Partners HealthCare is in negotiations to replace its patchwork of electronic health records systems, built in-house by pioneers in the industry, with a single commercial system created by Wisconsin developer Epic Systems Corp.
Expected to cost at least $600 million over 10 years, the Epic system would give each patient a single up-to-date record accessible by all Partners providers, at a time when doctors and hospitals are under pressure to keep closer tabs on the sickest people they care for and to better track their own performance over time.
Partners is the state’s largest health care provider, with nine hospitals and 6,000 physicians, and its executives said the decision is an important step toward a more integrated, statewide system for sharing medical records.
Much of Partners’ current systems were developed at Massachusetts General Hospital and Brigham and Women’s Hospital starting in the 1980s, before they formed Partners and when there were no products on the market that could meet the hospitals’ needs. The hospitals have separate but related inpatient systems, distinct from those used by many of their affiliates. A separate system, called the Longitudinal Medical Record, manages outpatient records.
“The result is, when patients move from one place to another, their information often does not follow them in a complete form or as promptly as we’d like,” said Dr. David Blumenthal, Partners chief health information and innovation officer.
Under the new system, data for a patient who is referred from a primary care office to an orthopedist, has surgery, and later is discharged with home care would be contained “all in the same record and all available in real time,” he said.
The change would make it easier to update the system as the technology evolves and to apply quality control tools—such as prompts about appropriate tests or warnings of possible drug interactions—uniformly across all Partners practices, Blumenthal said.
But it is not likely to be an easy adjustment as the system is rolled out in the coming years, said Dr. Thomas Lee, a primary care physician and president of the Partners physician network.
“No one is happy about changing the electronic medical record system that they learned,” Lee said. “The question is, is there something better on the other side of this transition?”
Judy Klickstein, chief information officer at Cambridge Health Alliance, which also uses Epic, said the change likely would make the Partners system more streamlined though doctors would lose some of the control they have had with the home-grown operation.
“If the clinicians had a brilliant idea, they could execute it,” she said. “With that comes many, many, many versions that you have to maintain.”
She called the decision a “game-changer” for health information technology in the state. Partners is Massachusetts’s dominant health care system, which means Epic would become the dominant records system.
“This is going to make my ability to integrate with them much easier,” she said. “The question I have is, what will this mean for people who aren’t on Epic?”
As President Obama’s national coordinator for health information technology, Blumenthal launched efforts aimed at creating a national “interoperable” health records system, in which doctors who see the same patient would share data even if they are at competing institutions.
The Epic system would make Partners better prepared to share data because it has a uniform interface for outside systems, rather than many different “docking stations” for data, Blumenthal said.
“There is absolute commitment at the most senior levels of Partners to full information exchange,” he said. “That’s not simply altruistic. It’s also critical to being in business in this new environment.”
Commerical and federal health insurers are beginning to pay doctors at least in part on how well they manage patients’ overall health care, rather than paying for each test or treatment provided.
“Health care providers, not health plans but hospitals and doctors, are saying, ‘We need to coordinate care better,’” said Dr. Farzad Mostashari, who replaced Blumenthal as the national coordinator, when asked about the change at Partners during a visit to Boston this week. “There’s going to be a business case for that.”
Epic, which reported $1.1 billion in revenue in 2011, according to a company factsheet, serves many of the country’s largest medical centers, including Kaiser Permanente, Geisinger Health System, Johns Hopkins Medicine, and Stanford Hospital & Clinics. An Epic spokeswoman declined to comment on the Partners negotiations.
Lee, the physician group president, said Partners has developed high-quality systems but he has seen how the Epic system works at Geisinger, where he sits on the board of directors.
“You look at Epic and you say, ‘Oh, they’ve taken our wonderful ideas, and they’ve incorporated them with lots of other things,’ ” he said.