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Is Epic Stifling Health IT Innovation?

Posted on April 30, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In many ways and definitely based on the buzz, Epic is at the top of the hospital EMR market. According to one estimate, about 40 percent of the U.S. population has its medical information stored in an Epic EMR, a stunning number given the level of competition in the hospital EMR space.

The question is, what impact is that having on the EMR marketplace?  According to one piece posted this week by Medical Economics,  Epic may be stifling health IT innovation due to its nearly-unassailable market lead.

As readers probably know, Epic has established an empire built around antiquated technology (MUMPS), which essentially forces any company that hopes to interoperate to bear its MUMPS core in mind. We’re talking the blunted edge here.

Perhaps more importantly, now that Epic has such a dominant market share, if it chooses to keep a closed system in place, customers will only get what innovations are driven internally by Epic.  If hospitals want innovations emerging outside the Epic bubble, they’ll have to consider the staggering costs — in some cases in the hundreds of millions of dollars — of switching outright to another vendor. If that doesn’t stifle innovation I don’t know what does.

This situation hasn’t been lost on healthcare industry leaders, some of whom have begun to balk at Epic’s rise, Medical Economics reports.

As the piece notes, Epic has attracted outspoken critics that question whether Epic’s’ market dominance is bad for the health IT world as a whole. One of those critics is Paul Levy, former CEO of Beth Israel Deaconess Medical Center, who has taken shots at the EMR giant from his “Not Running A Hospital” blog.

Levy, who Medical Economics cites as one of Epic’s toughest opponents, has been known to compare customers’ relationship with Epic to Stockholm Syndrome, a condition occurring when hostages begin to sympathize and identify with their captors.

All that being said, at the  moment, there’s little critics can do to change Epic’s business practices or development plans. Perhaps the Federal Trade Commission will step in at some point if it appears to staff there that Epic’s market control is anti-competitive.   In the mean time, though, Epic seems to have a lock on the hospital marketplace — and a disproportionate role in shaping the future of EMRs generally.

Do Epic Customers Have EMR Stockholm Syndrome?

Posted on December 12, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

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?

Does the Stockholm Syndrome Apply to EMRs?

Posted on November 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Paul Levy wrote an interesting post comparing Stockholm Syndrome to EMR software. For those who aren’t familiar with it, here’s a description of Stockholm Syndrome:

Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.

Paul Levy makes the case for EMRs being similar to the Stockholm Syndrome based on Epic’s decisions to not integrate with other medical record systems and some of the controlling tactics that Epic uses with its customers. They are interesting and it’s amazing what a hospital CIO will put up with from an EMR company like Epic.

I’d take this idea one step further. I’ve recently heard a number of people ask the question, “Is Epic really that good or is it just the best of the worst?” Doesn’t this sound a lot like the Stockholm Syndrome? Basically defending something that really isn’t all that great, just because it was better that the bad treatment they got from other EMR vendors before.

Paul Levy describes the myth that he thinks is why we are where we are today:

It is a widely accepted myth that medicine requires complex, highly specialized information-technology (IT) systems. This myth continues to justify soaring IT costs, burdensome physician workloads, and stagnation in innovation — while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their “civilian” life.

We believe that EHR vendors propagate the myth that health IT is qualitatively different from industrial and consumer products in order to protect their prices and market share and block new entrants. In reality, diverse functionality needn’t reside within single EHR systems, and there’s a clear path toward better, safer, cheaper, and nimbler tools for managing health care’s complex tasks.

The two killer points for me are the “stagnation in innovation” and the “functionally decades behind” comments. Those who argue against these things usually use a few specific cases of advancement and innovation as opposed to the industry as a whole.

I’d suggest that one of the biggest impediments to innovation is the barriers to entry for a startup company. How many hospitals do you know that would buy software from a startup company? It’s pretty rare. Yet, this is where the very best innovation comes from in other industries.

I still think that there will be opportunities for some startup companies to come along and disrupt the current EHR providers. Epic did it to Meditech in many ways, and I’m sure we’ll see another come along and do the same. However, I think the number of people that can do this is limited to a very small group of people thanks to the way healthcare is organized and done in hospitals. This lack of access leads to a lack of innovation.