The Billionaire Who Controls Your Medical Records (2021)(forbes.com)
forbes.com
The Billionaire Who Controls Your Medical Records (2021)
https://www.forbes.com/sites/katiejennings/2021/04/08/billionaire-judy-faulkner-epic-systems/
57 comments
It really is. And it's not good software. The UI looks decidedly amateur, and some of the modules are absolute garbage amateur hour (one I see a lot in my job is the ED track board, which captures information from the ED charge nurse about incoming ambulances, bed holds and cleaning needs, and gives a picture on what the ED might look like in the next hour or so).
It looks like a VB app from the 90s. Text layout is poor, often overflowing boxes, it's not customizable.
Epic is where it is because hospitals are so fucking locked in.
It looks like a VB app from the 90s. Text layout is poor, often overflowing boxes, it's not customizable.
Epic is where it is because hospitals are so fucking locked in.
Epic was a 10m+ loc vb6 app in the 90s.
That said, lots of the problems with Epic is it is used so differently between hospitals/installs. It's less a EMR + scheduler + hospital management app than a toolkit used to construct those for big enough medical companies. That inevitably doesn't lead to nice software: see all enterprise software everywhere.
That said, lots of the problems with Epic is it is used so differently between hospitals/installs. It's less a EMR + scheduler + hospital management app than a toolkit used to construct those for big enough medical companies. That inevitably doesn't lead to nice software: see all enterprise software everywhere.
No, it’s because they don’t pay for another HL7 interface. I am network admin for hospitals and see it daily. We use Meditech anyways, not even close to everyone uses Epic.
It’s total shit.
I’m rooting for something like this in the long term: https://github.com/openemr/openemr
I’m rooting for something like this in the long term: https://github.com/openemr/openemr
I love the idea of OpenEMR.
I desperately want it to gain some real traction.
Working in the enterprise world, including the enterprise healthcare world... it's not "right", but as long as it exists as a PHP webapp...
I don't see that happening. No matter how good a PHP webapp it is.
I really want it to succeed. But there is so much further to go. For example, on the subject of backing up your EMR data, there is this:
> Disaster can strike at anytime. Backing up will mean the difference between a mild inconvenience and a major imbroglio.
> Choose a method according to the operating system from this webpage.
> Windows users are advised not to rely on the built-in utility once their file size becomes too large. The reasons are discussed in this Forum thread.
That's it?? That's the extent of your backup discussion for a business critical application storing PHI? Oof.
Any CIO remotely considering OpenEMR, even one hugely cost-constrained, is going to run for the hills.
I desperately want it to gain some real traction.
Working in the enterprise world, including the enterprise healthcare world... it's not "right", but as long as it exists as a PHP webapp...
I don't see that happening. No matter how good a PHP webapp it is.
I really want it to succeed. But there is so much further to go. For example, on the subject of backing up your EMR data, there is this:
> Disaster can strike at anytime. Backing up will mean the difference between a mild inconvenience and a major imbroglio.
> Choose a method according to the operating system from this webpage.
> Windows users are advised not to rely on the built-in utility once their file size becomes too large. The reasons are discussed in this Forum thread.
That's it?? That's the extent of your backup discussion for a business critical application storing PHI? Oof.
Any CIO remotely considering OpenEMR, even one hugely cost-constrained, is going to run for the hills.
This is not universally true, but I don’t know where your family works or in what capacity. There are a lot of issues with epic but unfortunately it is the best out of all the garbage out there. Out of all the EMR’s I have used, Epic is the easiest to share information both within different hospitals using epic and sharing from epic to other emrs like Cerner. Source: Am physician who has worked in many different hospitals, and use Cerner currently, grabbing info from Epic most days.
FWIW, two separate deployments of Epic done in the last 15 years at two hospitals, from the perspective of folks working in the pharmacy.
In the last five years, it’s gotten a lot better. But I could see before then things are still pretty bad even with epic.
Yeah, I'm starting to see records from different medical organizations showing up in each other's EPIC MyChart logins. Not terrible!
My wife is dealing with cancer and associated complications at three distinct hospitals and a national cancer center.
The two hospitals on Epic are great - all of her records are immediately exchanged. The third hospital has a shitty cerner system and has problems sharing between departments. The cancer center has an excellent patient portal but doesn’t integrate.
Ultimately these problems are difficult as the creation of Medicare and Medicaid happened during the early days of computing. So we’re stuck with 75 years of legacy.
The two hospitals on Epic are great - all of her records are immediately exchanged. The third hospital has a shitty cerner system and has problems sharing between departments. The cancer center has an excellent patient portal but doesn’t integrate.
Ultimately these problems are difficult as the creation of Medicare and Medicaid happened during the early days of computing. So we’re stuck with 75 years of legacy.
Sorry to hear about your wife's health issues, I hope she's on the mend.
I had a similar experience when dealing with my chronic condition. Had to interact with almost a dozen different health portals, a couple of which were ok, the rest were awful.
I'm a software engineer, so I ended up creating my Personal Health Record (PHR) application, which I eventually open-sourced - https://github.com/fastenhealth/fasten-onprem
It's still a work in progress (and definitely not ready to be used as the primary source-of-truth), but I'm always looking for actionable feedback/contributors. I'd love to hear your thoughts
I'm a software engineer, so I ended up creating my Personal Health Record (PHR) application, which I eventually open-sourced - https://github.com/fastenhealth/fasten-onprem
It's still a work in progress (and definitely not ready to be used as the primary source-of-truth), but I'm always looking for actionable feedback/contributors. I'd love to hear your thoughts
I’m sorry, that’s terrible. Best wishes to her and your whole family.
On the contrary: when I moved from Kaiser to Sutter, it was a single push-button to move my entire EHR over (once I consented to the doctor). The doctor told me it's generally that easy when you have two Epic instances (note: I'm not directly denying what you say, because I know enough about Epic and EHRs to be suprised at my doctor's ease).
"Open, simple, interoperable formats are the way out. We need more of these, especially in the health care sector."
We're getting there quickly with FHIR!
We're getting there quickly with FHIR!
I've been working on my own Open-Source Personal Health Record (PHR) that leverages FHIR & Smart-on-FHIR https://github.com/fastenhealth/fasten-onprem
Hopefully with the Cures Act Final Rule, interoperability will become the norm
Hopefully with the Cures Act Final Rule, interoperability will become the norm
True facts.
Source - I design medical devices
Source - I design medical devices
pajushi(5)
You can't just blame to tools for annoying hospital policy, but similarly to https://chrisgagne.com/1255/mary-poppendiecks-the-tyranny-of... there's a nasty feedback loop that the provisioning of software for administration and tracking (vs direct use as tools) unlocks and enhance.
The perceived ability to have more detailed documents means all the effort goes into the detail of the documents and, with finite effort (or at least finite amount the higher-ups are willing to spend on individual contributors to give them more time to do things), more effort is spent on record-keeping than on the actual job.
Now that you have more record-keeping you can dig into "stats" and "trends" etc that may not have any statistical significance at the level you're inspecting them, but are suddenly much more visible, and pushes you towards tinkering with the process instead of the what of the work.
And then that slows down the doing, which makes you more interested in tracking and improving the process, repeat repeat repeat.
The perceived ability to have more detailed documents means all the effort goes into the detail of the documents and, with finite effort (or at least finite amount the higher-ups are willing to spend on individual contributors to give them more time to do things), more effort is spent on record-keeping than on the actual job.
Now that you have more record-keeping you can dig into "stats" and "trends" etc that may not have any statistical significance at the level you're inspecting them, but are suddenly much more visible, and pushes you towards tinkering with the process instead of the what of the work.
And then that slows down the doing, which makes you more interested in tracking and improving the process, repeat repeat repeat.
Hospital documentation (charting) policies are driven mainly by payer coverage rules and government care quality metrics. Administrator desire for stats and trends is much less of a factor.
There is a huge amount of waste and inefficiency in most provider organizations so any attempts at process improvement should be encouraged. As the industry moves toward value-based care reimbursement models there will be more financial incentives to do so.
There is a huge amount of waste and inefficiency in most provider organizations so any attempts at process improvement should be encouraged. As the industry moves toward value-based care reimbursement models there will be more financial incentives to do so.
If not for computers and software would those coverage rules and metrics have evolved to the same level of detail?
And then how do you keep insurance payers from considering things like "spent more than 5 minutes with a patient" that aren't "necessary" in the large majority of cases as "waste and inefficiency"?
And then how do you keep insurance payers from considering things like "spent more than 5 minutes with a patient" that aren't "necessary" in the large majority of cases as "waste and inefficiency"?
I always wondered why so many hospitals adopted EPIC, it's got the worst UI I've ever seen. This article provides insight to complete the picture: network effects, and lock-in.
It's likely resulted in many deaths. When my friend worked ER, any time Epic went down, they simply switched back to paper forms, the ER waiting room would empty within a few hours. EPIC is, in my opinion, a large fraction of why ER waiting rooms are always full these days.
Between Epic and HIPPA privacy rule[1], the effectiveness of emergency care in the US can only spiral downward. You're forced to slow down(because of EPIC) and fill out a bunch of online forms before you can let a patient go, filling the ER.
Then you're not allowed to follow up on patients and complete the feedback loop of care, because they're no longer an ER patient, and you're not allowed to inquire any more.
[1] https://en.wikipedia.org/wiki/Health_Insurance_Portability_a...
It's likely resulted in many deaths. When my friend worked ER, any time Epic went down, they simply switched back to paper forms, the ER waiting room would empty within a few hours. EPIC is, in my opinion, a large fraction of why ER waiting rooms are always full these days.
Between Epic and HIPPA privacy rule[1], the effectiveness of emergency care in the US can only spiral downward. You're forced to slow down(because of EPIC) and fill out a bunch of online forms before you can let a patient go, filling the ER.
Then you're not allowed to follow up on patients and complete the feedback loop of care, because they're no longer an ER patient, and you're not allowed to inquire any more.
[1] https://en.wikipedia.org/wiki/Health_Insurance_Portability_a...
That may be because when something like Epic or PACS (or other tier 1 systems, or the network/data center/power/etc) is down longer than X time the hospital will go into diversion, meaning as many ED patients as possible are diverted to a different nearby hospital.
And paper workflows can be fast in the moment but cause absolute chaos for cleaning up, reconciliation, and moving data between departments.
Source: Worked with many hospitals, including ones with Epic.
And paper workflows can be fast in the moment but cause absolute chaos for cleaning up, reconciliation, and moving data between departments.
Source: Worked with many hospitals, including ones with Epic.
> Then you're not allowed to follow up on patients and complete the feedback loop of care, because they're no longer an ER patient, and you're not allowed to inquire any more.
This is factually incorrect. Healthcare providers are allowed to share information about the specifics of care provided to a patient, and, crucially, they are allowed to do so, within limitations, without the explicit consent of the patient (many practices will have you sign consent paperwork for CYA).
It does not require a responding provider to share information upon request with other providers, but they absolutely are allowed to do so.
To be very clear:
> Yes. The Privacy Rule allows covered health care providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so.
Source: https://www.hhs.gov/hipaa/for-professionals/faq/482/does-hip...
This is factually incorrect. Healthcare providers are allowed to share information about the specifics of care provided to a patient, and, crucially, they are allowed to do so, within limitations, without the explicit consent of the patient (many practices will have you sign consent paperwork for CYA).
It does not require a responding provider to share information upon request with other providers, but they absolutely are allowed to do so.
To be very clear:
> Yes. The Privacy Rule allows covered health care providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so.
Source: https://www.hhs.gov/hipaa/for-professionals/faq/482/does-hip...
That may be what the law allows, but it wasn't what the hospital in question allowed.
Maybe, but you said "Between EPIC and the HIPAA privacy rule..."
[deleted]
You’re going to have to explain how HIPPA privacy slows things down because, frankly, it’s one of the most important privacy laws for citizens I can can think of.
It's not HIPPA, as others have stated HIPPA does not require that your software sucks. It just requires that it doesn't leak sensitive (or any) personal healthcare information.
Source - I design medical devices that are HIPPA compliant and our software does not suck.
Source - I design medical devices that are HIPPA compliant and our software does not suck.
That is simply misinformation. HIPAA rules do not prevent healthcare providers from following up with patients. You should read the actual HIPAA final rule.
And Larry Ellison’s Oracle now owns Cerner.
Epic failure to have no mention of THE https://en.wikipedia.org/wiki/MUMPS
Edit: see #Users ⇣
Edit: see #Users ⇣
The key to making money: find something with extreme regulatory capture.
There is actually not much regulatory capture in the EHR market. The FDA doesn't classify most of those products as regulated medical devices. Provider organizations are required to implement certain open interoperability standards so that authorized parties can securely access patient charts so they are unlikely to buy an EHR without those features. But the required APIs are fairly easy for any competent engineering team to build, and there are open source libraries like HAPI FHIR which already get you halfway there.
https://www.healthit.gov/topic/oncs-cures-act-final-rule
The real barrier to entry is relationships. Epic has made huge investments in direct sales and consulting services to give the decision makers in large provider organizations exactly what they want.
https://www.healthit.gov/topic/oncs-cures-act-final-rule
The real barrier to entry is relationships. Epic has made huge investments in direct sales and consulting services to give the decision makers in large provider organizations exactly what they want.
> huge investments in direct sales and consulting services
Ever been to the Epic campus? It's literally like Disneyland - they have a whole section that is entirely made up like Alice in Wonderland: https://www.nytimes.com/2018/12/20/business/epic-systems-cam...
They also wanted to build tunnels into the facility that were too low for the local fire department's trucks to get through, so they just... bought them all new trucks that were shorter.
That's where your medical dollars are going folks...
Ever been to the Epic campus? It's literally like Disneyland - they have a whole section that is entirely made up like Alice in Wonderland: https://www.nytimes.com/2018/12/20/business/epic-systems-cam...
They also wanted to build tunnels into the facility that were too low for the local fire department's trucks to get through, so they just... bought them all new trucks that were shorter.
That's where your medical dollars are going folks...
Alt link: https://archive.ph/PSQL4
Jeez, these people are like the supervillains of mundane Kafkaesque bureaucratic evil.
Jeez, these people are like the supervillains of mundane Kafkaesque bureaucratic evil.
In a grand fit of irony, https://open.epic.com/Home/InteroperabilityGuide
Look at your options for "Who are you?"
Look at your options for "Who are you?"
HN discussion: https://news.ycombinator.com/item?id=18735023
Related, "Why Doctors Hate Their Computers" (2018), https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...
Related, "Why Doctors Hate Their Computers" (2018), https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...
I especially liked, "The company’s dress code is that when visitors are on campus, wear clothes."
What do you mean by huge investments?
The sales team is about 7 people. Only in recent years have they begrudgingly expanded their consulting wing - but hospitals IT teams manage the software themselves.
Mostly it is driven by the fact that as bad as people like to think Epic is... All the direct competitors are magnitudes worse.
The sales team is about 7 people. Only in recent years have they begrudgingly expanded their consulting wing - but hospitals IT teams manage the software themselves.
Mostly it is driven by the fact that as bad as people like to think Epic is... All the direct competitors are magnitudes worse.
Anyone want to take a serious stab at dethroning them?
I've designed medical devices for 20 years, many of which directly interfaced with and fed information to EPICS.
Email me at address in my bio if you're interested in starting an exploration party.
I've designed medical devices for 20 years, many of which directly interfaced with and fed information to EPICS.
Email me at address in my bio if you're interested in starting an exploration party.
Epic is the result of obamacare. Such terrible software would never see production in a market-driven environment. No one wanted it but the surveillance industrial complex control freaks.
Epic Systems was founded in 1979. The Affordable Care Act was passed in 2010, and the Health Insurance Marketplace — a market-driven system — opened in 2014. Epic is not the result of "Obamacare".
Also, Epic deals with medical records, while the ACA deals with health insurance. These are two separate domains.
Also, Epic deals with medical records, while the ACA deals with health insurance. These are two separate domains.
People had a fit over Windows in the 90's and 2000's being proprietary lock in, but it was never the OS that was the problem, it was MS Office format lock-in that caused all the issues, which is still a problem.
Open, simple, interoperable formats are the way out. We need more of these, especially in the health care sector.