Are Best Of Breed EMRs Going Out Of Fashion?

This week, I visited a hospital which belonged to a health system going with Epic. This hospital, one of the smaller facilities in the chain, was running Picis in the ED and (I think) Cerner throughout, but the decision had been made to convert everything to Epic sometime soon, a tech told me.

I can’t say the news was surprising, but it was disappointing nonetheless. The community hospital in question has given me excellent service, and my guess is that when Epic barrels in, it will lose its way — at least for a while — frazzling the staff and decreasing the quality of their interaction with me.

However, I ‘d better get used to this trend. As Healthcare Technology Online editor in chief Ken Congdon notes in an excellent editorial, the pendulum is definitely swinging toward enterprise-wide EMR implementations, a direction encouraged by the standardized demands imposed nationwide by Meaningful Use.

If interoperability was easier to pull off, things might be different. But with HL7 and other integration standards and languages still not quite up to the job, one can see the sense of going with an enterprise option.

Here’s the story one CIO told Congdon as to why he’s deploying Siemens Soarian solution:

Michael Mistretta, CIO of MedCentral Health System  [said:]  “Vendor management was a key consideration in our decision to use a single vendor approach to EMR implementation,” says Mistretta. “With a single vendor, I only have one finger to point at. It simplifies my environment because I don’t have Siemens telling me it’s McKesson’s problem and vice versa. Also, the built-in interoperability is key. There is a trade-off in the fact that the system does not provide prime functionality to certain departments or specialties within our health system, but at this point in time, it’s much more beneficial for our organization to have the ability to share data across the continuum of care quickly and easily.” 

CIOs of large hospitals also told Congdon that enterprise system replacements were much cheaper than going through a long-term, highly-complex integration effort.

In an interesting twist, however, hospital IT leaders from mid-sized to smaller hospitals have reached the opposite conclusion, Congdon reports. They’ve been telling him that buying an enterprise system would be much more expensive than sticking with what they had and making it interoperate.

I see a market opening here. If enterprise EMR vendors can get their pricing in line for smaller hospitals, they may have a lot more wins coming their way than they expected.  Interesting stuff.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Let’s assume that you are right, that best of breed will die away and integrated will take over. Does that mean that we should settle for systems that don’t work well in some departments? If not, is there a way for us to reach out and tell the mega vendors that we appreciate the integration but that we 1. still need each department to have the system meet its needs, and 2. for very specialized departments, that we need to have an Open, consistent API for add on capabilities as have been discussed here?

    Hospitals can’t afford what has happened in some, where some departments essentially can’t use the EHR in the presence of patients because it is so mismatched to their workflows that it greatly slows them down, yet this is happening, probably far more then hospital execs want to admit or even to know. Now I’m not saying that it is automatically the vendor’s fault. In one case I’m aware of, the implementation team did not budget anywhere near enough time before or after go-live for finding out what users need done, or need to know or need help on. I’m sure that this is painfully common. And by now most of us have heard about the case – I believe in a prison hospital, where nurses are said to have complained that they only got about 10% of the needed training time.

    There are all sorts of MU standards, but somehow, they don’t include actual usability or training or implementation standards. Is someone assuming that every place doing an implementation absolutely has a large enough, well trained enough team with the right standards?

  • Most industries, such as banking, retail, and aviation to name just a few, ultimately settle on best of breed. You wouldn’t expect to use the same software to fly a plane and sell tickets. As you mentioned interoperability is key, but once that improves I can’t think of any good reason you wouldn’t want the best software for your department’s workflow.

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