier for our doctors and residents to access the same patient medical information, regardless of where they are working. It will create one billing system. It will give all of our patients access to their own complete medical record rather than having to obtain separate records if they were treated at various hospitals.

For all of these reasons, we will be making a major capital investment in an integrated clinical and billing information system. Initially this would be about $100 million to install Epic in our ambulatory centers. Remember, we are not just talking about East Baltimore, but for the entire Hopkins Medicine enterprise (except for All Children’s Hospital, which for now will not be involved). We are finalizing our plan of finance, which likely will be a combination of our own cash and debt.

Although we had been planning to phase in Epic on the inpatient side of our hospitals within the next three to four years, we will likely accelerate this for Howard County General Hospital and Sibley Memorial Hospital. What we are doing now is going through a methodical planning process to make sure we understand the full costs of Epic—capital costs and operating expenses—over a 10-year period. Also included in our review is quantifying the benefits of doing this, looking for opportunities for additional cost improvements that would better allow us to implement Epic, because the costs will be front loaded.

But it is not just about the cost. I strongly feel that Epic will help all of us to fulfill the goals of becoming more patient- and family-centered in our care delivery and to do a much better job of coordinating the care patients receive when they come to Hopkins. This is the real bottom line.