Epic Systems

Epic Systems Corporation, or Epic, is a privately held healthcare software company. According to the company, hospitals that use its software held medical records of 54% of patients in the United States and 2.5% of patients worldwide in 2015.[4]

Epic Systems Corporation
Private
IndustryInformation Technology
Health Informatics
FoundedMadison, Wisconsin, United States (1979)[1]
FounderJudith Faulkner
Headquarters
Verona, Wisconsin
,
United States
Key people
Judith Faulkner, Founder & CEO
Carl Dvorak, President
Revenue$2.9 billion (2018)[2]
Number of employees
10,000 (2019)[3]
Websiteepic.com

History
Epic headquarters in Verona, Wisconsin.

Epic was founded in 1979 by Judith R. Faulkner[5] with a $70,000 investment[6] (equivalent to $250,000 in 2019). Originally headquartered in Madison, Wisconsin, Epic moved its headquarters to a large campus in the suburb of Verona, Wisconsin in 2005,[7] where it employs 10,000 people as of 2019.[8] The campus has themed areas/buildings, such as a castle-like structure, a "fantasy-land" that appears to be inspired by J.K. Rowling's Harry Potter, and a dining facility designed to mimic a train station.[9]

As of 2015, the company was in the fifth phase of campus expansion with five new buildings each planned to be around 100,000 square feet.[4] The company also has offices in Bristol, UK; 's-Hertogenbosch, Netherlands; Dubai, United Arab Emirates; Dhahran, Saudi Arabia; Helsinki, Finland; Melbourne, Australia; Singapore; and Søborg, Denmark.[10]

Product and market

Epic primarily develops, manufactures, licenses, supports, and sells a proprietary electronic medical record software application, known in whole as 'Epic' or an Epic EMR. The company's healthcare software is centered on its Chronicles database management system. Epic's applications support functions related to patient care, including registration and scheduling; clinical systems for doctors, nurses, emergency personnel, and other care providers; systems for lab technologists, pharmacists, and radiologists; and billing systems for insurers.

Epic also offers cloud hosting for customers that do not wish to maintain their own servers; and short-term optimization and implementation consultants through their wholly owned subsidiary Boost Services.

The company's competitors include Cerner, MEDITECH, Allscripts, athenahealth, and units of IBM, McKesson, Siemens and GE Healthcare.[11]

The majority of U.S. News & World Report's top-ranked hospitals and medical schools use Epic.[12] In 2003, Kaiser Permanente began using Epic for its electronic records system.[11] Among many others, Epic provides electronic record systems for Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, Johns Hopkins Hospital,[11] UC Davis Medical Center in Sacramento, and multiple campuses of the Mayo Clinic.[13] Partners HealthCare began adopting Epic in 2015 in a project initially reported to cost $1.2 billion, which critics decried and which is greater than the cost of any of its buildings.[14] By 2018, the total expenses for the project were $1.6 billion, with payments for the software itself amounting to less than $100 million and the majority of the costs caused by lost patient revenues, tech support and other implementation work.[15]

Criticisms and controversies

Data sharing

Care Everywhere is Epic's health information exchange software, which comes with its EHR system.[16] A 2014 article in The New York Times interviews two doctors who say that their Epic systems won't allow them to share data with users of competitors' software in a way that will satisfy the Meaningful Use requirements of the HITECH Act. At first, Epic charged a fee to send data to some non-Epic systems.[17] Epic says the yearly cost for an average-sized hospital is around $5,000 a year.[16] However, after Congressional hearings, Epic and other major software vendors announced that they would suspend per-transaction sharing fees.[18] Epic customers must still pay for one-time costs of linking Epic to each individual non-Epic system with which they wish to exchange data; in contrast, Epic's competitors have formed the CommonWell Health Alliance which set a common Interoperability Software standard for electronic health records.[18] A 2014 report by the RAND Corporation described Epic as a "closed" platform that made it "challenging and costly for hospitals" to interconnect with the clinical or billing software of other companies.[19] The report also cited other research showing that Epic's implementation in the Kaiser Permanente system led to efficiency losses.

In September 2017, Epic announced Share Everywhere, which allows patients to authorize any provider who has internet access to view their record in Epic and to send progress notes back.[20] Share Everywhere was named Healthcare Dive's "Health IT Development of the Year" in 2017.[21]

UK experience

An Epic electronic health record system costing £200 million was installed at Cambridge University Hospitals NHS Foundation Trust in October 2014, the first installation of an Epic system in the UK.[22][23]

After 2.1 million records were transferred to it, it developed serious problems and the system became unstable.[24] Ambulances were diverted to other hospitals for five hours and hospital consultants noted issues with blood transfusion and pathology services.[25] Other problems included delays to emergency care and appointments, and problems with discharge letters, clinical letters and pathology test results.[23] Chief information officer, Afzal Chaudhry, said "well over 90% of implementation proceeded successfully".[22]

In July 2015, the BBC reported that the hospital's finances were being investigated.[26] In September 2015, both the CEO and CFO of the hospital resigned.[27] Problems with the clinical-records system, which were said to have compromised the "ability to report, highlight and take action on data" and to prescribe medication properly, were held to be contributory factors in the organization's sudden failure.[28] In February 2016, digitalhealth.net reported that Clare Marx, president of the Royal College of Surgeons of England and member of the NHS National Information Board, found that at the time of implementation, "staff, patients and management rapidly and catastrophically lost confidence in the system. That took months and a huge amount of effort to rebuild."[29]

Danish experience

In 2016, Danish health authorities spent 2.8 billion DKK on the implementation of Epic in 18 hospitals in a region with 2.8 million residents.[30][31] On May 20, Epic went live in the first hospital. Doctors and nurses reported chaos in the hospital and complained of severe under preparation and training. Epic and its Danish partners insisted that normal testing and training were carried out.

Since some elements of the Epic system were not properly translated from English to Danish, physicians resorted to Google Translate. As one example, when inputting information about a patient's condition, physicians were given the option to report between the left and the "correct" leg, not the left and right legs. As of 2019, Epic had not been fully integration with Denmark's national medical record system, which is meant to be accessed every time a patient is seen. Danish anesthesiologist and computer architect Gert Galster worked to adapt the system. According to Galster, these Epic systems were designed specifically to fit the U.S. health care system, and could not be disentangled for use in Denmark.[31]

An audit of the implementation that voiced concerns was published in June 2018.[32] At the end of 2018, 62% of physicians expressed they were not satisfied with the system and 71 physicians signed a petition calling for the system to be removed.[31][33]

COVID-19 Response

In 2020, the novel coronavirus pandemic spread in the United States. Epic Systems faced considerable criticism for their decision to require 10,000 employees to work on-campus instead of from home.[34] Employees expressed concern about returning to the office, with the first group being required to return as early as August 10th while the pandemic continued to spread.[35] The decision came despite a Dane County public health order requiring remote work "to the greatest extent possible."[36] Criticism revolved in particular around the fact that employees were being ordered back to preserve the company "culture," despite CEO Judy Faulkner's admission that work was getting done remotely.[37] According to the The Capital Times, who interviewed 26 Epic employees about the plan, "13 [employees] said they have knowledge of managers being demoted for expressing concern about the company’s plans to bring its nearly 10,000 workers back" to on-campus work, and all requested anonymity for fear of employer retribution.[38]

In a survey of Epic employees, 89% of employees expressed dissatisfaction with how Epic was handling the pandemic.[39]

Donations

In 2013, Epic donated $30 million to the Dane County Regional Airport to fund a project expanding available parking space.[40]

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See also

References
  1. Eisen, Mark (June 20, 2008). "Epic Systems: Epic Tale". Isthmus. Archived from the original on December 19, 2013. Retrieved December 18, 2013.
  2. "#207 Judy Faulkner". Forbes. Retrieved October 28, 2019.
  3. Arthur Thomas. "Epic Systems gearing up for yet another expansion in Verona". Retrieved October 3, 2019.
  4. Glaze, Jeff (January 6, 2015). "Epic Systems draws on literature greats for its next expansion". Wisconsin State Journal. Archived from the original on January 9, 2015. Retrieved January 23, 2015.
  5. Eisen, Marc (June 20, 2008). "Epic Systems Corporation: An Epic timeline". Isthmus. Archived from the original on May 22, 2011. Retrieved February 20, 2009.
  6. "Epic Systems soars with transition to electronic health records". Archived from the original on November 16, 2016. Retrieved November 15, 2016.
  7. Boulton, Guy (August 24, 2008). "Epic Systems' $300 million expansion tangible sign of success". Milwaukee Journal Sentinel. Archived from the original on February 4, 2016. Retrieved January 28, 2016.
  8. Thomas, Arthur (October 3, 2019). "Epic Systems gearing up for yet another expansion in Verona". Milwaukee Biz Times. Retrieved October 3, 2019.
  9. https://www.atlasobscura.com/places/epiccampus
  10. "Epic - Contact". Epic.com.
  11. Freudenheim, Milt (January 14, 2012). "Digitizing Health Records, Before It Was Cool". The New York Times. Archived from the original on December 25, 2016. Retrieved September 26, 2014.
  12. Spitzer, Julie (August 16, 2018). "All of US News' top 20 hospitals use Epic". Becker's Hospital Review.
  13. Reilly, Mark (July 14, 2017). "Mayo Clinic begins shift to $1.5B digital records system from Epic Systems". Milwaukee Business Journal. Retrieved November 26, 2018.
  14. "Partners HealthCare's new computer system challenges some doctors, nurses - The Boston Globe". BostonGlobe.com. May 16, 2016. Archived from the original on April 15, 2017. Retrieved May 17, 2017.
  15. Gawande, Atul. "Why Doctors Hate Their Computers". The New Yorker. Retrieved November 7, 2018.
  16. Sullivan, Mark (December 8, 2014). "Saying Epic is a Closed System is an Oversimplification". Venture Beat. Archived from the original on January 25, 2015. Retrieved January 23, 2015.
  17. Creswell, Julie (September 30, 2014). "Doctors Find Barriers to Sharing Digital Medical Records". The New York Times. Archived from the original on January 23, 2015. Retrieved January 23, 2015.
  18. Caldwell, Patrick (October 2015). "EPIC FAIL. Digitizing America's medical records was supposed to help patients and save money. Why hasn't that happened?". Mother Jones. Archived from the original on September 7, 2017. Retrieved September 6, 2017.
  19. Kobb, Enesha; Sauser, Kori (2014). Electronic Health Records (PDF). RAND. Archived (PDF) from the original on March 22, 2016. Retrieved March 7, 2016.
  20. Boulton, Guy (November 10, 2017). "Epic Systems lets patients share medical records with doctors around the world". Milwaukee Journal Sentinel. Retrieved November 16, 2017.
  21. Muchmore, Shannon (December 4, 2017). "Health IT Development of the Year: Epic's Share Everywhere". Healthcare Dive.
  22. "Addenbrooke's Hospital paperless system's 'significant problems' reported". BBC News. November 24, 2014. Archived from the original on November 27, 2014. Retrieved December 21, 2014.
  23. "'Major incident' declared for flagship IT project". Health Service Journal. November 25, 2014. Archived from the original on December 23, 2014. Retrieved December 23, 2014.
  24. "The NHS's chaotic IT systems show no sign of recovery". The Guardian. December 21, 2014. Archived from the original on December 21, 2014. Retrieved December 21, 2014.
  25. "Addenbrooke's consultants reveal eHospital concerns in letter to management". Cambridge News. December 11, 2014. Archived from the original on January 3, 2015. Retrieved December 21, 2014.
  26. "Addenbrooke's Hospital's e-hospital finances investigated". BBC News. July 31, 2015. Archived from the original on December 3, 2016. Retrieved May 17, 2017 – via www.BBC.co.uk.
  27. "Addenbrooke's Hospital chief executive Keith McNeil resigns". BBC News. September 14, 2015. Archived from the original on August 17, 2017. Retrieved May 17, 2017 – via www.BBC.co.uk.
  28. "Addenbrooke's and Rosie hospitals' patients 'put at risk'". BBC News. September 22, 2015. Archived from the original on September 24, 2015. Retrieved October 3, 2015.
  29. McBeth, Rebecca (February 25, 2016). "EPR implementation led to 'catastrophic loss of confidence'". Digital Health Intelligence Limited. Archived from the original on February 28, 2016. Retrieved March 7, 2016.
  30. "Har brukt 2,8 milliarder på ny plattform: – Ikke mulig å tro at profesjonelle aktører er i stand til å lage et så elendig produkt". Digi.no (in Norwegian). Archived from the original on June 25, 2018. Retrieved June 25, 2018.
  31. Allen, Arthur. "Lost in translation: Epic goes to Denmark". POLITICO. Retrieved March 22, 2020.
  32. https://www.eurosai.org/en/databases/audits/Report-on-Sundhedsplatformen/
  33. Christensen, Mikkel Fyhn; Sturlason, Astrid Sofie (January 23, 2019). "Blå blok vil droppe Sundhedsplatformen: "Har gjort det værre for sundhedspersonale og patienter i stedet for at gøre det bedre"". Berlingske.dk.
  34. "Wisconsin-based Epic Systems ordering its 9,000-plus workers back to the office, though some employees fear 'untold deaths'". Chicago Tribune. Retrieved August 5, 2020.
  35. Mesch, Shelley. "Epic Systems employees decry CEO's decision to call workers back to the office". Wisconsin State Journal. Retrieved August 5, 2020.
  36. "ORDER OF PUBLIC HEALTH MADISON & DANE COUNTY" (PDF). Public Health of Madison and Dane County. Retrieved August 5, 2020.
  37. Drees, Jackie. "Epic employees raise concerns over mandate to return to campus in September". Beckers Hospital Review. Retrieved August 5, 2020.
  38. Times, Natalie Yahr, Katelyn Ferral | The Capital. "Epic employees say coronavirus concerns met with retaliation, demotions". madison.com. Retrieved August 5, 2020.
  39. Yahr, Natalie. "Epic makes national news as employees criticize planned return to campus". The Capital Times. Retrieved August 5, 2020.
  40. mivey@madison.com, MIKE IVEY | The Capital Times |. "Epic Systems driving $30 million parking expansion at airport". madison.com. Retrieved March 22, 2020.
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