Epic or Best-of-Breed? The Billion-Dollar Question

Ah, the Judy Faulkner stories. They’re beginning to be as numerous, and, uh, epic as those of Microsoft and Apple’s early days.  Imagine the average-looking, middle-aged Faulkner — Epic’s CEO, of course — walking into a room of hospital CIOs and telling them she’d come “to decide who she wanted as customers.”  Kinda makes you want to admire Faulkner even if you don’t.

But more importantly, such behavior brings up the question of whether Epic brings enough to the table to make such grandstanding tolerable.  As Zina Moukheiber, a Forbes contributor, notes in a recent article, Epic has certainly convinced a lot of CIOs that the answer is yes, largely because it offers a single ecosystem hospitals can deploy across the enterprise.

But like myself, Moukheiber seems very skeptical that Epic has justified its astronomical prices, which include:

* Partners HealthCare and Duke University Health System, $700 million each
* University of California, San Francisco, $150 million
* Dartmouth-Hitchcock Medical Center, $80 million

I’d also drop in a casual mention of Kaiser Permanente’s Epic installation, which allegedly hit $4 billion-ish before it was done.

Of course, the issue isn’t merely whether Epic is expensive, but whether it gets the job done in a way which can’t be done by less expensive systems.  That, clearly, is the billion-dollar question.

In response, Moukheiber notes that in a recent New England Journal of Medicine piece, published earlier this month, two Boston Children’s Hospital Physicians argue that “diverse functionality needn’t reside within single EHR systems.”  Children’s uses Cerner, Epic and best of breed software as needed.

Yes, that’s  the heart of the matter, isn’t it. If you believe that there’s less risk and more chance of success implementing one system — thinking embraced by many hospital boards — Epic is likely to be a smash.

But if you’re a best-of-breed CIO, you’re probably astonished that anyone trusts their whole enterprise to a single vendor. Honestly, I am too.

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.


  • Does anyone here have an opinion on whether EPIC does get the job done? Does it provide an EHR that meets Federal needs, works and plays well with HIE with other systems, and truly unites EHR for an entire hospital/hospital system? And perhaps the attached medical groups?

  • Would you hire a construction firm to design fine jewelry?

    If you want a huge document repository available from anywhere, epic is fine.

    If you want an EHR that improves patient care, while decreasing cost and workload, you need specialty specific interfaces and decision support. Epic thinks one size fits all and that a pediatrician and a neurosurgeon need the same interface. Epic also has very little useful clinical decision support.

    You don’t need to be a brain surgeon to know this ain’t gonna work.

    Buy epic or any EHR the government supports and watch productivity fall. Why are we tolerating this?

  • “Epic also has very little useful clinical decision support.”

    There’s the understatement of the century.

  • Epic is not an (expensive) miricle in a box. just like any other EMR it is going to take a great deal of work to provision it to your hospitals needs. Software developers are not so dense as to think that a neurosurgeon and a pediatrician have the same needs, so they try to develop software that can be crafted to different needs. some of the problem is after making such a huge initial investment in the out of the box products, many are loathe to make any additional investment.

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