The race toward meaningful use of electronic health records has added a twist to hospital mergers and acquisitions. As part of the 2009 Health Information Technology for Economic and Clinical Health Act, physicians and health care organizations are eligible for additional reimbursements from Medicare and Medicaid if they meet a set of government-mandated criteria. HITECH is set to offer $27 billion dollars over the next 10 years.

When hospitals join with other organizations that are implementing different EHR systems at different paces, or haven't even started to do so, chief information officers have two options: "The typical approach in the last 10 or 20 years has been to rip and replace; rip out whatever they have and put everybody on a core vendor," says Pam Arlotto, president and CEO of Maestro Strategies, a health information technology consulting firm based in Atlanta. "Then, there are a lot of organizations that have more of a hybrid approach. People are beginning to focus on an integration platform."

Health care leaders who have been there and done that had to consider the cost — in time, money and manpower — of either replacing a system or supporting and integrating different systems.

For Atlantic Health System in New Jersey, the choice was easy. After acquiring Newton Medical Center last March, the hospital's outdated EHR system was replaced with Atlantic's current system, McKesson. Independently, Newton would have had to spend at least a year and $11.5 million upgrading its 5-year-old EHR system enough to qualify for federal incentives. "We had already put in that investment," says Linda Reed, Atlantic's CIO. Eight months after the acquisition, Newton went live on several applications, including electronic patient scheduling and nursing documentation.

One of the most common initial challenges is consoling staff who already had mastered their organization's old system, says Tom Smith, CIO at NorthShore University HealthSystem in Evanston, Ill. NorthShore also chose to replace the EHR systems at its newly acquired facilities, which included 12 physician offices and a hospital since January 2009.

To ease the transition, the acquired organizations temporarily were allowed to use the old system in a read-only format. "It's one thing to get trained on a new system. It's another thing to use it," Smith says. NorthShore has been live on an Epic system since 2003. "We also had extra staff from the other three hospitals on the floors to help people. It's a good way to bond with the new hospital."

In November, Provena Health and Resurrection Health Care merged its six Illinois hospitals into a 12-hospital system. A joint governance committee decided that the most efficient way to meet meaningful use requirements was to allow the hospitals to continue with their respective EHR systems and aggregate patient information in a clinical data repository. "Because of the scale, even if we had unlimited resources, there would not have been enough time," says Brad Howard, M.D., chief medical information officer. The most important thing is to "have a foundation of shared content."