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In my previous article on telehealth adoption due to COVID-19, I highlighted a number of telehealth adoption numbers that Epic shared. In the article, I asked the question about which telehealth applications these Epic customers were using. All of the Epic telehealth implementations I’d seen first hand were using Vidyo, but there were 15 telehealth providers in the Epic App Orchard (Note: Now there’s 16). I reached out to Epic to see if I could get the answer to the question of which telehealth applications Epic customers were using since Epic had supposedly “helped with the implementation.” However, I haven’t heard back from them. Not that this is any surprise since they only recently started engaging with the press at all.
A source of Healthcare IT Today recently reached out to let us know that Epic is working to develop their own Epic telehealth offering. The source told us that Epic was working with Twilio’s newly launched HIPAA compliant video application in order to offer their own telehealth solution within Epic. Word is that Epic has already started offering this solution to provider organizations and is an interesting move for Epic who’s largely touted the built in Verona approach to software development.
Let’s take a deeper look into what this move could mean. First, Epic would now be a competitor with 16 other telehealth organizations that are participating in Epic’s App Orchard. Imagine how it must feel to be one of these companies who now has Epic as a competitor. Those Epic App Orchard fees must really sting. Publicly they can’t really say anything about it, but no doubt privately they’ll be having a very different conversation. Plus, I’m sure many are wondering why Epic would go with Twilio that isn’t even part of Epic App Orchard instead of a company that had already committed to Epic. Granted, Twilio is quite different than those telehealth applications in Epic App Orchard.
However, it’s not hard to see how an application integrated by Epic is going to have a much deeper integration than any of the other telehealth applications in Epic App Orchard. That puts the Epic telehealth application at a distinct advantage. Although, this also illustrates how Epic could still do a lot more to open up APIs for their third party developers.
Whenever you create a third-party “app store”, there’s a challenging dance that has to be played with assuring members of your commitment to them as partners and allaying their fears that you’re not going to just become a competitor and take all the business away from them.
Assuming that Epic is creating their own telehealth solution, this will cause a lot of damage to Epic’s App Orchard efforts not only in the telehealth category, but for every other App Orchard partner. If Epic is willing to start competing with their third party partners in telehealth, then what’s to keep them from doing the same in all the other categories as well. That’s a bad look for Epic as they’ve tried to build up their third-party vendor community.
We’ve seen this happen many times before. The most obvious to me was Twitter. When they started they created a great API that was used by many to create amazing third party applications to participate on Twitter. Slowly over time, Twitter basically created all of the functionality you could find in these third party applications and basically put many of the third party vendor partners out of business.
Hopefully it’s not quite as bad in healthcare since most of the Epic App Orchard partners have more business opportunities than just with Epic directly. There are plenty of other EHR vendors out there beyond Epic and many of the partners have functionality that Epic would be unlikely to copy (at least one would hope). However, it’s still a massive mistake for Epic to alienate this third party vendor community.
As we’ve written about before, Epic is going to be able to do a lot of great things, but they’re not going to be able to do everything. So, it’s to their advantage to embrace a vibrant third party “app store” that fulfills the other needs of their customers. Is the telehealth revenue opportunity for Epic that great that they would want to alienate their third party developer community? Plus, don’t be surprised if the price of telehealth services drops in this hyper competitive market. Are their telehealth partners not providing the services their customers need? Hard to imagine this is the case or if it is the case it’s because Epic needed better APIs for these partners.
By at least some reports, Epic has been doing some great work supporting their clients amidst COVID-19. It just seems odd that Epic would choose to roll out their own telehealth solution instead of doubling down on their telehealth partner relationships.
UPDATE: Twilio issues a press release that Epic has indeed built their “native” telehealth platform using Twilio as we reported.
This would not surprise me, John, and it’s certainly not great news for most telehealth providers in the app orchard. But it probably doesn’t spell doom for other third party solution providers. Telehealth is becoming a key, technology-based channel of care. It may often make sense for that to be fully integrated into – even be a part of – the EHR. That’s different than many other third party solutions, which augment – but are not a core part of – the delivery and documentation of care. In my view, whether or not a company should fear Epic depends in large part on the specific solution they provide. Telehealth is likely just too close to the core for Epic to ignore it.
I’ve long thought that the app stores will serve as a test bed of potential EHR enhancements. EHRs have less bandwidth for innovation, so it makes sense for them to monitor the success of apps in the store, and then look to adopt the best ideas into their mainstream products. Those decisions are typically build/buy/partner. Epic seldom partners or acquires, so it’s interesting that they’re looking at Twilio as opposed to building their own solution. I don’t think any EHR vendor is going to leave strategically important functionality (like Telehealth) to others. Telehealth has been pulled to the forefront suddenly; and it’s now strategically important. Whereas before, there wasn’t much demand, and Epic was ok in leaving that market to others.
This is a normal cycle. Before there were App Stores EHR vendors did this. MEDITECH has done so for years. Many 3rd party apps such as phlebotomy, bedside medication administration, nurse rounding, physician desktop, surgery scheduling, and analytics have gone away when MEDITECH decided to offer these themselves. I am not criticizing MEDITECH for doing so, just noting that this is not unusual. MEDITECH more recently creating its own professional services organization, which is changing the landscape for consulting in that space. I wonder if Judy will go that route at Epic. Re: telehealth, it makes sense that EHR vendors create a fully integrated offering as this will be critical to future care delivery in this post-pandemic world.
Here is the biggest problem with Epic trying to enter Televisit. Epic lacks capability to engage patients. The proof is MyChart. Unfortunately as Epic enters this space, health system will adopt that even though Epic’s offering is inferior to other products. As a result you will see physician burnout and patients deciding not to use Televisit.
Thanks for the great discussion.
Joe,
You’re right. It doesn’t spell doom to them, but it does illustrate why companies like Epic need to communicate clearly their intentions and plans so that their third party partners can feel comfortable swimming in Epic’s pond.
Mike,
It’s definitely a test bed for EHR vendors. However, if they eat up all of the good business from that test bed, then people will stop being the guinea pigs for them. It’s a tough line to walk and requires real intention on their part.
Vince,
That’s interesting about MEDITECH, but you’re right that this isn’t just about Epic. It’s true for any third party vendor program.
One Epic App Orchard Partner,
This is an interesting analysis. Will Epic be able to meet the same functionality as other telehealth vendors? Or will they be just good enough in other areas that their customers still choose them despite their weaknesses in other pieces of telehealth?
Reminds me of a conversation I had with a CMIO that was an Epic shop. They had explored a lot of secure messaging companies. In fact, because of acquisition they had multiple secure text messaging companies in their system. They basically threw them all out and went with Epic’s inferior secure text. The integration was that important. Not to mention the “All Epic” mantra that seems to be so much part of the Epic culture. Add in the one neck to ring when something goes wrong idea and it’s a powerful force.