Breaking Down an Epic Versus Cerner Selection

Vince Ciotti, Principal, HIS Professionals

Elise Ames, Principal, HIS Professionals

Hey Vince & Elise,

I read with great interest your excellent article on which acute EMR vendors have the most robust and integrated ambulatory EMR products. I was hoping you could take me on a deeper dive as far as a Epic vs Cerner head-to-head matchup goes. Let’s say I’m a best-of-breed IDN looking to go as best of suite as possible, and I’ve got a few bucks to spend. What factors am I considering?

Dear Big & Rich,

First off, congratulations on having some money to spend – in Florida, they just announced over $200M in Medicaid cuts in Polk County alone! Factor in the inevitable cuts in DC to Medicare, and you are fortunate indeed to be looking to spend money… And you sure picked two great ways to spend some: Cerner & Epic. Like choosing between a Ferrari and a Lamborghini!

This not to criticize either system’s functionality: they are both at the top end in features, are extremely flexible, and have robust EMRs and CPOE.  In this “high-end” of the EMR market, their competitors are equally capable and pricey: Allscript’s (nee Eclipsys) Sunrise, GE’s Centricity, Siemens’ Soarian and McKesson’s Horizon. All cost mega-bucks for an IDN, depending on your size: 8 to 9-figures goes to the vendor, 7 to 8 figures in internal payroll costs for scores of RNs and IT analysts required for the multi-year implementation, as well as 7 to 8 figures to the inevitable “consultants” who can help you pick among them and then implement the one they (objectively) recommend. They call this a “clinical transformation,” but it also does a remarkable job of transforming your Balance Sheet…

So how do you pick among these two? As a CIO, don’t! Whatever system you recommend, you’ll get blamed when something (which it inevitably will) goes wrong. Instead, form a deep and wide System Selection Committee replete with nurse informaticists, med techs from ancillaries, and as many MDs who will volunteer their precious time as you can find. Let your CMIO chair it (you do have one, don’t you?), and you coach her on the side about how to go about the details of the process: demos, RFIs, phone reference calls, site visits, etc. Then, stand on the sidelines and let them pick. That way they’ll have a “buy-in” to the arduous implementation too.

So in the long run, just what does separate Cerner versus Epic? The answer is what makes Epic so formidable these days: having the only truly integrated (not just interfaced) and highly functional practice and hospital EMR. Cerner is probably more functional on the hospital side, with a decade head start on Judy & Co., who started in the physician practice space. But Epic would easily win hands down if your physicians were picking an ambulatory EMR, and their office managers were voting on reg, sched and 1500 billing.

The simple decision point then is: do you own your physician practices? If so, then they probably own you to an extent too, with several Board seats and easy access to your C-Suite. If so, then Epic will probably win when they cast their vote for a system that has the same passwords, screens, menus, reports, etc., in their office as in the hospital. If on the other hand, your MDs are independent admitters, not salaried by your IDN, then they already have a wide mixture of practice systems installed, such as eClinicalWorks, eMDs, NextGen, Allscripts, athenaHealth, etc. They will not incur the high costs and disruption of their private practices just to convert to whatever you pick. And, what’s more important, the leading practice systems listed above are far more functional than Cerner’s PowerChart, and a fraction of the cost of Epic. In that case, Cerner has the edge, especially if you have the temerity to want to discount prices and negotiate terms, something anathema to Verona.

So, check out your physician ownership and you may be able to choose between these two choices pretty quickly. Whichever one you chose, do invite many others to the dance to make it competitive: that’s the only way you’ll ever negotiate a decent price and contract terms. And, who knows, you might just find one of the many up-and-coming entrants that offers a good fit at a lower price.


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  1. Vince is spot on with respect to most of this – as usual. Owning both (Epic and Cerner), I do wish to temper one section of that reply. This consistent bashing of Cerner (and cult of Epic) is unfounded in the current state. Cerner’s advances in the ambulatory space in the last 3-5 years have them not only relevant but equivalent to Epic. My MD’s have each of their preferences (depending on which they are using), but I caution that there are no discernable differences. I have more than 1,000 MDs and many 1,000s of other providers using Cerner in the ambulatory space – 10’s of 1,000s in the inpatient space on the same system….these are not interfaced. In fact, my personal opinion is that Cerner is far superior than Epic in the integrated space. These maligned comments about Cerner in ambo are most typically referring to the PowerWorks product/offering – which is a shared product amongst many nationwide customers (read cloud), not what most of us run ourselves. I’m a CIO, I hate all vendors, so I am not here to promote either…just very much feel a need to dispel this rabid cult thread running rampant in our industry. Facts speak louder.

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