The Feasibility of Upgrading Hospital Networks to Newer EMR Systems: A Theoretical Analysis

Could it be theoretically possible for hospitals to migrate their networks from legacy Electronic Medical Record (EMR) systems like Epic to newer systems? This question addresses the hypothetical scenario where such a transition would realistically be possible, despite the current state of electronic health record (EHR) systems.

Introducing New EHR Systems

From a theoretical standpoint, the migration to a new EMR system could indeed be made possible, but it would require extraordinary circumstances. For instance, the loved one of one of the 1200 richest people or families in the United States would need to face adverse harm due to the limitations of any current EHR system. This hypothetical scenario envisions a situation where such an individual would have extensive networks—both philanthropic and political—that could mobilize influential coalitions.

Under these conditions, the individual would need to take it upon themselves to champion the cause, inspiring policymakers and lawmakers to address specific functionality gaps. It would require immense personal motivation and the leveraging of influential networks, akin to a modern version of Mothers Against Drunk Driving, but on a much larger scale with substantial financial backing.

Current EHR Systems: How Did We End Up Here?

The journey to the current state of EHR systems, particularly those like Epic, began with the HITECH Act, which was enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009. The HITECH Act was signed into law on February 17, 2009, with the primary goal of promoting the adoption and meaningful use of health information technology.

The implementation of the HITECH Act through its Enforcement Interim Final Rule, an integral part of Health and Human Services (HHS) guidelines, aimed to ensure the widespread adoption of EHRs. This legislation laid the foundation for the current EHR landscape but also highlighted the interoperability and cost issues that exist with these systems.

Are Current EHR Systems 'Legacy'?

It is a common misconception that systems like Epic are considered "legacy" in the healthcare technology sector. Additionally, the assumption that Epic is not interoperable is also inaccurate. Epic, in fact, has been highly transparent and open in discussions about interoperability, challenging other EMR systems to meet similar standards of openness and transparency.

The Cost of Legacy Systems and Migration

One of the major challenges in migrating from an existing EHR system is the sunk cost associated with the legacy system. Epic, being a market leader in large hospital installations, presents unique challenges due to the substantial financial investments involved. For instance, Epic’s largest installation, with Kaiser, cost over 4 billion dollars over a decade, equating to approximately 400 million dollars per year.

Even smaller installations can range in the tens of millions of dollars. The process of migrating to a new system involves more than just the cost of the software. Conversion costs, training costs, and equipment costs must also be considered. These costs are highly specific and custom to each hospital system, making it challenging to generalize the total cost. Therefore, any attempt to provide a generalized estimate without verifiable and recent data would be highly speculative and potentially unreliable.

In conclusion, while the migration from legacy EHR systems to newer systems is theoretically possible under extraordinary circumstances, the practical and financial hurdles make it a complex and daunting task. Understanding and addressing these challenges is crucial for healthcare providers and policymakers in the quest for improving the efficiency and effectiveness of healthcare delivery through advanced technology.