The Journal also reported that Wake Forest had launched another round of “multi-million dollar” cost-cutting measures that would last through at least June 30, related to “fixing Epic revenue issues.”

Wake Forest Baptist cited $8 million in “other Epic-related” implementation expenses. Also listed was $26.6 million in lost margin “due to interim volume disruptions during initial go-live and post go-live optimization.”

Detroit-based Henry Ford Health System, meanwhile, reported $53.1 million net income for 2012, as compared to $62.9 million in 2011 – a decrease of 15 percent.

The income decrease is due firstly to an uptick in uncompensated care cases, and secondly to “significant investment in state-of-the-art information technology in our clinical, business and insurance operations,” said Henry Ford’s Chief Financial Officer James Connelly in an April news release.

“It’s a large number,” Henry Ford CIO Mary Alice Annecharico acknowledged in a recent interview with Healthcare IT News, about the health system’s more than $350 million EHR initiative. Henry Ford, she said, chose not to float bonds or borrow for the project, but rather to use operating capital to implement the system. “That means we chose not to do other things.”

Kaveh Safavi, MD, North America health industry lead for Accenture, a global consulting and outsourcing firm serving large systems, said lately Accenture has worked mostly on Epic and Cerner implementations.

“The general rule of thumb,” he says, “is whatever you spend on your technology, you’re going to spend twice as much on the task of implementation.”

“What is often described as a ‘glitch,’” he said, “could be a glitch at the level of technology implementation, but it’s often at the level of the processes themselves. So translating business rules into technology rules … it’s not really a technology problem, but the technology has to catch it.”

Most organizations change their revenue cycle system either ahead or at the same time they deploy a new EHR, he said. “Because there’s such a close tie between diagnoses and procedures and charges and bills, they’re often linked together. Now, one may precede the other, but many organizations are often making a decision, which requires a substantial change if not a complete replacement of the revenue or billing cycle process ahead of the electronic medical record at the same time, or sometimes close to it.”

As Safavi sees it, “The harder work is more in the process than in the technology configuration.”

“Where you often see organizations struggle is when they’re a little bit resource-constrained, and they can’t actually invest in the process improvement and the process redesign necessary up front, but they’re still committed to a big bang implementation, but they just haven’t done the prep work,” said Safavi.