Epic

By | April 25, 2011
04 Epic

Epic Systems Corporation is a privately held health care software company founded in 1979 by Judy Faulkner. Originally headquartered in Madison, Wisconsin, Epic began moving staff to a new $300 million campus in Verona, Wisconsin in late 2005. Nearly all of Epic’s staff are based in the greater Madison area. Epic has a European office in ‘s-Hertogenbosch (Den Bosch), Netherlands.

Epic’s target market is large health care organizations who are making substantial investments in technology. Epic offers an integrated suite of health care software centered around a hierarchical MUMPS/Caché database. Their applications support all the functions related to patient care, including registration and scheduling systems for clerks; clinical systems for doctors, nurses, emergency personnel, and other care providers; ancillary systems for lab technicians, pharmacists, and radiologists; and billing systems for care providers as well as insurers. All applications leverage the same central database.

Epic had a partnership with Philips to develop a scaled-down version of Epic’s software, called Xtenity, which was marketed to mid-sized health care organizations. This partnership ended on September 29, 2006, and no organizations used Xtenity in a production environment. Epic hired many of the former Philips employees from the Netherlands who helped establish Epic’s European location.

Since 2006, Epic has increasingly been working on expansion into the international health care market. In 2007, Epic established a subsidiary in theNetherlands to market Epic software.

In 2010, Epic announced its intention to pursue green energy sources including solar, biomass, and wind power. The company hopes to eventually obtain 80-90% of its energy needs from alternative sources.

Epic Features

Alerts Patient education forms
Automatic refill requests Patient follow-up
Care guides Patient history
Care planning and patient education Patient portal
Chart management Patient profiles
Clinical charting Physician dashboard
Disease management Physician portal
Drug & Allergy alerts Prescription (Rx) writing
E&M coding Procedure consent forms
Electronic billing Referral management
Electronic labs Reminders
Electronic prescribing Report management
Health maintenance Report management
Lab management Restoration
Lab orders Speech dictation
Lab results Task management
Medication history Templates
Medication management Test orders
Networked Test results
Note management Tracking
Nurse portal Wireless
Order tracking Workflow
Patient check-out

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Get A Quote For an EMR/EHR

happy doctor bhvu6e 150x150 Epic





 

Epic EHR/EMR Review

vader 150x150 Epic

Que Darth Vader music. Epic is the market leader and seems to be everywhere. Unfortunately they seem to be a silo everywhere. Epic has a business model that doesn’t bode well for interoperability. If you go to their website and search for interoperability, you will find very little information. I actually found two pages that looped continuously (essentially click here for more info links that then took you to a page that takes you back to the original page).  Don’t believe me, check it out:

http://www.epic.com/software-connectivity.php

Epic is a dinosaur of a system that is monolithic in nature.  It is a hosted solution with absolutely no real open hooks for systems to integrate with it.  Epics user interface is circa 1985 and I half expect Frogger to jump across the screen chasing PacMan given its 8-bit look and feel.  Epic wins its market because it does have one thing going for it, it’s a safer bet for IT departments who want to minimize the risk of implementing new systems that address the areas of user experience, interoperability and overall usefulness.

From a functionality perspective, Epic is stuffed with features which does make some clinical systems very happy.   There are sophisticated clinical workflow systems and interactive charts.  However, most clinical staff that I have met who use Epic state they mostly just use the notepad (like your Windows notepad app) for their clinical charting notes.   This is a shame since chart notes written in free text are not “codified” or lack the ability to be parsed out in the clinical record for use in other areas.   This is why building a “connected health” approach to the product would be so much better.   Why write a chart note about a medical allergy that can’t automatically be pulled into the medication manager to trigger an alert for both the clinician and the patient?

Interoperability is the biggest weakness of Epic.    Epic makes their money by closed systems and they show it by well…keeping them closed.   Thats not to say they don’t allow interoperability with other systems, they do, its just you have to pay an arm and a leg to get it.   Whenever you talk to an existing Epic customer (and I have talked to many of them) ask them “how easy is it to connect Epic to your existing systems?”.  Immediately you will see their face contort and visual signs of pain will consume them.   Thats because most IT departments implement Epic THINKING it is easy to integrate with.  Then they call their Epic contact who politely says, “we have a wait list so it maybe a good 6-12 months out” oh and $50-100k in integration fees.   Ouch.

My Take On Epic

There are plenty of alternatives to Epic if you are looking for a safe bet.  If you can afford to really explore your options I would definitely do a feature matrix of what you really need and look at the alternatives out there.

Epic On Youtube

Here is an actually positive video on implementation and integration with Epic (see we are objective…somewhat).

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10 thoughts on “Epic

  1. admin Post author

    “We went live with this 4/18.

    I wasn’t interested in an EMR, and so far, must say I see little possible benefit in it. In fact I think it’s a very large lemon, like an old plymouth wagon my father bought 40 years ago.

    before emr, I was seeing about 7100 patients a year, getting my charts and messages completed at office, and feeling very good about it all.

    Now, I find it all very difficult. My face to face time with my patients is down 50%, at least, and see little way this will improve patient care. The chart is the patient now, and the patient is sort of a distraction, basically.

    I’ve always felt my job was to take a history and exam, render a diagnosis, and formulate a treatment plan. Now, however, I must be a coder, an order entry clerk – basically spending about 25% of my time being an overpaid clerk. Also, I am rapidly becoming a computer consultant, as I have to help my staff with the emr as well.

    I believe we are taking much longer to answer messages, and probably making more medication errors because of this emr.

    If you like to play with toys, I guess you’ll like epic. If you like to practice medicine, then I see little benefit from it.

    I’ve not played with other emr’s, but if epic is supposed to be the “best”, and some of our administrators assured us, I’d sure hate to see the worst.

    Steve ****, M.D.”

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  2. admin Post author

    Epic responds to critics of electronic record installation

    Joe Vanden Plas

    November 15, 2006

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    Madison, Wis. – Following weeks of blistering criticism of its electronic medical record system and its ongoing installation at Kaiser Foundation Health Plan, Madison’s Epic Systems Corp. has joined the subsidiary of Kaiser Permanente in defending its product.

    Epic Systems, a medical software developer, says it is very proud of the Kaiser installation and its electronic records system, which Kaiser has re-branded with the name KP HealthConnect.

    The controversy began several weeks ago when Justen Deal, a Los Angeles-based Kaiser Permanente employee, drew attention to implementation problems. His concerns have received widespread media coverage.

    Katie O’Brien, an Epic spokeswoman, said the prospect of further media coverage prompted the company to break its silence.

    “Epic is proud of its work on Kaiser Permanente HealthConnect,” O’Brien said. “There was a great deal of misinformation about Epic’s role in the project, and we wanted to make sure the facts were corrected in the event additional stories developed in the future.”

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    What’s the Deal?

    According to Epic, the software is designed to help Kaiser standardize the practice of medicine across its eight regions, create better access to patient data, improve safety and efficacy of care, and become the largest single research source in the nation. Even though both companies maintain the original system is live and aggressively being rolled-out, Deal has issued a devastating critique.

    Deal, a project supervisor who has been relentless in his criticism, recently sent an e-mail to Kaiser employees, questioning the wisdom of continuing with what he believes is a failed implementation. He cited reliability and scalability problems with HealthConnect, and claimed that internal projections show the company could lose $7 billion over the next two years.

    Deal has been placed on leave, but has maintained a website (www.fixkp.org) outlining steps he has taken to alert company officials. One of his allegations is that the decision to purchase Epic software was made due to conflicts of interest on the part of former CIO Clifford Dodd, who recently resigned, and current CEO George Halvorson, who was with the Minnesota-based HealthPartners when it selected Epic’s medical records software.

    Kaiser response

    Matthew Schiffgens, a Kaiser spokesman, said Dodd’s departure is not connected with KP HealthConnect, noting that Bruce Turksta, vice president and program director of HealthConnect, has been named interim CIO.

    Schiffgens said a company review of Deal’s claims found them to be unsubstantiated, and that Kaiser is proceeding with full implementation of HealthConnect, which comes with a project budget of $3 billion. “We expect to have it implemented within the scope of the full project timetable,” he said, adding that those timelines call for full implementation in outpatient settings in 2008 and in its 24 hospitals by 2009.

    Kaiser has made available a 722-page internal report, outlining issues with its network performance, including router failures and interface slowdowns, which have caused outages and downtime.

    Kaiser also took the step of sending a letter to its fellow Epic clients. In the letter, signed by Louise Liang, senior vice president of quality and clinical systems support for Kaiser Foundation Health Plan, and Andy Wiesenthal, associate medical director of the Permanente Federation, the company said it may be difficult to “separate one person’s viewpoint from fact.”

    The letter concluded as follows: “We have always been honest and forthcoming regarding our success, as well as the challenges we have faced and overcome. We would like to reassure you that these challenges are not atypical for an IT implementation of our size and scope, and we remain confident in the reliability and scalability of the Epic product to help us care for our 8.6 million members.”

    Reply
  3. ****, MD

    A hospital in NC recently purchased the EPIC system at a reported cost of $150 M. My outpatient clinic went live a little over 2 weeks ago. I have worked on EMR’s for years and been in private practice for over 30 years. I spent 40 hours in classroom training before we went live, and another 40 at home.
    I would warn anyone who purchases this system to be ready for a variety of catastrophic consequences to the users and the patients who rely on this communication system. So far, no less than 50% of my staff has had emotional meltdowns at work. Physicians with years of experience are looking for jobs elsewhere. Patients have had several near death experiences attributable to the “tunnel vision” induced by the complex, arcane formats presented. (100% of my staff have stiff necks from struggling with the displays)
    The system is NOT problem oriented, as advertised. It is source oriented. Graphic user interfaces for interoffice communication have no parallel construction, with “send” buttons varying from exiting the window, to selecting an “accept” tab, to closing an “encounter.”
    Our office is hemorrhaging money, the patient wait times have exploded, and the staff morale went from 95% satisfaction to under 25%. We are pleading for assistance from the hospital, which recently cut 401k pension matching in half because of “cost over-runs.”
    Warning: EPIC is dangerous to your patients’ and your health.

    Reply
  4. Bryan

    The health system I work for in Minnesota went live on Epic back in 2005 or 2006. I have been with the company Since 2008 so a little over 4 years now, I have heard of a number of complaints when our hospital went live, but that’s to be expected. When you go from paper charting to electronic, thats a HUGE difference.

    Hard to read these well educated Doctors comments above about going live recently with problems. When has anything you have done that was this big of a change NOT had any problems… It takes time to fine tune and get to know the system. You don’t learn all the things you know about being a doctor over night, or in 40 hours. As you know you “practice” medicine, well this EMR is a lot like that. takes time to learn where everything is.

    So with that, I say to you naysayers, Stick with it! It gets better

    Reply
  5. SMB, MD

    Several months ago, the handwriting being on the wall for the Atrocious… that is, Affordable Care Act, I sold my modest-but-successful practice to a larger concern that mandates the use of Epic. After nearly 10 years with Amazing Charts, I thought the changeover would be a bit stormy, but not horrendous.

    You’re never too old, skilled or experienced to be wrong.

    “Epic” is apparently short for “Epic Fail.” I’m a family physician, but in case you care, my CV includes an academic background in human factors design, perception and cognitive neuroscience. I started on UNIX systems in the early 1980s, and was in the thick of things when ARPANET became this newfangled Internet. I used to compile Netscape on the sly so I could surf the World Wide Web back when Al Gore was proposing a surcharge on blank tape cassettes to offset losses from bootlegging to the vinyl record industry. Excuse me if I don’t take “You’re just a paper-charting, old-school technophobe!” criticisms too seriously.

    Epic sucks. Here’s why: You enter the chart by digging for, then hitting this odd little “GO” button which starts the timer for your patient visit. Then you begin scrabbling around looking for any significant changes to the chart since the last time your patient was in the office. Don’t expect much cooperation from the program on this as the information is often hiding under various tabs that require you to scroll about and open them. The medication list is interesting, since you can’t see what’s active without opening yet another window and looking to see what boxes have or haven’t been checked by your poor medical assistant when they roomed the patient and opened this electronic Pandora’s Box, godgivethemstrength.

    At last you wend your way through your review of the patient’s history, “accepting” most of the rubbish already written, accurate or not, and probably missing their recently-discovered penicillin anaphylaxis because your patient would really like to explain to you why the hell they’re in your office this otherwise beautiful afternoon, and would you please look at them and not the damned monitor.

    Great. Into the actual narrative….
    Except that the automated text generator doesn’t know English grammar, punctuation or capitalization when it insists that your “66 y.o.” patient is here “with Diabetes Followup.”

    Ah yes, that dread disease. Well no worries, I’ll just correct that so it doesn’t look stupid when I get deposed. Oh, wait. I can’t. The program won’t let me do that. Nevermind.

    On to the HPI… wait again, wasn’t there some sort of pull-down check box thing for that? Oh, there it is. Hmmm… not very good for this. I’ll just enter free text. Ah. Have to go back out of the document, click “Accept” and then go back in with the free text editor, but that makes it impossible for the coding feature to tell you the correct E&M for the service. And they didn’t put the “Accept” button in the same place as they did the other ones.

    You haven’t even gotten to trying to order labs, make a referral or try to revise the family history.

    And so it goes. By the end of the visit, you have a nice, Medicare-noncompliant note that only took you half again as much time as if you’d dictated it. And you’re still not sure how it should be coded, so you enter in a 99213 when it was probably a 99214 and congratulate yourself for not throwing the wireless keyboard down the hall and into the eye chart.

    If all of this makes you think that the prudent practice of medicine is epiphenomenal to using Epic, you’re right. I think they intended it that way. In fact, the whole system looks like it was cobbled together out of legacy components written by angry CS grad students who hated doctors, with a “meaningful use” provision tacked on to make it seem less dated.

    Amazing Charts was an 8/10. Not bad, not great. Adequate to my needs.

    Epic gets a 2/10 through rounding.

    Hospital administrators and their IT minions seem to be the only people who like it. That ought to tell you all you need to know.

    Reply
  6. Pamela Farlow Fay

    I agree. I personally have been using Epic for years. I keep learning more every time I use it and the more I learn the easier it gets.

    Reply
  7. Student Nurse

    It is so sad to read the above review from the end-user’s view. Dr. SMB, have you talked about these issues with your IT team so that they may be able to customize the application accordingly?

    Reply
  8. Verk R. Bea, MD

    A little background: I have been practicing medicine for over 40 years; I have been using computers for over 50 years; I have considerable experience with programming and some experience with software development; and I believe that implementation of well designed EMR systems COULD lead to higher quality, more efficient, and safer medical care.

    However, in my experience, EPIC fails miserably in this regard .

    The view from the street. To paraphrase Emperor Joseph II in Amadeus, EPIC has “too many notes”. EPIC is clunky, bloated, and overly complex. It has been built layer by layer on its original foundation of MUMPS, a programming language almost half a century old, and it shows. It has an extremely anti-intuitive user interface, strewn with icons, tabs, and buttons which appear and disappear depending on which screen you have open. There are multiple ways to do even the simplest tasks, but one false click and you’re off down a rabbit hole where you “can’t get there from here”. I have spent as much time learning how NOT to do things as how to do them. Unbelievably, you cannot open multiple windows in EPIC, so one often has to write down information from one screen to transfer it to another (!!!) EPIC slows down patient encounters and ordering, and charting, even using its autotext features and voice recognition, is much more cumbersome than ever before. Clearly, EPIC was constructed with limited input from practicing MD’s. I’ve made my peace with EPIC, but MANY other providers in our organization curse its name at every mention (honest).

    The view from on high: Clinical productivity, physician morale, patient satisfaction, and income have ALL plummeted precipitously at our organization since EPIC went live. Over the past year our brand has lost market share, the drop in operational income has necessitated successive waves of layoffs, and our financials suffered so much that our bond rating was downgraded, despite the frantic efforts of IT, clinical operations, and top management to halt the slide. But software patches, fine tuning, more training, more experience, deployment of “super users”, and outside consultants cannot rectify EPIC’s essential flaw: it makes its end users lives harder, not easier.

    The bottom line: Caveat Emptor EPIC

    Reply
  9. Dan

    EPIC is typical of a closed legacy system….it pays lip service to the comments and suggestions
    of the day to day clinical users but is more concerned with the whistles and bells that make for
    pretty dog and pony shows for the bean counters and desk jockey’s who buy these systems and
    then hand them over to someone else to implement while they pat themselves on the back and
    perhaps give themselves a nice bonus for getting suckered in to the mystique.

    Anyone who is forced to use it will recognize instantly that it impedes work flow and takes time away
    from patient care because you are forced to jump through all the arcane and petty hoops this
    system puts in place. Since implementation the time required for me to perform a normal routine
    CT exam with contrast has increased by over 50%. And with 37 years in radiology I am no rookie.

    EPIC may serve the needs of paperwork and reimbursement but it sure as hell extracts a major cost
    for all those pretty reports and neat screens to flip through…and that cost comes at the actual patient
    contact/care level. We are throwing the baby out with the bathwater because the focus is shifting away
    from serving the needs of the patient to satisfying the needs of the beaurocratic behemoth the EHR’s create.

    As a long time practicing imaging specialist and long time PACS administrator I am most definitely NOT
    impressed by EPIC.

    Reply
  10. Sharon Bias

    The medical records portion of the software works OK, but its usefulness depends on the vendor who you buy the product from. The version used by the VA is well liked. In California, the version used by Sutter Health is missing key applications, and Sutter seems slow to upgrade and update. The billing portion of the software is the ugly step-child. You can get better results billing using a $2000.00 software package like Medi-Soft. We were quoted a fee of $500,000 to create a pathway from the EPIC billing software to another billing software. This was a quote from Sutter, not EPIC. You can hire a programmer for 1 year to write the code for 1/10 of that price. So, with EPIC, you have to rate your vendor first, then the software.

    Reply

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