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.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

11 Comments

  • Being personable does not make you not a ‘black widow.’ And believing that she doesn’t understand an open system strains credulity. Epic is in business for Epic, not to promote innovation by niche EHR’s. They’re also a favored contractor with the current admin, so really, they don’t need more good press.

  • Matt,
    There were other things she did beyond just being personable. In fact, I’m not sure I’d call her personable. She’s an introvert for sure, but she definitely cares about the patients than many believe.

    I don’t even see Epic being open as promoting innovative niche EHRs. I see it as enabling a whole slew of add on auxiliary vendors that will make the Epic EHR better. That’s what I think they’re missing with being so closed.

    The sharing EHR data where it needs to be when it needs to be there is just the right thing to do regardless of business, but I think that will benefit the Epic business as well.

  • John, i disagree with your assertion that Judy doesn’t understand open APIs. She’s been a programmer for 30+ years. Instead, I think that assertion was simply media manipulation on her part. Props to her, she knows how to work the press.

    As an entrepreneur working on a healthcare IT startup that deals with EHR integration, I cannot disagree more with her comments that Epic is the most open system on the market. I’ve spoken with dozens of doctors using different Epic installations around the country and they emphatically disagree. Open doesn’t mean configurable, it means having an API and publicly accessible documentation. I’ve been digging through Athena’s and Greenway’s marketplaces, and they are far less open than they promote.

  • Kyle,
    She was a programmer 30 years ago. How long has it been since she’s been a hard core programmer? When I met her I wasn’t impressed with her understanding of the technical side. In fact, I was told by a former Epic programmer that Carl does pretty much all the work with the program now. Have you had other experiences with Judy that would indicate that she’s up on the latest in APIs?

    We’re on the same page with your second paragraph. Even your last sentence is why I say that Judy can’t really look to anyone in healthcare to see how a real open API works. No one is really open yet. I’d love to see the day that it is.

  • Whether other people or companies can easily develop apps for Epic systems overlooks the elephant in the room: Epic systems and most EHRs ensure institutions control patient data, preventing patients from exercising their strong rights to control who can can see and use their sensitive PHI under state and federal laws, medical ethics, common and tort law, etc, etc. Every study for 20 years shows the public expects control over PHI. See: http://tiny.cc/di97ww

    Health information is an extremely valuable personal asset. Would you stand for a financial system if businesses/banks that hold your funds decided when, how much, and to whom your money is sent? Americans do not want a world where they have no ability to control their most sensitive personal data, the fuel for the destructive US surveillance economy.

    If Americans want apps like SnapChat that empower them to decide who sees personal data (“single use”, point-to-point control over data), and control the destruction of that data (the “right to be forgotten”–how do you think they will react to health IT systems that prevent them from even having a “chain of custody” over their PHI? There is NO data map that tracks all the hidden users and resellers of PHI. (Latanya Sweeney will demonstrate a first version of a health data map at the 3rd International Summit on the Future of Health Privacy June 5-6 in DC.) http://www.healthprivacysummit.org

    Despite her billions she made the decision NOT to build systems that comply with Americans’ strong rights to control personal health information.

    It’s a curious decision for someone with the resources to build trustworthy technology systems. Patients are the ONLY “stakeholders” who can legally, easily, and cheaply move/exchange health data—because it’s their data, no contracts, DURSA’s, etc, are needed.

    Why would someone with the resources to build systems that patients could trust decide not to do it?

    Judy, Epic, and all the vendors that sell to large institutions may rule today, but future of the US healthcare IS individual control of personal data.

  • John,

    I am sure you had a thoughtful chat with Judy, but trust me, it was calculated. Everything they do at the top there is. While you will find her to be an expert on HIT, you’ll also find she’s an expert at SPIN. I sat in meetings with her and heard her say to the exec team, that we had to fight sharing data (even with CCD standards) because it takes away Epic’s competitive advantage, or “hill to stand on.” It’s funny she uses that analogy given the “glass house on a hill” cliche we’re all too familiar with. This has led to some big price tags for non-Epic data exchange, but I suppose we should be thankful she’s agreed to share at all. That took customers and a big government stick, to change.

    Don’t pick up the stones she’s handing you and giving them credibility by lobbing them over to us without deeper context. Do more reframing, like you did with her patient share statistic. There are great stories to be written.

    FormerEpic

  • Care2x once had a sub-project, in 2004, called HXP (http://hxp.sourceforge.net/); for those who remember.

    How about thinking on reopen “The Really Open System” ideia?

    For me, an Open System also means:

    1. no vendor locking
    2. Open Public Patented protocol (or no patent whatsoever)
    3. Specifications and some server software licensed under a GNU compatible license
    3. Really distributed (i.e. no central entity delivering all traffic)

  • While it is easy and appropriate to lament how “closed” Epic is, the fact is Epic is no worse, and in some cases, better than a number of others. Ever tried to work with Meditech or McKesson to do any kind of integration with another system? Virtually impossible without the aid of someone who has experience developing with those systems. None of the big players have anything that approaches an open API. And it’s all for the same reason. They want to protect their markets. Simple as that. It’s the same mistake Apple made in its early days and which Microsoft figured out early on. But none of the big healthcare IT players have figured it out yet.

  • Kevin,
    I agree for the most part. Although at least the others are talking about opening up. Epic is talking about why they aren’t and in denial about being open when they’re not.

    Does your company have an API?

  • Epic will never open up it’s system – how can they continue to charge their prices if the system is open for all to see and make work better? Like it or not, Epic is based on the old MUMPS system from the -70’s-. Faulkner appears to have known a little bit at one point in time about databases, and through a bit of serendipity and an understanding of how software licensing works (a la the Microsoft model) has built one major success (Kaiser Permanente) into a huge corporation. For her to even pretend that Epic is an ‘open’ system goes beyond laughable straight into the realm of outright duplicitous. Faulkner clearly understands that the only way to keep prices high, and keep people locked into support contracts is to make sure to obfuscate and to ensure that no one is allowed to work on the systems except those that Epic deems worthy (read: those we can make money off of and control because they are directly or indirectly employed by us).

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