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Judy Calls Epic “Most Open System I Know”

After Zina Moukheiber from Forbes was declined an interview with Judy Faulkner, CEO of Epic, last year Judy decided to talk to Zina about Epic in this article “An Interview With The Most Powerful Woman In Health Care.” Zina does a nice job on the interview and raises some of the questions many people have about Epic. It’s worth a read if you like to follow the hospital EHR world.

Many people are likely going to latch on to Zina calling Judy Faulkner the “most powerful woman in health care.” I don’t think that’s really up for discussion. Judy is the most powerful woman in healthcare and so I’m really glad that Judy is starting to join the discussion about Epic and healthcare. She has an important voice in the discussion and we need her participation. Although, I’m sure she’ll hate being called a billionaire in the article. The reality is we don’t know how much Judy’s really worth until we know how much Epic is worth and I’m not sure Epic plans to go public anytime soon.

Semantics aside, the most important part of the interview was the discussion of Epic being a closed system to which Judy frankly replied, “We are the most open system I know because we’re built as a database management system, and database management systems need to allow their users to mold it to what they need.” I think she really believes that Epic is an open system and quite frankly there aren’t that many in healthcare she can look to that are more open. Sure, a number of EHR vendors have worked to be more open, but even they aren’t as open as many other non health IT software systems. Maybe Judy hasn’t looked at the APIs outside of healthcare.

The real disconnect I had when reading Judy’s thoughts on being open is her lack of understanding of how a truly open API works. In a well implemented API, you can allow any and all programmers to be able to build applications on top of your software without those programmers needing to read your code and study your internal software. I’m not saying you don’t want and need to have an application and verification process for those people who want to tap into your API. This can be part of the process, but a well implemented and documented API can be open to everyone interested in building on top of your software. The value Epic would receive from so many companies iterating and extending the core Epic functionality would be amazing.

The other facet of Epic openness discussed in the article was around interoperability. Judy offered these comments on Epic’s ability to share patient records:

As of March 2013, our customers exchanged 760,000 patient records per month; about one-third were with non-Epic systems. Based on the historical trajectory, we expect that we’re closer to exchanging approximately one million records per month. We are currently exchanging data with Allscripts, Cerner, Department of Defense, Veteran Affairs Administration, Social Security Administration, eHealth Exchange (formerly Nationwide Health Information Network), Greenway, MEDITECH, NextGen and others. We expect to be exchanging data soon with eClinicalWorks, General Electric, Surescripts, and others.

This sounds good on face, but lets consider how many records Epic is sharing. Let’s use the round number of 1 million patient records shared per month. The article says that Epic has about half of the US population on Epic, or about 150 million patients. That means that about 0.67% of Epic’s patient records are being shared.

I’m happy to applaud Epic for sharing 1 million records a month with so many different vendors. My only complaint is that they could do so much more. For example, if you can share records between Epic and Cerner now, does that work for all Epic hospitals or do you have to do the new integration with every hospital that says they want to share records with Cerner? If it was a turn key way to integrate with Cerner, I’m quite sure that instead of 1% of Epic’s patient records being shared we’d see tens of millions of patient records flowing where they needed to go.

Many might remember my surprise breakfast with Judy Faulkner at the CHIME Forum. From my personal experience, Judy is not the black widow that I’ve heard many portray her to be. In fact, I found her incredibly thoughtful, caring, and really interested in quality patient care. That’s why I hope Judy will see that she’s sitting on an opportunity to do so much more than she’s doing now. Although, it will take a shift in her understanding of what it means to be an open EHR. Right now it seems her mostly unfounded fears won’t let her see the possibilities.

Epic Module Targets Patients For Care Coordination

At Gundersen Lutheran Health System, executives have put together a program to target the 1 to 2 percent of those most likely to be hospitalized, seen in the emergency department or face other complications. To manage the program, the La Crosse, Wis.-based system is leveraging a feature of their Epic EMR which sifts out the patients most in need of additional care coordination, reports Health Data Management.

Gundersen Lutheran is targeting complex patients with its program, but not just those with medically-complex conditions. They’re also hoping to find patients who, while they might have simpler conditions, live alone or have trouble following sometimes difficult medical care plans. The system is using the EMR first to identify the patients, then to treat them, according to Health Data Management.

To find patients in need of extra care coordination services, Gundersen is using a “tiered scoring” module built in to the Epic platform which includes one component for medical complexity and another to measure psycho-social issues. When clinicians want to refer a patient to the care coordination program, physicians use the Epic scoring tool to see if the patient qualifies. Clinicians can also notify the care coordination team using the Epic system, in three clicks or less, noted Beth Smith, R.N., executive director of patient and family-centered care at the health system.

The patients identified by the scoring model as in need of extra care coordination are farmed out to a group of 22 nurses and social workers, whose job it is to monitor the care of these complex patients who are more likely to face adverse events.

The workload the care coordinators face is intense. Typically, care managers are supervising some 1,700 patients each, who not only stay in touch with patients but also attend office visits and follow through with specialists. Epic plays a role here too, however. Care coordinators get a special tab in the Epic EMR which pulls key elements of the patient’s history into a single view, making it easier to get a sense of the whole patient. Epic also notifies them via a message in the system if a patient shows up in the ED.

According to Health Data Management, this program has helped stabilize hypertensive and diabetic patients, with just under half showing sustained improvements over a two-year period.

Cleveland Clinic Brings Epic Smarts To NY Hospital Practices

The Cleveland Clinic is going the consulting route, this time around by working with the physician and specialty practices for a New York hospital to bring Epic up to speed.

Glens Falls is a 410-bed nonprofit which began implementing the Epic EMR in early 2012. The New York facility has 3,000 employees and 28 regional locations.

Apparently dissatisfied with its internal knowledge base on the subject, It’s now contracted with the Clinic’s MyPractice Healthcare Solutions (MPHS) to help deploy and optimize its rollout, reports the Cleveland Plain Dealer.

Among the Epic products installed at Glens Falls is “MyChart,” offering a clinical and billing records portal for patients, according to the Plain Dealer.

The Cleveland Clinic has had Epic in place for more than 10 years, making it one of the first healthcare systems in the country to install the vendor’s product. Having learned from that experience, Cleveland Clinic MPHS now brings project management and implementation expertise to other facilities.

I think this is an interesting business model for the Cleveland Clinic, and I’d be curious to see what other consulting agreements it has put into place. (So far I wasn’t able to turn up any others but my guess is that they exist.)

It seems to me that hospitals who have tamed Epic — Kaiser Permanente comes to mind — might very well go into this line of business, as the need is great. Not to mention that if I were making a decision as to who I’d hire to wire my medical practice into my hospital, a successful institution would have a very strong pitch to make.

Can any of you readers share other examples of hospitals/clinics who are turning their Epic experience into a consulting revenue stream?

Do Epic Customers Have EMR Stockholm Syndrome?

John’s Note: I guess Anne didn’t see my post about the EMR Stockholm Syndrome. I think she adds to the discussion with this post though.

According to a recent piece appearing in KevinMD.com, by next year an astonishing 40 percent the U.S. population will have their medical data stored in an Epic system. Heaven only knows how many billions of dollars of IT capital outlay that represents. What we can safely guess is that not a single customer making up that list failed to make painful sacrifices to bring Epic on board.

Having spent so much and worked so hard to get Epic up and running, you’d expect to hear at least some complaints from hospital C-suites about the ordeal of it all. And despite its popularity, you’d expect far more hospitals to blanch at the, uh, epic price tag on an Epic install and say “no thanks.” But instead, you see hospital leader after hospital leader speaking glowingly about Epic and choosing it over competitors time and time again.

As author Paul Levy notes (himself the former CEO of Beth Israel Deaconess Medical Center), Epic isn’t just expensive. It’s also something of a pain to work with:

* Epic has made a policy of not being interoperable with other EMRs, scuttling HIE plans that have become increasingly important to hospital business plans

* Epic decides when system upgrades are needed and changes to the EMR are needed

What Paul doesn’t mention, but is worth considering as well, is that Epic only gets installed if you work with teams of its relatively green staff members, hotshot types in their twenties who may be very smart are definitely on the arrogant side if reports I’ve heard are true.

So, if hospitals are still singing Epic’s praises after all of this stress and expense and letting a vendor dictate important aspects of its development roadmap, is the industry suffering from Stockholm Syndrome (a feeling of bonding with people who have captured you)? As Levy sees it, the answer seems to be yes. What do you think?

Epic EMR ROI

I think we are familiar with the HUGE institutions that have selected Epic. The most famous of these is the Kaiser implementation of Epic which started at $1.2 Billion and was projected to cost $4 Billion. Yes, that is Billion with a capital B for an EHR implementation. I haven’t done any in depth research on the average cost of an Epic installation, but I can’t remember seeing one lower than a few hundred million at the least.

As I consider these numbers, the following question keeps nagging at me: What’s the ROI for an Epic installation?

Don’t get me wrong. I already know about the many EMR benefits. Although, billions or even hundreds of millions of dollars is a lot of money to make up.

The problem is that covering the EMR space as long as I have, I have yet to see someone do a ROI analysis of an Epic installation. If there’s one out there that I don’t know about, I’d love to take a look. Maybe Epic has some, but it’s part of their tightly controlled process for selling their EHR. Although, if the ROI was so good, it makes you wonder why they wouldn’t want that information in the public domain.

A part of me wonders if hospital CIO’s really care about the ROI of an Epic EHR install. Epic seems to be similar to what enterprises use to say about IBM: “Nobody ever gets fired for buying IBM.” Do many hospital CIOs see it as “Nobody ever gets fired that buys Epic”?

Hospital System Builds EMR Buy-In Using Social Media

If you’re like most IT leaders, you’re used to leaving the social media efforts to your marketing department. But maybe you’re missing out. Here’s a nice example of how hospital CIOs can use social media to move EMR buy-in ahead using social media tools.

Just over a year ago, 24-hospital health system Texas Health Resources decided to promote the existence of its Epic EMR installation to a broad cross section of stakeholders, including employees, clinicians and the public at large. To do so, THR began making heavy use of social media tools.

First, the chain build a microsite promoting the EMR, which included videos explaining the benefits of the Epic system to key users such as doctors in urban practices. In many health systems, the effort might have stopped there, aside from perhaps an e-mail announcement or two.

In this case, however, system leaders like Ferdinand Velasco encouraged everyone involved to talk up the site — and the existence of the Epic EMR — across the social media universe. Dr. Velasco, vice president and chief medical information officer, personally recorded the videos on the microsite. THR then used Facebook, Twitter and YouTube to drive traffic to the microsite and other related information.

Velasco, who talked to Healthsystemcio.com about the project in October 2010, said that the idea was not to spend lots of money on a social media campaign, but rather, just to get the information out there. “I don’t recommend you spend a lot of time and effort putting a major production together,” he told the site. “This way, it allows you to organically as the need for information evolves and emerges through those interactions.”

Fast forward to today, and it seems THR’s social media efforts have borne fruit. According to one social media marketing publication, THR now ranks in the top 5 percent of all hospital systems in EMR adoption.

This may be, in part, because THR didn’t stop with using social media to broadcast the EMR’s existence. Since the microsite launch, execs have installed a private, behind-the-firewall social network tool to help move the in-house conversation forward.

Now, as the system brings the EMR to more hospitals, doctors are sharing information via the social network and helping their peers be successful, according to Business2Community.com.

Why Do People Dislike Epic So Much? Let Me Count The Ways

Man oh man, Epic is burning up the track. As my colleague John Lynn noted in a recent post, there are tons of reasons why it’s developed a near monopoly in some sectors, especially with large hospitals.

Founded in 1979 with an initial investment of $70,000, the company now is conservatively estimated by Wall Street analysts to be worth $1.2 billion (as of 2008), Lynn notes.

And there’s tons of reasons Epic is doing so well (facts courtesy of @DanMunro) including:

* Kent Gale, president of KLAS Enterprises, a research firm known in healthcare specifically for its customer surveys said “…there’s a huge gap between Epic and the other vendors. That is probably the biggest differentiator. They are able to keep their commitments better.”
* Epic ranked No. 1 in seven out of 20 categories in one of KLAS’ most recent survey (and they don’t sell products for several of the categories).
* Epic’s software enabled Kaiser, the country’s largest health system (outside of VA?), to confirm that Vioxx increased the risk of blood clots, leading to the prescription painkiller being pulled from the market.
* The company rarely negotiates on price. There is one exception: It has been known to give breaks, such as waiving its annual maintenance fee, to struggling hospitals.

But is that all there is to the story? I don’t think such complaints are enough to generate the resentment, heck, hatred you pick up out there sometimes regarding the EMR giant.

It can’t help that many users dislike the Epic interface and generally find the product to be a PITA to use. That doesn’t exactly generate good will.

The capper, really, may be the way Epic is handling its clout. CEO Judith Faulkner seems to be taking on an imperial attitude, doubtless because her company controls so many installations that it practically controls aspects of the entire US health reform process.

If you think that’s scary, consider the following. About six years ago, Geisinger Health System spent $35 million on an Epic Systems install. Not only after, during a pilot test of the software, the hospital’s psychiatric unit started to get wildly inconsistent and inappropriate medication orders. Apparently, the problem was an incompatibility between a commonly-used pharmacy database in place at Geisinger and the Epic system.

OK, just about any system can fail, and unfortunately, drug dosage problems are one of the many possible points of failure. That’s not what frightens me.

What had me reeling was a quote from a Business Week article written not long after the Geisinger debacle. When questioned, Faulkner didn’t apologize: she said, in essence, that it was Geisinger that was at fault for having the temerity to try and integrate Epic technology with existing systems. “It doesn’t work when you mix and match vendors,” Faulker told the magazine. “It has to be one system, or it can be dangerous for patients.”

Bear in mind that this was several years ago. I can only imagine that Faulker’s attitude has hardened since then, as her company’s market share and power has grown. Will her position — that using best-of-breed, integrated health IT products is a bad idea — push the entire industry in that direction? Perish the thought.

And that, my friends, is reason enough alone to reject Epic and all of its works, if you have the option. At minimum, a healthy dislike seems very much in order. But maybe I’m being too harsh. What do you think?

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Judy Calls Epic “Most Open System I Know”

Epic Module Targets Patients For Care Coordination

Cleveland Clinic Brings Epic Smarts To NY Hospital Practices

Do Epic Customers Have EMR Stockholm Syndrome?

Epic EMR ROI

Hospital System Builds EMR Buy-In Using Social Media

Why Do People Dislike Epic So Much? Let Me Count The Ways

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