I recently watched a Cleveland Clinic interview with Epic Founder, Judy Faulkner. The interview overall was quite boring since the interviewer didn’t ask Judy any hard questions and he chose not to dive into the details which wasn’t probably the goal of Cleveland Clinic, an Epic customer. However, there were a few interesting tidbits that were shared by Judy that are worth highlighting.
The first was Judy Faulkner expressing with glee that “165 million patients have Epic MyChart that makes them the 8th biggest country in the world if you counted the MyChart patients as a country.” No doubt this is an impressive number and Epic has certainly been successful in the work they’re doing. In fact, it shows the potential opportunity for good that Epic could do to empower patients.
The disappointing piece for me was when Judy described the amount of engagement they saw from those 165 million patients in Epic MyChart:
“Our experience has been that about 0.5% of the patients have even been interested in managing their own record and then it falls off…They want the health systems to manage it. The health systems to exchange it so that all that data is there.”
Judy didn’t share details on how exactly they measured patients “interested in managing their own record”, but 0.5% is a tough number to swallow regardless of how it was measured. Doing some simple math, that’s still means 825,000 patients are engaging on MyChart and that’s worth noting. However, what’s happening with the other 164 million patients? Do patients really not want to engage with a healthcare organization so much that 99.5% of them aren’t engaging in MyChart.
While I’ve written a number of times previously about how many patients aren’t engaged in their healthcare and it is especially difficult to engage a “healthy patient”, these numbers are so small that there has to be more to this story than just patients who don’t care.
A recent discussion online highlighted one challenge with MyChart:
Cool, cool, Epic can consolidate my data but I have 4 flavors of MyChart on my phone.
— Arien Malec (@amalec) September 2, 2020
His tweet references Epic’s ability to consolidate data for their Cosmos product which has over 65 million records vs his own personal MyChart access which doesn’t reconcile across 4 Epic customers. For those not familiar with Arien Malec, he’s one of the foremost experts on healthcare interoperability and standards and so no doubt this was a snarky tweet. However, his point is a good one. His Epic MyChart app has access to 4 Epic healthcare institutions that all have a wide variety of data and functions in MyChart they’re making available or not. Each healthcare organization chooses how they want to use MyChart and so a patient doesn’t know what to expect.
This begs the question of whether it’s Epic’s responsibility to consolidate a patient’s record across multiple health systems or not and should they be more prescriptive in what features and data are universal. Turns out, Epic does have the ability to consolidate a patient record across MyChart instances in a product that’s been around for 4 years called Happy Together, but many hospitals aren’t enabling it. This is where we can easily imagine Judy saying that it’s up to the health systems to decide if they want to enable this or not. While you can see where Judy is coming from, there are plenty of other situations where Epic hasn’t been so generous in allowing the health systems to choose how they want to implement Epic. Why doesn’t Judy and Epic take a firmer stance in enabling patients to be able to consolidate their records across Epic instances?
I think the answer lies in who Judy sees as the real customer. While on the video mentioned above, they talk about health systems and patients as the “customers” of Epic, the reality is that health systems are Epic’s customer. If the patient was truly Epic’s customer, would there be any question that the ability to consolidate a patient’s health record across health systems would be an essential MyChart feature?
If we take this a step further, I believe the lack of patient as customer is why MyChart has seen lackluster engagement. If the patient was customer, MyChart would better serve that customer. If the patient was truly Epic’s customer, then Judy would go ballistic at the idea that only 0.5% of customers were engaged in their product.
The lack of a consolidated patient record is one simple example, but the harsh reality is that Epic MyChart doesn’t serve the patient’s needs. MyChart was largely an answer to regulatory requirements that health systems had to fulfill. It wasn’t designed with creating an amazing patient experience where the patient was engaged with the product and their health was improved.
Don’t get me wrong on this. I actually think that Judy truly does care about patients. However, for some reason she hasn’t seen the opportunity available to Epic to be able to really move the needle when it comes to creating a patient centric platform for patients. Certainly, some of Epic’s customers have pushed them forward with things like OpenNotes and other initiatives that have benefited patients. However, sometimes as a vendor it’s worth building something health systems customers don’t realize they need.
I wonder how many times Epic has done patient focus groups to improve MyChart. If they need help, there are great organizations like Savvy Coop that can make accessing patient feedback easy for them. Plus, they’re probably going to have to travel outside Madison to find some user experience designers to really make the experience amazing for patients. Based on reviews of MyChart and their own numbers on engagement, my guess is there’s a lot that could be done in both regards. Health system customers won’t likely ask for it, but they love patients as much as Epic does so it would be worth it.
Leaving MyChart engagement, Judy also shared another stat that illustrates the US healthcare and EMR world so well:
Judy Faulkner from Epic said that their overseas users’ notes are 1/4 the size of Epic notes in the US.
— John Lynn (@techguy) September 2, 2020
That number is a little hard to comprehend. Think about that. Chart notes in the US are 4 times as large as Epic notes by international Epic users.
Admittedly, a lot of this is not Epic’s fault even if there’s some things they could do to help. In many ways, Epic is implementing the regulatory and reimbursement requirements their US customers require. This is why I’ve started saying that one of the best ways Epic could improve their EHR is by working to streamline the regulatory and reimbursement requirements in the US. Unfortunately, note bloat is a real thing and frustrating for patient and doctor.
A reoccurring theme for me when writing about Epic and Judy Faulkner is that their hearts are in the right place, but they often fall short in the execution. While being so focused on what their customers asks them to do has made Epic successful, at this stage of Epic’s journey there’s an opportunity for Epic to invest well beyond what customers are asking. Two areas to consider is really working with patients and using their weight to improve other regulatory and reimbursement overhead. Customers may not be asking for this, but the best gifts are often something we didn’t realize we needed.