In one of the biggest health IT announcements in recent memory, the Mayo Clinic earlier this month selected Epic to replace its existing electronic health record and revenue cycle technology.

[See also: Mayo Clinic moves to Epic]

In an interview with Healthcare IT News, Mayo Clinic Chief Information Officer Cris Ross explains why – and discusses his strategy for ensuring this massive, multi-year project stays on time and on budget.

Q: When did Mayo Clinic start thinking a change needed to be made with your EHR and revenue cycle systems?

A: Mayo has been steadily working toward a convergence of its practice for many years. Across all of our locations – the Midwest, Arizona and Florida. But we started to take a very serious next look at this issue in the spring of 2013. We had done this many times before, and that was time for a fresh view.

Q: When you started looking around at your options, what were some of the big things you considered?

A: We have been longtime customers of both GE, for their Centricity enterprise product, and of Cerner. We issued RFPs to those two organizations, Epic and others. And it became clear that the two vendors who could best meet our needs are Epic and Cerner. GE has announced that they're exiting the business with that product. So we fairly quickly focused our attention on Cerner and Epic, which should be no surprise. They're the two dominant providers.

Q: So you made a fairly big switch, then. You'd been a Cerner customer for a while. What was it about Epic that made you want to try something new?


A: We've been a longtime customer of Cerner, and they've been a really great partner for us. As we looked at what met our needs, across all of our practices, around revenue cycle and our interests around patient engagement and so on, although it was a difficult choice, in the end it was a pretty clear choice that Epic was a better fit.

Q: Epic is often knocked for a real or perceived lack of interoperability. Was that a concern of yours? Do you think those charges are baseless? Or is data sharing something Epic is learning to do better, in your view?

A: We're comfortable that they are strongly interoperable with other systems. We heard those concerns, of course, and evaluated them. But when we looked at things like, for instance, their ability to connect via the Direct protocol to many other EHRs, and the volume that's floating across that network, from Epic to other EHRs, we were pretty impressed. Obviously they've been focusing a lot on Epic to Epic communication, and that's fine. There are many Epic sites that we do want to communicate with. But the fact that they have such robust connectivity to other EHRs as well really alleviated that concern for us.

[See also: Epic defends interoperability bona fides]

Q: What are some of the strategic imperatives for Mayo you think Epic will be well-poised to help with?

A: Part of our core operations is to make sure we continue to keep focus on meeting patients' needs first. And we really believe that an integrated EHR, across all of our organizations, can help us with that core mission of meeting patients' needs. Practice convergence is our first-and-foremost goal for what we're trying to accomplish with this project.

We also wanted to continue to do better and advance what we can do with revenue cycle management, to make bills easier to understand for patients and to address upcoming changes in reimbursement as we move from fee-for-service to value.

Beyond that basic level of operations, Mayo has been pretty clear that we have a big focus on knowledge to delivery, which, as our CEO has described, means that we view knowledge as our most scalable asset – as opposed to brick and mortar facilities. Because of that, we have a focus on how we can support that mission: providing: Mayo-vetted knowledge, outside Mayo.

We have a lot of activity in that space. The EHR is not central to that mission, but it is strongly supporting our longterm goals to do that.

Q: Some say we're in the "post-EHR era," while RCM technology is also being forced to evolve for a new reimbursement landscape. Do you think Epic is well-poised and agile enough to evolve with those two aspects?

A: Yes, we do.

Q: In announcing this deal, Mayo noted it will be a partnership of "several decades." What do you see in the years ahead?

A: Decades is a long time to try to predict. But obviously this technology commitment is very longstanding. We believe this is an important foundation to what we do. It's a part of our strategy – but only part, from a technology standpoint.

Mayo will continue to do what it needs to to be innovative and differentiate itself in the market in a way to better serve patients. Part of that will come directly out of the EHR, and some of it won't.

Q: Strategically and tactically, what are your next steps? What are the first items on your to-do list in the coming months? Because this is a big project.

A: Yes it is. We have to assemble a team that will be composed mostly of current Mayo staff, but we'll supplement that with Epic staff and some third party consultants as appropriate. So it's assembling that team, getting them trained, and then there's a lot of design decisions that need to be made early in these types of projects. Any kind of variations in terms of technology need to be vetted quickly and effectively. The scope of Mayo's practice is very large, so we have a lot – a lot – of detailed decisions to make. Promptly.

Q: How big will this team be? IT folks? Clinicians?

A: I think it's fair to say it's somewhere between 400 and 500 people.

Q: Wow. That's a medium-sized company.

A: (Laughs.) Yeah.

Q: And you'll eventually have 45,000 people to train – that's the size of a small city. Here in Maine, we had some problems with an Epic rollout, largely because of lack of training – they had to bring people back in and retrain a lot of nurses and clinicians, at great cost.

A: There's been a lot of really successful EHR implementations, and there's been some that have been challenged. We've done a substantial number of calls to peer organizations around the country, and they've been very gracious in offering lessons learned. And, y'know, we're approaching it humbly and with respect. This is a big project. And we're sure it will be successful. But only if we do it with the right amount of care.

[See also: Epic installation proves more expensive]

Q: Any other strategies you plan to keep in mind to make sure this goes smoothly and that 2017 deadline is met?

A: This will take us beyond 2017. It will take us about four years to complete. Mayo has a lot of experience rolling out sophisticated information systems. And we'll use that experience as a base. And then also to be humble and learning. Look around. learn from other people. Apply best practices in a sensible way. Partner well with Epic and consultants we bring in to support us. This is just a project that needs to be managed successfully and well. That's the key to success.