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The Other Side of Epic
By Vince Ciotti
It’s almost gotten boring to read about another large hospital or multi-IDN picking Epic. It’s as if they have no competitors in the high-end market, which is silly. Mckesson Horizon, Siemens Soarian, Cerner Millennium, GEs Centricty, and Allscripts / Eclipsys Sunrise all have equal or better functionality. What they don’t seem to have is a back door to sell a hospital’s C-Suite through the medical staff, an insurmountable advantage Epic has due to its ambulatory roots.
Having assessed a number of Epic hospitals and having several CIO friends relay their Epic experiences recently, I think it’s about time someone listed the many weaknesses of Epic instead of just more glowing testimonials (to be sure, every vendor has their strengths and weaknesses: one could list many things wrong with other vendor systems too.) This “other side” is intended to open the eyes of those who are considering Epic just because everyone else is.
- Rookie implementers. Epic hires fresh college graduates for their implementation consultants (IC), a practice that saves them a fortune in salaries and gives them malleable candidates to learn “the Epic way.” Unfortunately, these ICs are terribly naïve when it comes to hospitals and do poor work on site, mainly sitting in their offices and looking up questions in “Epigoogle,” their search engine. A hospital would be far better off with veterans that have many installs under their belt, plus several years working in healthcare, to know the many challenges that make hospitals one of the most difficult industries to automate.
- “Epic” costs. Epic charges huge sums for their software and implementation services, just like most other vendors — equal to or greater than license fees. However, there are internal costs that make an Epic budget just that: dozens of hospital FTEs from IT and every user department who need to travel to Verona for many weeks/months of training and testing. Factor in their salaries and the cost for replacement temps and the re-training for inevitable turnover and you can understand why clients like Kaiser and Sutter reported budget overruns of 2-3 times their initial cost estimates.
- The “Epic Way.” Time and again I have heard from CIOs who have gone through an epic install (lower case intended) that the only way to make an Epic implementation successful is to not change the system, but rather adopt your workflow to EpicCare. This is silly in light of the mega-bucks Epic charges. Vendors like Cerner and Siemens pride themselves in adopting their system to their clients’ workflow through screen painting and workflow engines. How can Epic dare charge so much, yet be so inflexible?
- What hardware? Like Meditech (which Epic seems to have copied many bad ideas from, like all employees having to live near headquarters, running up hospital travel costs), Epic does not sell hardware. It is your responsibility and good luck that you buy enough to achieve decent response times. Any problems, just call Dell or IBM and buy more servers. Contrast that with more sensible vendors like Eclipsys and GE that sell hardware and negotiate reasonable system response time guarantees where they will buy more servers if needed. And Epic’s proprietary Cache’ database does take many minutes to run even simple reports.
- Interfaces. What, you thought Epic was integrated? Well that’s true, except for “minor” applications like ERP (AP, GL, PR, HR and Materials). Even the smallest vendors in the industry — such as CPSI, Healthland and HMS — include functional, totally integrated ERP suites, let alone leaders like Meditech and Paragon. CPSI even offers totally integrated PACS and time and attendance modules. Many of Epic’s ancillary department systems are relatively weak compared to specialty vendors. For example, their Beaker LIS can’t hold a candle to SCC Soft Computing or Sunquest, and their ED suite pales in comparison to A4 or MedHost. So, you better add an interface engine, servers, and analysts to that bloated budget.
- Physician training. Physicians love the fact that they see the same Epic EHR in their practice as they see in the hospital, but for two minor problems. First, the Epic build is different for ambulatory versus inpatient order screens, so physicians have to learn two ways of entering orders, responding to alerts, etc. Second, they have to sit through 12 to 18 hours of training classes – factor those hourly expenses into your budget (physicians are not exactly low paid!) At least they don’t have to fly to Verona for weeks of indoctrination like your poor users and IT staff.
- High ratings. Epic has the highest ratings KLAS has ever seen, but think back to all the dozens of IT and user department staff who spend weeks and weeks getting brainwashed on the Epic way. How do you think QuadraMed or Keane’s scores would look if they required their clients to send dozens of FTEs to their headquarters for months of training or testing? And it they didn’t cooperate, they wouldn’t qualify for “good” software maintenance rates, running up their budgets even more. Is it cause or effect?
Well, I could go on, but I doubt Mr. HIStalk will publish much more heresy. Indeed, if he even publishes this, I’ll admire him even more than I do today, as no one in HIS circles seem to challenge Epic these days.
Again, every HIS vendor has their strengths and weaknesses. I could go on for pages of weaknesses about any vendor, not just Epic. It is just sad that everyone seems to conform to only praising Epic while ignoring these and other weaknesses. Anyone else have the nerve to join me in calling for more rationality when dealing with the Epic “cult?”
Vince Ciotti is a principal with H.I.S. Professionals LLC.
They’re Killin’ “Me”
by Richard E. and Joy Goodspeed
My colleagues present themselves with an air of professionalism both in dress and in conduct. However, they look sloppy when they forget some grammar basics in speech and emails. My biggest pet peeve is that they are killing “me.”
They don’t understand what happens to the first person singular personal pronoun (“I”) when it follows a preposition. If the pronoun is alone behind that preposition, they get it right, but when it is part of a group of two or more, it is usually wrong.
Grammar rules may be a little hard to understand, so I’ll illustrate with some examples.
Say I invite Tim to go to HIMSS with me. I tell you, “I invited Tim to go to HIMSS with me.” Good. Inga decides to come along to keep us out of trouble. I say: “Inga went to HIMSS with Tim and me.” My colleagues would say “Inga went to HIMSS with Tim and I,” and that’s bad grammar (killing “me,” . . . get it?). How do I know it’s bad? Take Tim out of that last sentence. Are you going to say “Inga went to HIMSS with I”? Of course not. “Inga went to HIMSS with me.” Sticking Tim into the middle of the action doesn’t change the need for “me.” The pronoun is the object of “with” (a preposition), so it’s got to be “me.”
Now you’re on a project, and you’re telling your partner about a physician who came to a project meeting to make a complaint. “The radiologist complained to the project team and me.” Right! Now you’re catching on. It’s not “the project team and I,” as it would not be “to I” if you were the only one there. “To me” and “to the project team and me” are both correct.
This discussion is all about the “objective case.” It makes sense that you use the objective case for the object of a preposition. However, “I” also changes to “me” when it is the object of a verb.
Suppose you are going to take Tim to the new ER. “I’m taking Tim to the ER.” There’s nothing hard about that. Along comes Inga. She’s going to take Tim to the ER, and you can come along. You tell Jane about it. “Inga’s taking Tim and I to the ER” Oops! No, no. You’re killing “me” again. You and Tim are now the object of a verb (to take), and you have to use the objective case. “Inga’s taking Tim and me to the ER.” We use the same criterion for the case of that pronoun that we used when it was the object of a preposition: take “Tim and” out of the sentence. In your most ungrammatical of moments you wouldn’t say “Inga’s gonna take I to the ER.”
Keep thinking about objective case (and quit killing “me”).
Joy Goodspeed is a senior integration analyst with Sarasota Memorial Healthcare of Sarasota, FL.
Passionate People Perform
By Peter Longo
Another day, another conference call. “OK, we have everyone on the line and we are ready to review our ACO strategy that will affect v5.5 and the ICD 10 but we can’t forget the FFS model or the FQHC needs as we build the HL7 exchange. With the eMPI not ready, the focus should still stay on the CSI program and promote the current CCD standards that hopefully won’t affect the DR on the COF for client CPHR or the CPQs …” (do we use too many acronyms?)
With all this work selling software that enables physicians and nurses to deliver high-quality healthcare, we still can feel removed from the impact on a patient’s life. Yearning to be reminded, a group of dedicated sales professionals felt the need to get directly involved with delivering care and service to people in need, volunteering at Wheels For Humanity.
Wheels For Humanity (I guess that is WFH) is an organization that is dedicated to supplying wheelchairs to incredible people who are unable to walk for many reasons and who can’t afford mobility. Generally, they spent their young lives being carried from place to place. Painfully, the time comes when they no longer can be carried, and they are left to stay in their rooms. Recipients of these chairs are given the joy of mobility, but equally importantly, they are given dignity.
We work in an industry that is focused on the patient. This live experience stands as a pivotal reminder that the patient should be the center of everything we do. Many of the wheelchairs will be sent to places like El Salvador, Indonesia, and beyond. This whole operation is possible through donations and volunteers wanting to make a difference. Volunteers with a passion to help others.
The one thing our industry is not short on is passion. It is incredible to see so many individuals passionate about improving healthcare. I don’t think anyone can find an industry with a rivaled passion toward helping others. I am pretty sure there is no acronym for passion.
Please take a moment to read more on Wheels For Humanity.
Peter Longo is vice president of sales with Allscripts.