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Readers Write: Epic Concerns

November 6, 2013 Readers Write 18 Comments

Epic Concerns
By Long-Time Epic Customer

Wake Forest Baptist is just the tip of the iceberg for Epic clients struggling with revenue, based on conversations I’d had with various contacts at UGM. There was quite the buzz about a large number of customers with revenue concerns who are not hitting the news. Yet.

We installed Epic years ago, but have seen a vast difference between our prior experience and a recent rollout of newer products. The method where time was taken to help us build our own system has been replaced by a rushed, prefab Model system installed by staff where even the advisers and escalation points at Epic have little knowledge of their applications. Epic has always had newer people, but it was much more common to have advisers during the install who did have experience to watch for pitfalls.

Though today’s economy is certainly a large factor in any revenue struggles, I am unsurprised by stories like Wake Forest or Maine and believe Epic should have seen some of it coming. We had enough experience with Epic to spot trouble with new products. New clients likely don’t have that built up yet, and they probably rolled off the cliff with nothing but green lights on Epic’s reviews of their install progress from newbies who didn’t know any better.

It feels like Epic tossed a winning formula in favor of a faster, cheaper install. What many of us are getting ends up being cheaper, indeed. That is a tough contrast to reconcile at UGM. After getting my ears blown out at an expensive, new, rarely-used auditorium that was just built to replace a barely older, rarely-used auditorium, Judy spoke at length about how the campus was cost-efficient and made employees more productive. Many of us are developing an alternative thesis, which is that productivity has been getting squeezed (and compromised) to support the costs of the campus.

I want to keep loving Epic. They are still good, but their services are declining.  The campus strikes a nerve with many clients who justifiably wonder whether our vendor is investing in the things that made them great when we’re getting answers, solutions, fixes, and reports slower than ever.

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18 Responses to “Readers Write: Epic Concerns”

  1. 1
    Anonymous Says:

    We implemented the full Epic suite across 8 hospitals and 38 clinics in 18 months including PB and HB. While we had a slow down in rev cycle while we validated things, we quickly recovered and actually significantly improved on our pre-Epic performance. Our rev cycle team actually wanted to convert our legacy AR into Epic because they thought it was better than what they had been using.

    At the end of the day we don’t feel it’s as much about the software as it is the process and attention to detail and integrity of the data.

  2. 2
    Nom De Plume Says:

    Over the years I have found one truth in Healthcare IT. That which rises will eventually fall, or at least find it’s own level.

    Watching Epic’s amazing rise over these last few years left me only one question. How long will it last?

    And I am asking if those Epic customers who are struggling with revenue issues resulting from ineffectual implementations are knocking on Judy’s front door?

    Their frustration with the financial impact of this product would seem contrary to paying for her new Harry Potter themed fourth campus.

    Having been born to soon I will never work on any of her campuses.

    Fortunately, I can get a Universal package that includes breakfast at The Three Broomsticks at The Wizarding World of Harry Potter™!

  3. 3
    Code Jockey Says:

    Puu-leeeze! Really? How about this – man up and read the contract with Epic. Their engagement begins/ends with whatever scope is specified in the agreement. I don’t think it requires a host of professionals at the client site to suspend their careers and critical thinking just because the ‘kids’ from Epic have arrived and are working on an implementation of their systems. Epic provides software and resources to configure the software to perform – it remains the responsibility of the client (buyer) to oversee the effort in a manner that serves the interests of their employer and patients. If an Epic site suffers a hit in rev cycle metrics related to the implementation it is because the EMPLOYEES of the client site have suspended their own responsibilities and taken a break from their fiduciary responsibilities. I’ve been on the road for a long time as an Epic contractor and would offer this – how about – challenge every suggestion that the ‘kids’ make and retain control of your own business. In the end a financial hit ‘because of Epic’ could be translated to ‘we are so incompetent we could not increase our revenues even when working with the industry leading solution’.

    And, just for the record – I’m not an Epic employee, never have been, and am an active critic of many things Epic related. BUT – it slays me to see senior level adults suspend their decision making just because Epic has arrived.

  4. 4
    On The Other Side Says:

    I wonder how things are at Duke? Not much has been said about their finances around the area. However, as a patient I find it interesting that it took 2 weeks for the claim for a recently physical to hit my insurance carrier. Interestingly last year it took 2 days.

  5. 5
    Bob Uecher Says:

    Dear Long-Term Epic Customer

    Remember the days before the idea of Model (now new and improved! We call it Foundation! Not to be confused with Cache Foundations!) existed? – I cut my teeth with Epic at ye olde ENH so I remember those days … right Tom Smith!

    100% of the problem at WFUBMC does not sit with Wake, as 100% of the problem does not sit with Epic.

    I remember someone saying that clients don’t pick Epic and Epic does not pick the client, they pick each other.
    Mr H, can you do us a favor and reprint the 10 ten list of things that happen when a new EMR comes to town?

    Statement: Wake Forest Baptist is just the tip of the iceberg for Epic clients struggling with revenue, based on conversations I’d had with various contacts at UGM. There was quite the buzz about a large number of customers with revenue concerns who are not hitting the news. Yet.

    Response: It is really not a revenue problem, but the lack of very very early on workflow analysis. These legacy systems Epic is replacing? Some are very old; we’re talking 20 years old, with layer after layer of changes laid on top of them (think geological sediment … and to really look at them you need a pith helmet, an archeologist brush and hammer, and Louis Leakey) , and some of the folks that implemented them are either retired … or dead.

    Statement: We installed Epic years ago, but have seen a vast difference between our prior experience and a recent rollout of newer products. The method where time was taken to help us build our own system has been replaced by a rushed, prefab Model system installed by staff where even the advisers and escalation points at Epic have little knowledge of their applications. Epic has always had newer people, but it was much more common to have advisers during the install who did have experience to watch for pitfalls.

    Response: You were very lucky as you had a green field to design a new system, and I take it you did not want to recreate a “new” old legacy system. That is some of the challenges we are facing … comments like “well that’s the way we did it before” or “we need it to work the same way”. So the question might be … did you just spend x number of dollars to get a new 1997 model emr? I think earlier on Epic bent over backwards to make sure the end result worked and worked well, but as of … say … 2009 or so they stopped learning while listening, or is it, they stopped listening while learning? Example1: In the early days the Clarity Instance was a dump, and I mean that literally, it was just a mess, but Verona listened and learned, and made it better (but not best). Epic is a very integrated and complex system (you need to buy your own Epic Pith Helmet), and certain products need to be installed in certain order, and some products need to be installed in tandem. Example2: I believe, and I know someone will pounce on this if I am wrong, if you install HB you pretty damn well install ADT or you’ll have problems from day 1.

    Statement: Though today’s economy is certainly a large factor in any revenue struggles, I am unsurprised by stories like Wake Forest or Maine and believe Epic should have seen some of it coming. We had enough experience with Epic to spot trouble with new products. New clients likely don’t have that built up yet, and they probably rolled off the cliff with nothing but green lights on Epic’s reviews of their install progress from newbies who didn’t know any better.

    Response: Epic probably did see it coming and made weak efforts to mention this in any risk mitigation models that may or MAY NOT have been used or read (“we spent x number of dollars!!! just turn the damn thing on!!!, and cross your fingers, toes, eyes, etc.). These advisors you speak of? I sure hope they have at least 3 versions under their belts, and at least 10,000 hours of on the job work (see Malcolm Gladwell’s Tipping point) experience. Which brings me to the other side … Just because you have the cert (so you can get the refund/kickback on your good install) doesn’t mean you are an expert

    It feels like Epic tossed a winning formula in favor of a faster, cheaper install. What many of us are getting ends up being cheaper, indeed. That is a tough contrast to reconcile at UGM. After getting my ears blown out at an expensive, new, rarely-used auditorium that was just built to replace a barely older, rarely-used auditorium, Judy spoke at length about how the campus was cost-efficient and made employees more productive. Many of us are developing an alternative thesis, which is that productivity has been getting squeezed (and compromised) to support the costs of the campus.
    I want to keep loving Epic. They are still good, but their services are declining. The campus strikes a nerve with many clients who justifiably wonder whether our vendor is investing in the things that made them great when we’re getting answers, solutions, fixes, and reports slower than ever

    There is a lot to talk about in your last paragraph, Epic was cheaper long ago, it’s more expensive now that it is the golden boy. Absolute power corrupts absolutely, and where are the customers yachts?

  6. 6
    Josie Says:

    Interesting read. RE: “It feels like Epic tossed a winning formula in favor of a faster, cheaper install. What many of us are getting ends up being cheaper, indeed.” If true, that would not surprise me because as I understand it, those undergoing their implementations right now would likely have signed their contract a year or better, right? Maybe during the MU gold rush, and then the demand for HIT staffers to install this stuff goes up, supply goes down blah blah blah. But I can’t help but wonder how it’s going for all those newly acquired practices who are being “forced” to use Epic because the hospital that bought their practice also bought Epic. Often those practices are at the end of the food chain when it comes to support. Would love to hear from any of those practices on how it’s going! Monopolies are rarely a good thing. Choice is better!

  7. 7
    Retired Epic Guy Says:

    As a former Epic guy, I still have nothing but praise for my old employer. It’s not just lip-services she plays towards building her own ‘empire’, Judy earnestly believes that the campus helps foster the culture that is going to keep Epic innovative, high-quality, and focused on patient care.

    You can’t really argue with the results and with their expansion into European and Asian markets, there’s even greater need for growth.

  8. 8
    Industry Observer Says:

    Nom De Plume, you’ve obviously been grinding axes for a while.

    It isn’t about rising and falling and about Epic, it’s about the differential ability of health systems to execute. It isn’t like any vendor systematically weakens a product over time so that those who do an install now are somehow disadvantaged over those who went before.

    No product and no vendor can work miracles on their own. It’s an all in exercise and it takes a tremendous attention to detail to get things done well.

    So many systems are moving so quickly through installs for Meaningful Use and ICD10 that to have some struggle shouldn’t come as a huge surprise.

    And the buildings are cleverly done without costing any more than AllScripts or Cerner – who spend quite a bit on buildings themselves.

    Epic’s not good at marketing so defending against the onslaught of people like you is tough for them.

    Focus some energy on sites that did well and ask how they did it. Go back and read the Daniel Barchi interviews and learn from that.

  9. 9
    Ex-Epic Says:

    Here’s the thing that Epic customers don’t understand: your organization is dysfunctional. If Epic’s flaw is that they hire young impressionable people and work them to death, the hospital’s flaw is that they hire incompetent people and overly politicize issues. You want proof? Look at what sort of change management policies you have in place. Just stop and consider the fact that your key decision makers thought that this process that they devised was the best they could come up with to handle changes to your system. Look, I’m not saying Epic is perfect and there are many points on which I agree with the author but there are many reasons why your hospital is in the red after your go-live. To suggest it’s solely Epic and has nothing to do with your organization is pretty disingenuous.

    To paraphrase Homer Simpson: “Sure it’s easy to blame ourselves, but it’s even easier to blame Epic”.

  10. 10
    HISTALK Says:

    I thoroughly enjoy the regular letters and comments about Wake, Maine, LSU, Miami, and the number of other RevCycle implementations that have gone sour recently with Epic. All too often it seems that commenters believe responsibility of failure starts and stops with Epic. In a way I find it funny that the model system is regularly called out for its “cookie-cutter”-ness, when every one of these comments reads like a cookie-cutter complaint about Epic.

    Blame Epic’s model system.
    Blame the fact that the Epic employees are still wet behind the ear.
    Blame Epic for rushing the project.

    Does anybody have specifics about the factors that caused problems at these sites, or are letters like this just propagating the rumor-mill?

  11. 11
    Thomas Magnum Says:

    The problem with Epic hospitals that fail is the same as hospitals with Cerner, or Meditech, etc that fail… management takes the vendor’s word for everything, hospitals don’t have enough Epic experience on their staff and they allow politics to make their way into the decision making process. Disfunctional organizations…

  12. 12
    Fourth Hanson Brother Says:

    I was in a implementation where the management was warned they were going to have issues due to insufficient build. They simply refused to believe it. Model system is getting misused.

  13. 13
    The 'kid' who does it all for you Says:

    You want to talk about changes in implementation strategy? How about changes in legislation that have forced your decision to be innovative and adopt and EMR? Late adopting organizations from personal experience want a rushed implementation to meet MU deadlines so they just expect to drop millions of dollars and have Epic do it all for them; unfortunately leading to poorly staffed projects and no accountability on the side of the organization. If you are are you going to give a contracter a million dollars to build a house without a blueprint or any sort of guidance throughout the project, don’t be mad when you end up with a mudhut.

    #takeresponsibilityforyourownbaddecisions

  14. 14
    Redacted Says:

    I’m not familiar with the exact reasons why Wake went poorly, but I do know that Epic had experienced implementers across all of the major apps, and that when it became clear that there was an insurmountable ticket volume, they immediately pulled all hands on deck and war rooms were created where all Epic staff were encouraged to come help Wake tackle their issues.

    As many have mentioned, there is never one reason that an install goes poorly. Epic has some glaring deficiencies in its implementation process, but the resounding success that they have had with many of their customers proves that it’s not solely responsible for project failure. Many customers exceed pre-live baselines within their first year. Having your credit rating downgraded is anomalous, to say the least.

    Projects fail because there is mediocrity at some or all levels (and sides) of the project. If you have strong project leadership backed by a knowledgeable and hard-working project team, this would not happen. These projects are too long-term, and should be too well-planned to result in failure of this magnitude.

  15. 15
    Former Epic Says:

    As someone that worked at Epic for several years, then directly with hospitals for a couple more, here is my perspective.

    I started working at Epic when the Model System was brand new, and have experienced implementations both with it and without it. Those without were painful, long, and resulted in lost opportunities with a lot of functionality that we simply did not have the time to build out. On the other hand, we also ended up with a very practiced team – both the Epic newbies and the customer project team – that had a very thorough knowledge of the build in the system and could problem-solve and build very well. We had a lot of issues at go-live (there is no getting around that), but the team was able to quickly identify them and implement fixes.

    With the new model system, hospitals can have shorter timelines, spend less on Epic billable hours/contract assistance and end up with a much more robust version of the software. The problem is that they also end up with a project team that doesn’t understand how a great deal of the build works, struggles with problem solving, and therefore takes a really long time to find and fix issues (many of which were overlooked during testing due to the same unfamiliarity). At the same time, Epic newcomers aren’t learning the system like we used to. They don’t have to decide how to set every setting, so there are many that they have no idea what they do. It takes several implementations for them to get to the same level that an implementer was at after one install before the model, so I agree that the assistance that Epic is able to lend at this point is not nearly as good as it was previously, as with the turnover and amount of time that it takes implementers to really become experts of their product, there are fewer and fewer experts.

    Everything is a trade-off.

  16. 16
    John Says:

    Being in a hospital close to the Epic campus, we were often inundated with new Epic employees coming to shadow the system. These people are PROGRAMMERS and do not have the slightest clue of how a medical facility works or its nuances. This is part of the HUGE problem. Programmers cannot begin to understand how to correct or create answers to difficult facility issues. You then have to give the LONG list of issues to your Epic rep who then hands them over to the people to “fix” the problem. Half the time it’s like watching the phone game be played. Half fixed issues that inevitably break with each upgrade.

    My two cents.

  17. 17
    FLPoggio Says:

    Could all this Epic noise be the onset of the Seven Deadly Sins??
    See:
    http://histalk2.com/2013/01/02/readers-write-1213/

  18. 18
    Ann Farrell Says:

    John – your point is supported by decades of largely ignored research. Most (>70%?) of SW issues rooted in poor requirements definition and translation into specs. Agile, e-tools, MU, and ITculture exacerbate problem. Good developers are great problem solvers but rarely good business analysts. User involvement is key but doesn’t mean programmers interviewing end users whose context is often limited to one or a few orgs and EMRs /hybrid systems.

    Current trend is to deliver small bits of quickly defined, lightly test functionality to iterate, redo or worse yet build on – ironically @ far greater expense with longer time to get right). Process & data models, human factors/UI and systems design on front end and testing on backend shortchanged (“save money,shorten cycle”). HCOs reducing IT staff/ testing – many equate vendor MU Certification to a “quality system”. Any wonder we see user outcry?

    Even Epic fans agree EpicCare for nurses was initially ill-conceived and poorly designed, not surprising with ambulatory (MD-Centric) roots and bias. Reengineer Epic (other EMRs) to see developer and user view – MAR on med station, Kardex on nursing station, assessments and notes in chart, care plans in binders. Not seeing interrelated, underlying, highly complex processes and data, they automated duplicative, inefficient. paper-based systems. While improving, other RN-centric groups, e.g. Case Managers, remain underserved. If Epic understood TDS or UltiCare before coding EpicCare, they would have earned huge respect and saved 10 years of unnecessary “fixes”/costs and buyer and user frustrations.

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