Becker's ASC Review

29 HEALTHCARE NEWS 29 'Rip the Band-Aid off': Health systems opt for 'big bang' Epic go-lives By Giles Bruce E pic is encouraging health systems to turn on the EHRs across their enterprises all at once, though some organizations are sticking with a phased rollout. "Implementations have been getting bigger, faster and better," Epic founder and CEO Judy Faulkner said at this year's Epic Users Group Meeting. "At first, years ago, we thought that installs that were slow would be best — slow and piece by piece. We found out that they require too many interim workloads that keep changing. Turns out that fast installs are better and 'big bang,' all at once is oen better than piece by piece." Most, if not all, of the 28 health systems that have signed on with Epic in the past year plan to go live with the EHR on a single date enterprisewide. Salt Lake City-based Intermountain Health, one of the largest health systems to adopt Epic in recent years, recently did a "big bang" install across its 33 hospitals and six-state footprint, switching over from Oracle Health (formerly known as Cerner). "We opted for an 'all-at-once' approach because it best aligns with Epic's proven installation methodology and with our own goals for patient safety, caregiver experience, and operational simplicity," Intermountain Chief Digital and Information Officer Ryan Smith told Becker's. "An enterprise cutover minimizes the period of running parallel systems, accelerates the benefits of a single patient record and billing platform for every Intermountain region. It also supports more consistent, high-quality care across our footprint." But some other big health systems moving to Epic are sticking with a region-by-region strategy because of their size. "UPMC's scale and complexity make a 'big bang' EHR implementation unrealistic, even if we were starting fresh today," said Ed McCallister, senior vice president and CIO of the Pittsburgh-based health system, which includes 40 hospitals and 800-plus outpatient sites across multiple states. "is scale and geographic spread introduce enormous variability in workflows, infrastructure, and readiness across facilities," he added. "Based on extensive evaluation with UPMC and Epic technical experts, we determined that a phased approach to our single EHR implementation was the safest and most effective path forward rather than a 'big bang' implementation." e second wave of UPMC's implementation alone will break the Epic record for the number of users going live at once, so a "big bang" would have carried too high a risk for patient care and clinical operations and pose challenges for data migration, system integration and user readiness, Mr. McCallister said. is way also enables UPMC to "build momentum, learn from each wave, and refine our approach, ensuring a safer and more sustainable transformation." UPMC is consolidating to Epic from nine EHRs, accumulated through decades of mergers and acquisitions. "ere are clear benefits to a 'big bang' Epic implementation, particularly having everything integrated from Day 1, which can reduce fragmentation, simplify governance, and avoid extended periods of overlapping systems," said Kristin Myers, executive vice president and chief digital officer of New Hyde Park, N.Y.-based Northwell Health, a 21-hospital system — New York's largest — which is migrating to Epic over the next two years, a $1.2 billion project. "With Northwell's size, scale, and diversity of operations, we made an intentional decision to do a phased, region-based approach that allows us to better manage operational readiness and business continuity, minimize disruption, and ensure a more controlled transition for our community." Still, several health systems — while not the size of UPMC or Northwell — are opting for the "big bang" method. "We know through our experience with go-lives in general that it is much less disruptive to patient care and end-user satisfaction to rip the Band-Aid off and go all in," said Diane Hunt, MD, chief health information officer of State College, Pa.-based Mount Nittany Health, a one-hospital system launching Epic in May. "Patient safety is our primary concern, and introducing multiple new workflows in disparate systems was a mitigating factor we did not want to entertain." Baptist Health South Florida plans to go live with Epic at its 12 hospitals and more than 100 outpatient clinics simultaneously in mid- 2027. "Having to pull people out for training and do elbow support and super users over a longer period of time would be much more disruptive, in my mind, than just getting it over with," said Sha Edathumparampil, chief digital and information officer of the Coral Gables-based health system. "It's just kicking the can down the road. Might as well just bite the bullet, get it done and move on." Springfield, Ill.-based Memorial Health is turning on Epic across its five hospitals concurrently with its Community Connect partner — SIU Medicine, also based in Springfield — in the first quarter of 2027. "Memorial Medical Group and SIU's medical group share the same EMR right now, so splitting them up and integrating to our new EMR would require a lot more effort than bringing them live at the same time," said Suresh Krishnan, senior vice president and CIO of Memorial Health, which has five hospitals. "I have done a lot of Epic implementations previously but never gone live with a large Connect partner on Day 1 — this will be a new challenge." "You're on one single platform, and at this point, that's the recommendation from Epic," said Pam Ramhofer, CIO of Sarasota (Fla.) Memorial Health Care System, which is readying for a "big- bang" go-live in October 2026. "Also, it would probably be a lot more problematic to bring half the organization up and leave half of it behind. at's how tightly wound it is." n

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