Documents ascertained under the Tennessee Open Records Act and shared with EHRIntelligence.com raise doubts about the recent EHR selection process at Erlanger Health System, a public health system in the state.
On May 28, 2015, the health system’s Board of Trustees voted in favor of an EHR technology from Epic Systems rather than rival Cerner Corporation following the recommendation of the health system’s EMR committee.
At the time, the contract the Epic implementation project was valued at $91 million, which will include an complete replacement of the Erlanger’s various health IT platforms across its five hospital network, according to Kate Belz of the Times Free Press. In that report, Erlanger’s Executive Vice Present & CFO Britt Tabor said Epic’s bid was less expensive.
It is the work Erlanger leadership and the EMR committee in reviewing bids from both Epic and Cerner that is being called into question.
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What happened?
Overseeing the work of Erlanger’s EMR committee was Tish Ingalls in her capacity as Chief Technology Officer who was terminated in September 2015 without any public announcement.
A report in The Chattanoogan following the board’s vote noted that Ingalls told its members that 100 percent of Erlanger’s physician were behind the Epic EHR selection. While the Epic EHR enjoyed a vast majority of support, it was not unanimous according to the recently requested documents. In fact, the health system’s department of obstetrics and gynecology voted in favor of Cerner.
Other disparities emerged from emails included in the documents requested. At the time when Ingalls requested clinical leadership to vote on the EHR selection, she did not respond to a request by Executive Vice Present & CFO Britt Tabor about finalizing “the final investment number” prior to voting.
Back to The Chattanoogan, the $91-million Epic contract represents only one-half of the total cost of ownership over the ten-year duration of the contract. Another $97.3 million will be required in operating expenses.
From bid assessor to implementation support
Speaking of financials, Erlanger brought in Deloitte Consulting to assess bids from Epic and Cerner. In its first presentation to the Tennessean health system on Dec. 30, 2014, the consulting firm recommended the lowest cost option of Cerner valued at $301 million in total cost of ownership compared to $326 million for Epic based on “Erlanger’s financial position, IT organization make-up and reviews of vendor costs.”
Despite a clear recommendation, Deloitte then produced a second presentation on Jan. 23, 2015, which still listed Cerner’s bid in total cost of ownership at $359 million compared to Epic’s at $361 million.
In an email following the second Deloitte presentation, Ingalls expressed her distrust of the findings to consultant David Peterson, who recommended Ingalls to the CTO position, was then hired to review the EHR bids, and ultimately took over for Ingalls after her termination.
Upon learning of her dissatisfaction, Deloitte emails point to the firm’s ability to ensure Erlanger additional cost savings using its own Epic implementation and operation model.
“Britt wanted me to set up a meeting next week with you and he to discuss the potential opportunity and additional cost savings if Erlanger was to choose Epic and the vendor of Choice,” a January 29 email from Deloitte’s Todd Shores stated.
A chain of emails emerging later that year showed that Ingalls had had no correspondence with the board prior to its vote on the Epic EHR selection in May 2015. Given the scarcity of information between January and May 2015, it is possible additional reviews of the bids led to Epic coming out on the less expensive option.
Date: 20 May, 2016