Could Epic End Up The Victim Of Its Own EMR Success?

Here’s a recap of a really useful post  laying out why Epic has, and can’t afford to let go of, total control of  the large-hospital EMR market.

Interestingly enough, the post appeared in Lab Soft News, which is published by the Pathology Education Consortium. (Let’s take a wild guess and assume that PEC isn’t too pleased by Epic’s stranglehold on hospital EMR business, which doesn’t give its pathology information systems supporters much wiggle room.) But I digress…

In essence, the post makes three key points:

*  Epic is implemented, or soon will be, in virtually every large U.S. hospital

*  Epic keeps very close control of how its system is implemented and developed in an effort to control performance

*   Given this desire for control, Epic isn’t likely to let other vendors create software to interoperate with its EMR

If the Lab Soft News author has his facts right, Epic isn’t just acting like a monopolist, it actually can’t afford to let any other vendors play in its sandbox at this point. In fact, the Wisconsin giant has basically painted itself into a corner.

As part of its winning sales pitch, Epic apparently guarantees that it will singlehandedly give a hospital all of the EMR functionality it needs. Under these circumstances, letting other vendors extend its platform would never do, as any system requiring additional integration doesn’t offer the “turnkey system” feeling Epic offers.

My instinct is that this situation will backfire on Epic.  I’ve always believed that software firms benefit from working closely with development partners — or even by simply allowing others to extend its functions.

No matter how brilliant a company’s engineers are, and I’m sure Epic’s are top-notch, it can benefit from the ideas and energy that comes from creating compatible applications. In fact, I’d go so far as to say that if an enterprise software house like Epic is too inward-looking, it will inevitably deteriorate simply due to the lack of fresh air.

But that’s just my take. What do you think?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


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  • I just commented at the original post before seeing this one. I totally agree. The direction of health IT is moving toward more open systems, more flexibility – not less. When you have a vendor responding to interoperability needs with, “It doesn’t work when you mix and match vendors,” ( instead of accommodating a more flexible environment, this isn’t in anyone’s best interest but the vendor’s. I realize that comment was made at the time in regard to assuring patient safety, but facilities need to have the ability to maintain that assurance without giving up flexibility and efficiency. No one system can or should be the be-all and end-all for everyone. Technology has come a long way, generally and in health IT. Enterprise EHR systems that can easily interface with partnering vendors and that enable integration of some of the new innovative applications coming down the pike will be the ones to succeed, in my opinion. If Lab Soft News’ info is right, then I agree, it certainly doesn’t seem like Epic can sustain its success under its current strategy.

  • I am the author of the Lab Soft News piece quoted above. As you correctly surmise, I am not happy with the stranglehold that Epic now commands over the high-end EMR market. I have been active in the LIS world for nearly 30 years. About every 10-15 years, there has been a major shift in the leading LIS vendors for reasons that I don’t have space to explain here. I think that the EMR/EHR market has behaved, and will behave, in a similar fashion. Some upstart company will soon start to pick away at the Epic position, perhaps with a more open architecture and based on more modern code. Don’t expect any innovations from the current incumbent EMR/EHR companies.

  • Although they occupy most hospital’s EMR, the actual EMR, Epic, is completely outdated, poorly designed (user interface horrendously designed), inefficient, and hence detrimental to patient care.

    They will now give you a disclaimer saying that you (the physician) will be LESS efficient.

    I find this unacceptable and most industries would not accept this kind of performance.

    But I am sure that out of the hundreds of startups in this arena, one will create a design both front end and back end (using a Hadoop database or similar, Oracle is too expensive) that will actually make health care delivery more efficient. Most importantly, it will be priced cheaply or even free (without ads). This happened in multiple other industries, one that comes to mind: Netflix destroying Blockbuster and Hollywoods.

  • Having heard a powerful CIO talk about how the EPIC code was written in the 1970s, it will be interesting to see what happens to the enchanted castle in Madison.

    Startups are always a good way for the big companies to remember those early days of innovation. Startups can create features and efficiencies the “big guys” have not thought of or simply forgotten in the quest for growth & marketshare.

    Brian…that article was written by someone from the Heritage Foundation. Need we say more?

  • I worked on an EHR system that was installed by British Columbia at all hospitals, clinics and doctor offices in the province. It was based on an existing EHR (actually called an MIE when it was first installed) operating among a group of hospitals in Manhattan. It is programmed in open source Java and has all the bells and whistles. This was circa 2007 when the decision was made by the province. It might be interesting to see why they didn’t choose Epic, and the extent to which Epic is or isn’t used in Canada.

  • I disagree that Epic is “painting itself into a corner”. I am a former Epic employee and now an Epic consultant and know the inside story better than many. Epic is paying a lot of attention to interoperability and interested in working with other vendors.
    Also I don’t see open source software thriving in Healthcare in the long run. Might work in other industries but Healthcare is a totally different beast and healthcare execs think very differently. Their #1 concern is physician adoption and that’s why they prefer well established vendors with proven success.

  • AA, I have to disagree with you regarding healthcare and open source. If healthcare execs are that concerned with physician adoption, they might want to chat with my friend the ED doc — and he’ll tell you just how unfriendly established vendor products can be. His experience with Cerner has been so bad that he dreads the idea of using any other EMR. Are you contending that open source products are by definition less usable than any product from a high-profile vendor?

  • MD Coder commented that “Epic, is completely outdated, poorly designed (user interface horrendously designed), inefficient, and hence detrimental to patient care.”

    This is a vast understatement. From this post one might infer that, at one time, EPIC might have been up to date. I have been forced, as a clinician, to use EPIC as an EHR in clinic for about 6 weeks. EPIC would have been bad software in the 1970s, but in 2012, it is about 5 standard deviations worse than terrible. EPIC is certainly one of the 5 worst commercial software user interfaces ever, and, considering the hours of “training” and hours of use that I have put in, may even have a lock on the number one worst user interface for commercial software, ever. It is incredible how bad the navigation and functionality are. And buggy! As someone who sat through a lot of statistics courses, I would say that a user interface this bad could not possibly occur by chance alone.

  • Innovation is fostered by a broad base of contribution. Epic, by definition, is restricting this facet of growth and change. The interesting factor is that an integrated and functional EMR is not appreciably reducing the cost of delivering care. There are definite advances in the quality of a patient’s record as well as the care patients receive in hospitals. Unfortunately, the effort nurses and docs expend to overcome the inefficiencies of trying to practice the care they were trained to deliver is not going down. As a result, there appears to be a significant pool of professionals who still feel frustrated about the difficulty they experience working with the Epic system on a day to day basis.

    When one element of a healthcare enterprise, in Epic’s case the EMR, limits innovation, it slows down progress for the whole system. It is nothing more than basic constraint theory at work.

    The good news is, as has been stated by others replying to this post, Epic’s success will be self limiting. It was for IBM and other historic monopolistic ventures. If you consider what has happened to Microsoft’s loss of it’s almost absolute monopoly…, a change in Epics stature is only a matter of time.

    No one can deny that Epic has significantly advanced our expectations of the value and EMR should provide.

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