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Readers Write 6/8/11

June 8, 2011 Readers Write 41 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note: today’s first article was written by the CIO of an academic medical center that will move to Epic once the necessary approvals are in place (not yet announced). I suggested drafting some thoughts about why Epic is so successful in that market, even with hospitals that had no plans to replace their existing systems. I thought the perspective of a CIO in the middle of that decision would be interesting since it’s hard for the rest of us to understand how Epic can be so consistently successful, and therefore tend to blame unspecified “Epic Kool-Aid drinking” rather than the real differences between Epic and its competitors.

Why Epic? Why So Many Decisions to Deploy Epic?
By Thoughtful CIO

As a nation of healthcare delivery systems, we seem to be selecting Epic in record numbers. I’m told that nine of every 10 decision-makers are selecting Epic.

It is astounding, but it is also rather obvious. Epic has become the market choice for many of us. And like many market swings, the causes are many.

I’ve given it some thought. I fully expect that many will disagree. This is just one person’s opinion.

In some ways (I hope you can forgive the melodramatic root cause), I think our focus on Epic and the need for tight integration and simplification of our environments might relate to the upcoming 10th anniversary of September 11. We are longing for a return to a simpler time.

It has been ten years since the “world stopped turning.” I think many of us are carefully revisiting where we have been and what we have accomplished since that September day. It might not be deliberate, but I think it is real, nonetheless.

We all refocused on the “main thing” back in 2001. It may have been different for different industries, but in healthcare, we decided we were going to make a difference. And I think we meant it.

Sadly, in spite of much hard work, and many system deployments, we are not yet achieving safe, efficient, and effective healthcare to the degree we all had hoped.

Here is some thinking out loud. 

  1. In a world where healthcare decisions and information flows are growing increasingly complicated and are conflicting, our care providers are overwhelmed with complexity, burdened by too much not-always-relevant information, and are often interrupt-driven as they attempt to make decisions. It feels like chaos because it is. It’s a difficult balancing act. Many of us are longing for a simpler and safer approach to the management of information. We haven’t yet found it, and we worry that it is hurting our patients and making it more difficult to be a care provider.
  2. Patient- and family-centered care is going to become even more critical in the world of individualized health and personalized medicine. This will require improved access to longitudinal patient records. It will necessarily involve and empower the patient to be an active member of the care team. It will soon be the only way to effectively and efficiently manage and allocate scarce resources. Targeted interventions and therapies will be the future of medicine, and information technology will be a critical component of the deal. But we are not yet delivering on the promise, in spite of many millions of dollars of investment.
  3. To deal with this complexity, chaos, and the critical focus on the patient-centeredness, we are focused on minimizing the burden on our care providers and our patients. We want to collect data once, at the source, in the most user-friendly way possible. We want our data collection to be the by-product of care, not an added responsibility. And we want it to be easy to do. We have not yet found a way to achieve these goals in a meaningful way, at least not consistently.
  4. Some current vendor-supplied solutions offer choices and options. They promise to be all things to all people. They rely heavily upon a provider-based organization to make wise decisions and “perfect decisions” in the midst of a very imperfect world. The decisions that must be made expect that there is clarity, when in fact there is not. We are not realizing increased productivity, lower costs, and more efficient care. In fact, many of our healthcare delivery systems are questioning the investments we have made and are not yet able to clearly define the benefits we had hoped to achieve.
  5. Many of us have experienced implementations that over-promised and under-delivered. We trusted our vendor partners and some of them failed us. We then we failed our user partners. The systems didn’t perform well, the vendor was unable to deliver the rich functionality that was promised, the product didn’t scale, the developer didn’t listen, etc. Everyone loses, and we were parties to the losses.
  6. Enter Judy Faulkner and Epic. There is no ambiguity! For more than 30 years, she has been crystal clear about her strategy and the strategy of Epic. The patient is at the center. The business of healthcare is about saving lives and managing information to support life-saving activities. No ambiguity. It’s about the basics, and she gets the basics right! From the beginning, what you see is what you get. No ambiguity.
  7. Judy Faulkner and Carl Dvorak treat everyone the same. No deep discounts, no development partners. We’re all in this together. There is no ambiguity.
  8. Judy and Carl have a healthy optimism about the future. They believe there are many opportunities we can leverage, but they never make a promise they can’t keep. They tell the truth. They do what they say they will do.
  9. Judy doesn’t offer to solve problems she can’t solve. She is completely transparent and tells the truth, both when it is popular and when it isn’t. No pretense. She doesn’t need to be liked. She has a product that works, that scales, and is fully integrated. There is no ambiguity.
  10. Judy also sells a product that works well. She provides the rules for how it must be implemented. Again, she eliminates the ambiguity. Follow the rules and everybody wins.

I’m not sure I’ve captured what I was hoping to capture. In summary, when I think of Epic, I think of a few words:

  • Honesty
  • Integrity
  • Candor
  • Trust
  • Transparency
  • Consistency
  • Focus
  • Commitment
  • Patient-centered

These are words I hope folks will use to describe the work we all do in healthcare IT.


What Providers Need to Know about Patient Engagement
By Donna Scott

6-8-2011 5-49-48 PM

Given all the talk these days about patient-centeredness, is there really change afoot? Will the US healthcare system of the future really be built around the needs of patients? Or is “patient-centered” just another buzzword which won’t quite survive the complexities, the political realities, and the multi-faceted stakeholders in the great healthcare reform debate?

Well, I have been called an “optimist,” so you can probably guess my opinion on the subject. Yes, I believe that we are truly at the crossroads of change in the healthcare system in the United States. In spite of the complexities and difficulties ahead of us, the desire to implement new ways of managing healthcare in this country has never been stronger.

Regardless of what you think about the future success of Accountable Care Organizations or Patient-centered Medical Homes, there appears to be widespread agreement that US healthcare delivery needs to shift from a quantity orientation to quality of care and better outcomes. And better patient outcomes will be enabled by a much higher level of patient engagement across the healthcare industry. This shift toward quality outcomes and patient engagement represents both an opportunity and a challenge for providers.

Because of this shift, a small group of patient engagement enthusiasts and industry pundits were recently asked by The Institute of Technology Transformation to write a paper for providers about the current state of patient engagement. The objective was to offer healthcare providers a summary of the latest research that exists about patient engagement and provide some key points for their consideration as they embark on the healthcare reform journey. The Top Ten Things You Need to Know about Engaging Patients is the result of our efforts. The paper can be accessed here.

In summary: there is a lot of good patient research out there that our group has synthesized into the following key ten considerations for providers:

  1. Providing Patient Education Online
  2. Interactive Online Dialogue
  3. Patient Segmentation
  4. Role of Caregivers
  5. Trust in Physicians
  6. Consumer Mobility
  7. Security and Privacy Concerns
  8. Leveraging Inexpensive Tools
  9. ROI of Patient Engagement
  10. Changing Care Models

In each of these ten areas, we briefly discuss the research and the key learnings which are relevant to providers. In addition, we include four key recommendations for practical action:

  • Walk the talk: set specific patient engagement objectives and measure them
  • Champion your hospital’s social media strategy and assure mobility as a key component
  • Pay attention to caregivers and do your homework on patient demographics
  • Consider HIT solutions that already incorporate patient access and engagement capabilities

For some progressive hospital administrators, this information will simply affirm what they are already doing. For the others, we hope it will spark ideas on how to take their patient engagement strategy to the next level. Because the need for more patient engagement in the U.S. healthcare system will impact all of us, sooner or later.

Donna Scott is leader of the Patient Engagement Action Group for the Institute of Health Technology Transformation and executive director of marketing strategy for RelayHealth.

Twitter, Dogs, and Healthcare
By Ronnie James Dio

I see a lot of dogs out in public these days. They’re everywhere. People bring them to Home Depot and into Starbucks. Sometimes they’re peeking out of purses. 

I love dogs. I’d even go so far as to say I consider most dogs excellent judges of character. But I’m not wild about sharing my coffee and oatmeal at Starbucks with somebody’s dog right next to me. When I go to the grocery store, I don’t want to see a dog riding in the basket of the grocery cart. 

I went to the dentist the other day. Guess who’s hanging out by the reception desk? You got it — a big black Lab. Named Elliot, by the way, which I consider to be a decidedly un-dogly name. The look in his eyes said, “I’m begging you, call me Fetcher.”

I want some boundaries is my point. Just give me a shopping experience without dogs. 

Same goes for ubiquitous talk about social media. More specifically, Twitter. I really don’t care that Anderson Cooper of CNN on-air wants to tell me he’ll be tweeting during the broadcast. (I especially don’t like the word “tweeting,” while we’re coming clean with each other.)

Also, I don’t need software I use in my healthcare IT business to update Twitter with what I’m doing, as a contract management tool I have is dying to do for me. Just sent a contract out! Third one today!

I don’t say this thinking trade secrets could be disclosed. It’s much simpler: I’m just not that interesting.

And now that we have these two things on the table (too many dogs in public; I’m largely boring) I need to cover one more thing. I don’t find Twitter interesting or helpful for healthcare except, I’m sad to say, in a catastrophe such as an earthquake or tornado, where we actually learn things we couldn’t know otherwise. 

When tornadoes strike or a tsunami hits, Twitter can be indispensable. It can become a strikingly important tool for healthcare, if only to inform others where help is needed. When we least expect it, a hula hoop becomes a vital messaging tool.

Otherwise, it’s the dog in Starbucks, the thing I can’t escape that I actually don’t dislike, but I want to pick and choose my interaction with it. 

And just because there’s a tool that lets us share 140 characters of text with the world doesn’t mean it’s valuable. In the real world of healthcare, when things are not catastrophic, I’m arguing that Twitter is rarely helpful, and as parents can attest (via the attestation process) in the breezy “real” world teenagers move in, few have the slightest interest in Twitter. It interferes with their texting.

I have a very high professional focus on healthcare IT, so I typed in “healthcare IT” from the main Twitter screen. This popped up: 

We r letting d Tfare issue overshadow d aim of the damn lunch. It was a forum where issues of light, good healthcare / education were discussed.

Besides the fact that I find the phrase “damn lunch” funny, I have no idea what the post means, but I’ll bet a quarter it’s right at 140 characters. I’m also pretty sure there is no such thing as “light, good healthcare,” and I’m positive that you should be able to find “healthcare IT” in context when using an ever-present tool for social media.

So I put to you a simple question. Outside of emergencies or catastrophes, when does Twitter actually benefit healthcare? Who is helped, and how? 

I’m wide open to learning something here, but please answer in 140 characters or less. I’ll be back in touch after I take my dog to church, then out for a damn lunch.

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Currently there are "41 comments" on this Article:

  1. Having worked on Epic installs over the better part of the last decade I cannot agree more with Thoughtful CIO’s summary of Epic. That said, if you really want to walk into this eyes wide open then also remember that:

    1) Epic’s products though integrated become exponentially more complicated to implement each year/release – it’s impossible to know all of the options, programming points, settings, and the documentation is hit or miss – sometimes it is excellent and sometimes it doesn’t exist. You truly need to find GOOD analysts that are 100% dedicated to the install (not supporting legacy systems being replaced) and who are willing to put in the time and energy required to learn the system – buy now or pay later. If not, you will just be paying paychecks to analysts and relying on consultants (if you can find them).

    2) Epic’s implementation team is burnt out with all the new sales exasperating the high turnover that is inherent with any 100% travel occupation. Given this – expect that the team you are assigned will change – the longer your implementation timeline, the more turnover you will have in your implementation team and you will consistently be presented with a very smart, hard working, 20 something right out of college.

    3) The Epic knowledge pool if finite. Good or bad, Judy/Epic frown on on consultants and why wouldn’t they – you are MUCH better off investing 200-300k a year on your internal staff keeping them happy. If you internal staff are not cut out for the job hire a college grad yourself and grow them don’t through 120-200 an hour at consultants if you can avoid it. So that said, if you are looking for a consultant know that the pool is very limited since the only way to be Epic certified is to have worked at Epic or to have worked at a another Epic customer. Also know that 80% (may estimate) of consultants are not worth the job they perform – look at their resumes, there is a reason they jump from firm-to-firm and project-to-project every 2-3 months. Make sure you have talked to someone on the phone that has physically worked with the consultant before you sign a contract with them.

    4) Combine 1, 2, and 3 above and you have very few people in the world that truly understand the integration aspects of Epic – it is highly doubtful your Epic representative will know much outside the silo of their assigned application, unless they have been at Epic for a couple years, are certified in multiple applications, and have spent all of their free time going to go-lives. This doesn’t mean you can’t fumble through them in your implementation – just don’t have high expectations of anything being easy.

  2. I would have to agree with most of what Epic Fanboy has to say with one notable exception: the majority of consultants with whom I have worked really knew their stuff, but there are certainly rotten apples that spoil the bushel.
    Short engagements aren’t always a warning flag provided the role the consultant played could actually be performed in a short period (e.g. go-live support, classroom trainer). Five weeks as a Team Lead and left the project before go-live? Maybe not a good choice…
    On the flip side, client expectations are often unrealistic as well (e.g. need an AC with PB and claims build experience as well as Cadence template build, BCA, and a working knowledge of the Wyoming payor mix). Or perhaps you have read the requirements list that mandates 3+ years build experience with Canto or 5+ years with Phoenix?
    My recommendation (and my admitted bias) is to find a consultant with build (not merely support or SME) experience who has a combined FTE and consulting background and who works for a firm that can switch out that consultant out if the need arises. There are plenty of great independent consultants out there, but if you select someone not-so-great or who is not a good fit, how long will it take you to find a replacement?

  3. Thoughtful CIO has apparently just gotten out of the sales demonstrations and all the promises speeches. And let’s not forget the “whale” speech and the “wedding song” giggle.

    Epic Fanboy was dead on with the assessment that every Epic implementation is very very silo’ed. Inpatient Orders overwrites or breaks something for Ambulatory Orders and vice versa. Suddenly you are in a production setting, and things stop working. During our demo, the patient got lost in the system multiple times because they couldn’t hand off a patient from registration to placing orders.

    The Epic implementations of today remind me so much of the Cerner implementations around the year 2000… Suddenly there are a bunch of kids on site who have been through a 6 week crash course on their one area, and have no idea how to get Epic to fit with (“heaven forbid”) any legacy systems that are going to remain. Yes, every now and then there is a real ray of light that actually “gets it” and can make all the different parts work together, but just as suddenly, they are gone. And, they must have a class on being confrontational, because there are times when it seems to be forgotten who is paying the bills.

    And the monthly score cards… stating where your site is behind out of left field, and suddenly, everyone loses a week trying to explain how a RED BALL ended up on the report (that suddenly turn GREEN when a go-live is near). It is slightly funny that one of the top items on the score card is whether you have been paying your bills on time.

    The CIOs are at a different level and Epic doesn’t let anyone talk to them. So unless the CIO is proactive and gets his\her own monthly Epic “report card” from his\her project team, they will only get Epic’s side of the story.

    But the Kool Aid is strong, so people just keep drinking it.

  4. The unsaid other side of Thoughtful CIOs piece about Epic is:
    All the other vendors are liars, full of sleazy salespeople, untrust worthy, fakers, money mongers…etc.

    If only 60% of what he/she said is true, what an indictment on this industry.

    As one who has been in this HIT business for decades I know that is not true. If you want to condem the vendors don’t forget to include the buyers who really did not want to hear the ‘truth’ (and I know many who tried) and the consultants that saw their job as nailing the vendor to the wall to save a buck on the install.

    I do commend Epic for ‘taking the high road’. I just think this industry may have been ready for it, and timing can be everything.

  5. Epic is probably the best enterprise system, but it is still very first generation. I counted over 39 steps to document a central line. From an end user standpoint, it is better than Meditech, but it is not 45 million dollars better, maybe only 50% better. I think their increased market share has mainly to do with the fact they would only install for a long time in hospitals they knew they would be successful in. There is a certain cache with Epic, a feeling that you get to be one of the big boys. But I think they will struggle to keep up with the second generation of EMR whenever that happens.

  6. Mmm, I have to disagree with Epic Fanboy. I have worked in Healthcare IT since 1976. I’ve seen a lot of systems, as it seems with every new leadership group you get a new system. I have been a consultant for the last eleven years, and have seen even more systems. My specialty area is interfaces, so my exposure is pretty broad and well tuned to integration.

    What I have learned is, that in many of the Epic implementations, the organization’s staff are fresh out of training, but need guidance. Unfortunately, the Epic support team is also fresh out of the same training and have to “get back to you” on what seems like everything. They are missing some of the core knowledge of how a hospital really works, or an Outpatient Clinic, or the total cycle of a patient going from the outpatient clinic to the ER to hospitalization and finally getting that bill. If your implementation is difficult, your post support is probably going to be difficult too. You might as well double your staff to handle the rework, the support and the remaining roll-outs. And yes, there can be a lot of turnover on your Epic Reps, because the implementation team finally figures out they are not getting what they need as far as guidance. Instead, you get scripted recommendations. So you look to consultants who have that core knowledge.

    The next thing I have experienced is all too often, the package you purchased really isn’t enough to do the job. It seems like Epic is forever coming back and saying, “well, you can do that if you had …” . Cha Ching. Sometimes I feel like I’m witnessing bait and switch. Not a good feeling.

    Don’t get me wrong, I don’t dislike Epic, but I don’t like them either and I don’t have to. I think they are just another vendor, with a lot of glitz and glam. And just like all the other big players (GE / IDX, Cerner, Allscripts, etc), they all have their rise and fall.

    And as far as Epic Fanboys’ consultant theory goes, I think he is off, and I take offense to his statement that 80% of consultants are not worth the job they perform. Sounds to me like you are a current or former Epic employee that can’t get a job as a consultant. In real implementations, consultants can be a vital part of the implementation team providing experience and knowledge that the scripted grads just don’t have.

    Tip: while you are considering your staffing requirements, ask Epic how much REAL experience their implementation team that will be assigned to you has, and then you can decide how to augment your staff with experienced and knowledgeable consultants. And just remember, all that build work the Epic team is doing for you, is costing you just as much money. Cha Ching.

  7. Ditto on what Epic Fanboy and Blah said. I often hear of people saying the Epic software is very good. I rarely if ever hear of people saying the implementation experience was positive.

  8. Thoughtful CIO’s post about “Why Epic” struck a cord with me while reading it. Everything he/she said should apply to all companies, whether HIT or another area of healthcare. If all companies made the patient the center of all planning and execution and ran their day-to-day operations based on the summary points listed in the “Why Epic” article, they would realize the same growth, profit and success as Epic. Instead, many companies lose their focus and make too many exceptions. I think that Epic is a good business model for the rest of us, no matter the healthcare segment, and we can learn a lot from their intense focus and dedication to their goals.

  9. I respect’s Epic’s focus, but having worked with them closely (as a technology partner), there wasn’t a day that I wasn’t floored by their insularity and, frankly, arrogance (hubris?).

    How many and what vendors did you evaluate?

    Were there any empirical criteria…or just your gut feeling? If others are buying it, it must be good (a safe choice)? Are they simply the “cream of the crap”?

    If 9/10 new health systems EHR installs are Epic…then the success or failure of EHRs in achieving all that has been promised with HITECH is largely riding on…Epic… That will be the true measure of whether Epic was the right choice.


  10. If you don’t think 80% of consultants out there don’t know what’s up, then perhaps you don’t know what’s up 🙂

    What Fan Boy is saying is, yes you get a bridges consultant and he can build your vanilla lab interface, setup device integration etc. You get a clindoc consultant and they can take the model system flowsheets and customize them. Create some BPA’s that only serve to annoy the clinical staff. This is the very start of being able to implement the full range of Epic features and make the best out of what is an extremely customizable system. Perhaps too customizable for most people.

    The depth and breadth of the Epic system allow creative innovation in the build. The best implemented hospitals (your NorthShores) are paperless and consistently show up on the top hospitals lists. Not because they are the top hospitals but because they just report extremely well.

    And this is just the top of the 80%. There are many consultants out there that shouldn’t be doing implementations at all. I have worked with people who have never implemented, at all. They just have certification. They knew somebody at XYZ consulting company who told them how much money they could make. I have been on some installs where I have spent 50% of my time training other consultant on the basics. People are just cashing in.

  11. I agree with almost everything written above except the initial post by Thoughtful CIO. Every single reason to choose Epic is straight from a sales and marketing strategy. Epic is not even a little bit different than any other vendor on the market, and those who have been in the field a while can attest to the fact that every single major vendor in the field today was once an Epic-style golden boy before creeping into the legacy vendor category. Epic is trendy today, that’s all. It’s easy to trace back HIT trends, from Epic back to Cerner to HBOC/McKesson and GE to Meditech to TDS/Allscripts. All the reasons cited are just emotional reasons to want to justify a relationship, rather than logical reasons to suggest why Epic is intrinsically different than any other company. Healthcare has been complicated for decades, ever since a little thing called Medicare came on the scene; Epic hasn’t really done anything to make it simpler, at least not any more than any other HIS vendor out there.

    I’ll offer one very simple reason why hospitals are running to give their money to Epic. The 9/11 analogy was only partially right – ever since then, our economy has been in the tank, and for any self-interested CIO or CMIO to keep their job it’s easier to blame software or a vendor for failures instead of pointing the finger in the mirror. Epic is trendy and everyone’s doing it, so if your hospital is failing now with a current vendor, why not run to Epic, and be like everyone else? It’s also the perceived “safe” choice right now. Epic provides such a rigid implementation strategy that a CIO can coast right through the roadmap and boast about his/her newfound “integration.” Adoption is typically mandatory, regardless of how much damage it does to the hospital’s business. As long as 100% adoption can be touted, doesn’t matter what the consequences are. I’ve seen hospitals and clinics that have never recovered to their pre-Epic productivity levels even years after implementation. Shocklingly short-sighted, self-absorbed decisions are being made to purchase Epic with little business logic involved. Buyer’s remorse is already starting to set in with some unhappy Epic customers, and will only continue to grow over the next several years.

    As mentioned in a couple of posts above, HIT will continue to evolve, and Epic will become like every other legacy system but with an even poorer ability to integrate and interoperate with outside technologies and devices. My greatest fear is that with hospitals tightening their belts, they may have invested so much time, money, and resources into their Epic purchase that they won’t be able to afford many new technologies. Couple that with CIOs unwilling or unable to manage complex information systems, and I fear that Epic will cripple the evolution of health care technology adoption over the next decade. We’ll end up right back into technology siloes, except this time it’s doubtful any one will want to spend the money to dig out of them.

  12. Complex projects are complex. And then, you have clumsy project managers, conflicting demands, lazy people, patient care imperatives, organizational dysfunction… and then you bring in an external group who has to manage the chaos and absorb it. There’s poor expectation setting within the industry about what it takes to install a clinical EHR. It’s messy, it’s hard, and we do it because we get to work with the best clinicians in the world and see the things that organizations like Geisinger and Stanford and Kaiser are doing with quality outcomes metrics made possible through that work.

  13. Ronnie James Dio’s comments reminds me of the MCA executive that declared that guitar bands are on their way out after hearing the Beatles audition in 1963.

    Twitter has value for patients and professionals in healthcare. It is all in the way you use it and who you follow. Patients have communities of information and support around conditions. This can be very helpful and reassuring. As a professional, increasingly I get my news, views and input via the twitterverse. It has become a great source of insight.

    As with guitar bands it is all in the execution and implementation.

  14. Another small Rodent (Lemming) aka CIO…….Good Lord I just think I vomited a little in my mouth

    ……Mr. Thoughtful CIO, needs to crawl back into his hole in the arctic like all of the rest of the lemmings and stop drinking the kiool aid. Here are the facts about EPIC

    1.) They are not unique (how many times have they been sued for intellectual property infringement?) (see IDX; Mckesson and on and on)

    2.) They don’t live up to their promises when it comes to cost. If they tell you it’ll cost $100 million you’d better add 60%, and plan on $160million.

    3.) People who have been in the industry more than 10 – 20 years cannot believe the hubris and arrogance of this vendor when one tries to explain to a 20 year old kid, who hasn’t voted in his/her first presidential election, yet, that interfacing simple registration data is not a new concept, and should not corrupt your database. Also, if your database is that fragile that interfacing registration data will corrupt it, how good is the underlying code?

    4.) They cost Americans jobs. Most Healthcare systems end up laying off 10-15% of their staff, not because of discovered efficiencies, but because EPIC hasn’t lived up to their promise regarding cost, and the $100 million budgeted has now grown to $160 million, and the project is now 6 months to a year behind schedule.

    5.) Model System = Doesn’t work in the real world. ‘Nuff Said’

    6.) Here is the New Math EPIC = CIO = Carreer Is Over…….How many CIO’s who have tried implementing EPIC have been fired due to the “koo koo” talk like the garbage that just came out of Mr. Thoughtful CIO? I give him 18 months…..

  15. Hey Ronnie J….twitter is great for starting and breaking trendy things. Like, if everybody twitted about all these Epic failings, and then twitted about my new software firm : Meaningless Use Systems…I could be the next HIT wonder kid!

    So lets get twitting!
    Oh, and Mr. H, if I ever do a readers write piece please don’t post it after an Epic piece. Thanks.

  16. Epic FanBoys comments regarding trust and integrity are spot on. Judy has clearly demonstrated a commitment to excellence. Her unnamed counterparts…..gentlemen who spend their time on Mad Money….will tell you anything you want to hear. And then you’ll end up with an array of systems that don’t talk to each other and swampland in Florida.

  17. Anonymous32, your “facts” are more fallacy

    1) not unique just because they were sued – so by that argument absolutely no tech company is unique, great argument. Also, have you seen the version IDX had when they sued Epic – Yeah, I believe that Epic really stole that 1980’s looking text screen from them. As for Mychart – yeah, I’m sure Epic didn’t come up with that idea on their own… whatever. Also, if Epic has to steel their intellectual property from IDX and McKesson then why is it that neither of these companies can sell their product to begin with and have to resort to frivolous lawsuits?

    2) Epic tells the truth about their costs and they charge/invoice what they say they are going to. In fact, if you are going to go over a budget it must be re-approved and it gets escillated. Just because an organization goes way over on other install related aka consultant costs and add-on/integration costs – not sure how that would be Epic’s fault or Epic specific – Epic in fact suggests highly against the use of consultants and the associated costs.

    3) In my experience interfacing data issues almost always result from the other system, not Epic. So for your example – what do you do when IDX only allows 72 characters for a person’s name. If the name in Epic has more than 72 characters then sends that info to IDX – it gets truncated, then when Epic gets the message back should they just ignore it? There is no problem with underlying code as you say, there is a problem with incompatible data structures and databases… Again, this has nothing specific to do with Epic or its underlying code, and Epic is one of the few vendors that will do interface work – try to get a bi-directional ADT interface with any other ADT vendor – they just won’t do it, either because they can’t or they won’t – crappy software on top of crappy support.

    4) Same as #2, Epic is charging what they said they would charge this seems to be a hospitals problem, not Epic’s.

    5) Ok, agree with you there but that said – I have never heard anyone from Epic say that it will, out of the box. They say it is A) a starting point and B) It’s much better starting there then from a blank system.

    6) Not sure, how many…

  18. I have to agree with one of the questions that Donna brings to the table, “Will the US healthcare system of the future really be built around the needs of patients?”
    To answer that question, although Epic seems to be in the forefront of many today, I’ve learned there are other companies (Optum) on the cutting edge of building their technology/processes around the needs of patients.
    I just saw an article published today that touched upon the First Fully Operational Accountable Care Organization….Tucson Medical Center

  19. Have another shot of kool-aid as you convince your board that the $20-40mill over budget you are is worth it……man, how do you live with yourself?

  20. Judy saving us all from our 911 angst…that’s an interesting explaination for Epic’s market dominance.
    It is not much better than prevailing theory on HISTALK that “it’s because they are all Lemmings.”
    How about a more simple theory out of Econ 101…consumers are rational actors making rational choices based on a value proposition?

    My organization (not currently on Epic) is contemplating changing its system and this is what we see:
    Our peers are using Epic, they are excited about the results they are achieving with it, and their physicians are very happy.
    KLAS data confirms that Epic customers are significantly more satisfied (15 to 40%) than other vendor’s customers in all aspects of vendor and software performance.
    No Epic customers report to KLAS that they regret their decision to purchase Epic vs. 15 to 55% of other enterprise vendor’s systems.
    We can’t identify any Epic customer who has switched to a different vendor…except for 1 customer who switched because they were bought by another corporation.
    Gartner consulting has Epic in the highest part of their Magic Quadrant for enterprise systems.
    The overwhelming number of organizations who have achieved HIMSS level 7 HIT adoption are on Epic.
    A significant number of HIMSS Davies award winners are on Epic.
    Epic is consistently among the first vendors to achieve each new level of CCHIT certification.

    Regarding the ongoing “Epic works its employees to death” rants:
    As a potential customer it makes me think “Excellent, the rest of us on the healthcare front lines are overwhelmed with the challenges we are having to meet. It is good to know there is a vendor that is working as hard as we are. The Epic leadership is obviously focused and on task.”

    Judy, on behalf of America, thank you healing our battered collective psyche.

  21. Did y’all red this?

    Larry Lotenero, chief information officer at UCSF Medical Center, is stepping down in late June after a decade on the job, according to UC San Francisco officials.
    The move comes after UCSF went $100 million over budget on a long-delayed and circuitous electronic medical records implementation.
    In a May 23 email to staffers at the medical center, CEO Mark Laret said that Lotenero was retiring in late June, and that Chief Operating Officer Ken Jones would take “immediate responsibility” for UCSF Medical Center’s IT operations.
    “We will provide other updates on our plans as they develop in the coming days,” Laret concluded.
    In mid-April, Laret confirmed that the installation would cost about $160 million, or $100 million more than earlier estimates.
    UCSF switched in late 2009 to an Epic Systems Corp. EMR after earlier implementing parts of a General Electric (then IDX Systems) electronic medical records system in mid-2005.
    Some UCSF clinics have installed the Epic system or are about to do so.
    Industry critics say the more than decade-long EMR implementation at UCSF Medical Center has been a costly disaster, with multiple delays and missteps.
    The San Francisco Business Times reported last month that the project was way over budget, and that the medical center began implementing various iterations of administrative and clinical information systems in the late 1990s and early 2000s, before dramatically shifting gears in late 2009.
    The game plan announced internally in November 2009 called on the Epic system to be implemented first in ambulatory clinics, then in stages to adult and pediatric acute care units, then the emergency department and finally intensive care.

  22. @Epic Fanboy: since Epic is clearly what pays the bills for you, will give you the benefit of myopia. You’re wrong on every count though

    1. Epic and U. Of Wisconsin settled with IDX based on allegations of corruption and sharing trade secrets. That’s bad business in any industry. RelayHealth, part of McKesson, is one of the big 3 HIEs and is exponentially larger in scope and deployment than MyChart. If MyChart is so spectacular, why did they have to steal the idea/patent from RelayHealth? These aren’t petty little things; these are an arrogant company literally lying, cheating, and stealing to get ahead.

    2. Epic lies through their teeth about cost. They create a contractual environment where the customer bears a heavy cost and resource burden, and Epic can walk away saying that Epic’s cost was in scope, it’s the consultants/other vendors/CIO/etc. who accounted for the blown budget. Truth is, none of those costs would’ve been incurred if not for Epic’s limitations in the first place. You must be literally dumb if you think Epic argues against consultant use; they do quite the opposite, and have embraced consultants to the point of collusion. Exhibit A: read the paper posted by Accenture where they describe how they convinced the University of West Virginia med center to buy Epic even when the hospital admins didn’t think they could afford it; surprise, Accenture got the consulting contract to implement Epic shortly afterwards.

    3. In your experience working for Epic, you don’t realize that most of those interface problems you encounter are Epic’s fault, and the other vendors are quite adept a interfacing with each other. IDX/GE is actually one of the most interoperable platforms on the market because they actually adhere to the letter, not just the spirit, of interoperability and interface standards.

    4. Epic is only just beginning to come back with the application add-on game that all the big vendors play. It’s a natural transition in doing business once you have a big, established customer base that needs to grow, and new applications to sell them. Epic just never had a large enough customer base for long enough to do it, but they’re already trying to sell their departmental add-ons rather than perform any useful interfacing or integration with 3rd party apps. Gotta love things like Beaker, ASAP, and OpTime that are among the worst products in their category. At least they’re integrated though, for all those CIO’s that crave it.

  23. Health care may be a huge part of our economic expenditure but healthcare IT is a small industry. The EMR space is dominated by only 6 vendors: Allscripts, Cerner, Epic, GE, McKesson, Meditech, and Siemens. By HIMSS data: in the inpatient and ambulatory sectors, those 6 have over 66% of the market so we know them well. Of those 6, three are mish mashes of disparate systems that were most often stuck together with chewing gum and tape. One of the companies had no fewer than 50 acquisitions or partnerships to deliver an “integrated” system. Sales people move from McKesson and GE and Cerner and Allscripts like jumping beans – how can customers trust their word? All public companies serve one master that sits on their heads quarterly. Meditech stand off to the side, knowing its market, its limitations, and has loyal employees that clients have grown to trust.
    In this small market where most healthcare IT folks are one or two degrees away from each other (just look at LinkedIn – and discard the HIStalk folks), Epic has surveyed the land and followed the Meditech model but staked out a higher ground. Healthcare is not a cut throat profit motivated industry. Highly educated, hard working people in healthcare just want to trust their systems vendor and they trust Epic. As for 23 year old kids installing systems – that’s who does it for everyone, the older folks are back at the ranch supporting those traveling yahoos.

  24. Don’t get me wrong, I don’t blame Judy, I blame the CIO(s) that sell their board a line of BS as their A/R days go bad, and their budget dollars run dry…….Ms. Faulkner is a lovely woman with an angelic soul..I do think her system and her implementation model is poor, however……The real devils here, however, are the CIO(s) who are overselling their boards …….and then not living by the motto “An honest man’s pillow is his peace of mind!”

  25. This Epic debate will never be solved, it’s like politics, people have their opinions which won’t change. I wish we could all just agree that Epic is good at what they do though rather than having a mudslinging contest every 3 months.

    It really irritates me that people just make up their own facts though…one poster mentioned that Beaker, OpTime, and ASAP are among the worst in their category. I’ll give you that Beaker is severely lacking in functionality, but I’m pretty sure that OpTime and ASAP are both pretty high in KLAS rankings, though I’m sure that’s just part of the big KLAS/Epic love fest conspiracy.

    I used to work in health care IT and have since moved on to a different industry. The reason that you go with Epic (and the reason that execs love it) is because in the end, it doesn’t have to make it very far up the chain before someone fixes your problem. And if you still have issues Judy and Carl will see to it that it’s fixed. We just terminated a contract with a vendor that had a really good product because their support was absolutely dreadful and there are others that are right near the bottom. People can say what they like, but they are top notch when it comes to support and that’s why people stick with them and the rankings show it.

    I’m sure a big reason they’re able to retain that advantage is because they’re private. They have advantages that you just couldn’t have in a public company.

  26. KLAS receives a significantly large portion of its revenues from the vendor community and they are cagy about what their methodology is any of their “analysis” must be measured in this context..

    How many Epic contracts have NDAs included which legally handcuff the customer from representing anything negative concerning the products tehy licensed? That could possibly explain why their KLAS scores are perfect. Educated consumers need to ask what do they have to hide? Do all vendors have similar language in their agreements?

    If you’ve convinced your board you’re buying the ” Best System” and got them to approve a $40 million budget why not spend $20 million more to make sure it is implemented the right way. It is tough to walk away from a system after spending $40 million of a Not-for-Profit Hospital’s limited financial and community resources.

    The higher they reach the farther they fall…

  27. “There’s poor expectation setting within the industry about what it takes to install a clinical EHR. It’s messy, it’s hard,…”
    Petyr Baelish

    Cogent observation. I think Epic’s success in an organization will be better measured after 5 years than by implementation woes.

  28. Mr. Bradford–have you seen an Epic contract? Would it surprise you that the agreements don’t include anything like you suggest? Occam’s Razor? Perhaps the reason that the KLAS scores are good is simply that those responding believe the product is good? Nah, much more interesting to come up with an unsupported conspiracy theory. Here’s mine–aliens are influencing the minds of healthcare CIO’s, causing them to not only choose Epic but then also falsely report to KLAS.

  29. @Epic Fan: you’ve obviously never spent much time trying to use Beaker, OpTime, or ASAP. Every clinician I know – different sites in different geographic regions around the country – dislikes these products. KLAS scores aren’t generated by the rank and file, but walk through any ER in the country with ASAP in place and ask the physicians what they think. Comments will typically range from “It’s OK” to “It’s awful.” Few ER docs have ever heard of KLAS, but when I tell them how highly it’s ranked, they are typically surprised. The problem with KLAS rankings is that they are highly subjective, with relatively few objective criteria to use for comparison. As established with many of the comments here, despite the fact that medicine is a highly scientific field, multi-million dollar decisions in our field are still made by people using irrational, subjective criteria.

    @William Bradford: perfect analysis. Once you’ve sunk your organization deep into a money pit, how is it possible to back out without offering a resignation as well?

    @LemmingWannabe: If you haven’t found any unhappy Epic customers, you haven’t tried hard enough. Get past the CIO and CEO, down to the people who actually use it every day. Wonder if there’s ever been a study about whether heart attack rates are higher among CFO’s at Epic hospitals than non-Epic ones?

    @NotALwayer: You may be unfamiliar with what Epic calls the Good Install Program, which is written into all their contracts. Based on certain criteria for implementation satisfaction, Epic provides a credit back on the implementation fee. If you spent a boatload of money on software with your name on the line, and you got money back for saying it went well, is it any surprise Epic customers are more satisfied with their implementation experience? It’s ultimately a kickback, but I’m not a lawyer either, so who am I to judge.

    Then again, there are those who believe Epic doesn’t use lobbyists, despite the fact that the Faulkners donate thousands of dollars to politicians and managed to have the congressional delegation from Wisconsin set aside its busy agenda to tell the VA how much better Epic would be than VistA. Maybe it’s just that all those Wisconsin congressman believe deeply in HIT, spent so many hours directly using and comparing the 2 products that they needed to get the word out, and felt compelled to get together to carry that message to Washington, with no nudging from Epic whatsoever. I don’t particularly care that they do it, because everyone does, but to hold up Epic as some sort of utopian company is to simply turn a blind eye to reality.

  30. I’ll just comment on the Twitter piece (what’s left to be said about Epic??)…

    You obviously dislike the Twitter platform (or is it all Social Media?), but if you *really* want to engage patients, shouldn’t you aim to do so on their communication platform of choice?

    Might not be major (YET), but I personally think SM holds benefits for healthcare – particularly when it comes to managing chronic conditions as healthcare continues to make it’s move beyond the four walls of the traditional acute care institution.

    Forgive me for breaking up the Epic debate 😉

  31. I for one think KLAS is fairly open about their methodology for those that take the time to look:


    It’s true that the KLAS ratings include much more feedback from IT people and executives than they do from clinicians in the trenches. I don’t think KLAS tries to hide that–that’s why they show you the job title of the people giving comments and all of their reports show the percentage of respondents that come from IT vs clinical positions.

    However, I think if I were a CIO looking to buy Epic (or Cerner or MEDITECH or any other system), I would be more interested in hearing a what another CIO that has already bought Epic has to say about Epic than what some ED doc or surgeon has to say about Epic.

  32. This is an excellent thread – reader comments really add to the magic of HIStalk. We have alot of smart people in the discussion, so wondering if anyone can opine about the notion that the Epic architecture will soon “hit the wall”? I get the argument that it’s not a “modern architecture” – i.e. not object oriented, no relational database, etc… but any projections on what this will mean in practical terms (e.g. Cache simply won’t scale after a certain point… or, without a J2EE or .NET underpinning, at some point it will simply be too difficult to maintain and enhance?)… guessing the logical conclusion is that ultimately Soarian will gain a lead – a sustainable lead – over Epic… but what do you think?… I’ve been hearing about the demise of the MUMPS derivatives since I was a young lad, and Epic & Meditech don’t seem to have a pothole in sight… so not sure what to think..

  33. nobody said KLAS was secretive. but if you read that link, it’s all based on surveys. where is the ROI calculation, TCO, quality metric improvement, hospital v. hospital performance benchmarking, etc. etc. etc.? if i were a CIO worth my paycheck looking to spend some cash, i wouldn’t just read the IT version of Rotten Tomatoes to make my choice. i’d want real research!!!

  34. Cache scales very well. There will be no problems there. Epic have a SOA product called Interconnect, infact Epic is now being written in .net. Cache also has a full set of utilities that allow SOAP, REST etc. Epic do not utilize them however. Most people who comment in M and Cache really don’t know what they are talking about.

    The big issue with Epic’s Cache utilization is they use KBSQL. It’s an interpreted SQL layer or a broker, rather that Cache native global mapping, which is far more efficient.

  35. Should have said, Epics big immediate issue is getting away from Citrix. You get 50 or 60 users per Blade server on the Citrix architecture. Once they break free and are able to be fully browser based that’s going to free up a whole bunch of resources and reduce the cost of an installation.

  36. I am CMIO at a large group practice using Epic, and a 25% practicing MD using Epic. Our install was right on budget. Our productivity dropped only 15% during the 2 weeks following go-live, and then it returned to baseline productivity levels. 99% of our MDs have already achieved Meaningful Use. Most of our HEDIS scores now exceed the 90th percentile nationally. So when I fill out the KLAS survey ranking Epic highly, it’s not because anything in our contract told me to answer that way, but rather because Epic is a very powerful and flexible tool that has been highly successful for our organization.

  37. Dear Epic Watcher,

    With the entire VA, the entire Kaiser system,nor several – MANY very large multi hospital networks in the US, financial institutions, and some country’s governments using Intersystems Cache and other products why are you still waiting for it to hit a wall? It obviously scales and works. Move on.

    By HIMSS data – Meditech might have 24% of the hospitals but at this point Epic probably has 40% of the providers since they do the big systems and the wall isn’t technology it’s hiring and keeping talent with the mazing growth they have had.

    Hey…let’s see…what percent of the US is served by MUMPS systems if the VA, Meditech, Epic, Partners, CareGroup, and some other systems out there? GUess it works!

    Thank you Intersystems for years of continued hard work and a shout out to the CEO for donating millions to medical research.

  38. earlier in the thread, somebody referred to epic as the cream of the crap. i think that sums up emr technology in a nutshell. health care accepts mediocrity like epic and figures it must be awesome if everybody else in health care uses it. reality says that nobody graduates from harvard, mit, or stanford using mumps to write the next facebook or nuclear submarine programming. none of them would be caught dead working for epic either, assuming they have ever even heard of it. for those of you who think it scales just because big systems use it, keep in mind that none of those systems run off a single database and are networked together geographically as disparate database systems. the systems are connected through essentially an hie, not running off a single, massively scaled database. that’s actually a major limitation of both epic and vista – it’s not scalable. to the cmio who installed his emr well, kudos to you. all you do is reinforce that success is more about leadership than software, since you can find examples all over the country of successes and failures with every single emr platform made. i have a feeling you would have succeeded no matter what software you had bought. i also have a feeling you paid more for what you bought, without any justification besides that it looks nice. you’re entitled to ride around in your lexus, but just remember that all your friends in toyotas are driving the exact same car with a few less bells and whistles, for a lot cheaper. i guess doctors just always feel like they need to be in a lexus because they deserve it.

  39. Vista doesn’t run on cache. It runs on a free GNU version of mumps. See what I mean by people knowing nothing about M or cache? People tend to make all sorts of meaningless high level arguments that sound good. The basics are simple. A linked list, binary tree (people use different terminology for thus same technology) database structure is far more efficient than an relational database. So from the ground up Cache is superior to MSSQL and Oracle.

  40. @WTF–actually I am familiar with the Epic contracts and the Good Install Plan. The program is available to any customer for certain types of installs whether its mentioned in the contract or not. It actually has nothing to do with reporting to outside sources regarding the success of the project or user satisfaction; it’s an internal mechanism to judge the success of the project.

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