A bit OT, perhaps: I think Apple should follow SJ’s advice to say 1000 times ”no” before saying one “yes”. In other words, focus, and then be consequent.
You're a little confused. Jobs resigned in 2011 and Tim Cook became CEO. The Thousand No's was a short Apple produced for WWDC in 2013, two years later.
You’re correct and thanks for the link. I was referring to this in a broader sense, like SJ supposedly advising the Nike ceo to “just leave out the bad stuff”. Which is along the lines of lots of “no” before one “yes”.
Bottom-line? EMRs are doable: they need political will & support
I'm going to have to disagree with you here. Politicians and governments have never been the source of great software. The software our society runs on, Windows, macOS, iOS, Android, was not developed or commissioned by politicians. This stuff is totally beyond them. Getting them involved only derails projects because they have nothing of value to offer except money, and pouring money alone can make things worse just as much as it makes it better.
There will be a good EMR one day. It's inevitable. But it won't be at the behest of some parochial health minister.
Epic is full of epic user problems. Just talk to any medical receptionist who’s had to transition to Epic. Why would Apple even consider wasting their money buying out this company? Work with them but be able to ditch them whenever they want to.
Yes. My doctor agrees wholeheartedly. Spends more time filling in records/forms than spending time with patients (he said). He alluded to the system being broken and ultimately detrimental to the patient recovery time & rate.
Fucking insurance companies. And this mentality of profits before people.
Yeh, that's what everybody is missing about this: Electronic Health Records had great potential, but as implemented, have little or nothing to do with healthcare --- and everything to do with Wealthcare (mostly for the hospitals and other large organizations).
They do very, very little for the patient. They do very, very little for the physician (at best!)
But, what they do very well is help large organizations generate profit.
And that is why EPIC says they WON"T EVER MAKE DEALS and WON"T EVER BE SOLD.
... Because they are a central player in the healthcare scam ravaging this country and driving it into bankruptcy.
......... Very simply: they don't want to kill the goose laying the golden eggs. Omerta!
EHR has great potential to help medical care and patients, but unfortunately, its true reason for existence is not for patients or clinical care. The EHR exists for billing, actuaries and for regulation. There is a spiral occurring - the government was told that 'modernizing' health records and converting to an EHR would allow for better tracking and quality improvement. Now that we have an EHR, various organizations say 'great, now we can track...' and there is an ever increasing, endless onslaught of documentation requirements to 'document quality care.' On top of this, insurance companies are saying 'we won't pay unless you document in this way.' The end result is providers spend more and more of their time documenting not for clinical care but to satisfy billing and regulatory requirements. Beyond that, because there are so many requirements and missing one can mean a denied payment, the only way to make sure you satisfy all the requirements is by using a template that includes all the required elements for every entity that is auditing the chart, whether they are relevant or not. The end result is the chart is packed full of random notes that are all templates, virtually meaningless, and so full of random information that you can't find what's actually relevant.
I work in healthcare and I had a patient who came in to the ER with gall stones. She had an endoscopy one day and was going to have her gall bladder removed the next. Before her surgery she had been in the hospital less than 48 hours and had 48 separate notes in her chart. Of those, only one or two had any meaningful information.
Very true! But the last sentence is also applicable to Apple as they begin to import that Garbage into their own health app and users iPhones. When the data is garbage, it doesn't matter how pretty the front end is or even how well it works. GIGO (Garbage In, Garbage Out) still rules and always will.
Bottom-line? EMRs are doable: they need political will & support
I'm going to have to disagree with you here. Politicians and governments have never been the source of great software. The software our society runs on, Windows, macOS, iOS, Android, was not developed or commissioned by politicians. This stuff is totally beyond them. Getting them involved only derails projects because they have nothing of value to offer except money, and pouring money alone can make things worse just as much as it makes it better.
There will be a good EMR one day. It's inevitable. But it won't be at the behest of some parochial health minister.
Neither will it be at the behest of a major healthcare provider -- because to them, it is a Wealthcare system, not a Healthcare system. Thus, the main thrust of Epic is to increase profits, not improve health. With that in mind, then a government backed plan with improving health rather than wealth stands the best chance of success.
I work in a licensed Medical profession and am burdened with Epic for our medical charting system. It is awful, a dumpster fire during a zombie apocalypse. Navigation is an inconsistent, jumbled up mess and the interface redefines busy and cluttered. Phonetic search is the worst thing I have ever seen- ask any Physician trying to order exams in an ER- it makes Siri look like a genius. Search for ”ankle” will not consistently get you all of the various series options for Radiology exams for an ankle, nor will ”XR ankle” or ”CT ankle” or ”MR ankle” - search is all over the place.
Epic got big selling their product to an audience taking the least objectionable option- not something best in class. One of the many parts of the PPACA (Obamacare) was a mandate for EMR (charting) software and that drove the adoption of this awful product.
Cramer may have a TV show, but he also was pushing people to buy into the market during the meltdown of 2007-8. Jon Stewart did a famous takedown of his stock picking show over this very thing.
Apple under Steve Jobs could have done a better system, buy not so sure about Tim Cook’s Apple. If they cannot fix iTunes, I doubt they could fix Epic.
I am a hospital CIO and have implemented Epic at multiple sites (big systems, not small regional facilities). I hold no interest in any EHR company, nor do I receive any compensation from any of them, these are just my observations having been in this industry for a long time. When it comes to EHR's, in my humble opinion Epic is the best of them, but none are perfect. A couple comments about all the comments on this thread.
1. In my opinion most comments here are inaccurate, and demonstrate a lack of understanding of the platform or EHR systems in general.
2. Epic isn't about "wealthcare", I meet with Judy, Carl and the rest of the Epic leadership several times a year, and the fact is they always put patient outcomes first. Yes, they are expensive, but they have a very comprehensive solution which they spend a considerable amount of their revenues into R&D. Their ratio of income to R&D is likely the highest of any software vendor in any industry.
3. Absolutely physician fatigue with the EHR is real, this usually isn't a result of "bad software". There are massive CMS and other regulatory mandates which dramatically increase the data collection requirement burden on the physicians. These mandates are typically formed by large committees of academics and politicians who have little to no bedside experience. See the details for the 724 page regulation HHS just put out on data sharing. https://www.healthcareitnews.com/news/hhs-unwraps-new-information-blocking-rule
4. Secondly, poor implementations riddled with years of customizations are very real issue and dramatically increase keyboard time and flow of the UI. These poor implementations are the result of bad decisions relating to need, design and scope, not bad software. (this is largely consistent in all large package software platforms regardless of industry)
5. Adding to the poor usability of the application stems from technology decisions as health systems rationalize many specialized systems onto the Epic platform, while not learning about the epic functionality and trying to rebuild their legacy applications on to their new EHR platform.
6. Epic, just as all EHR companies are constantly evolving and innovating within their projects. Unfortunately many hospitals tend to try and build it rather than evolve with their vendor's roadmap. This leads to a huge administrative burden and a UX that doesn't flow through the platform. (this isn't just common to EHR platforms, ERP, HR, CRM and SFA all suffer similarly) It really is a lick of discipline..
7. Those critical of MUMPS again seem not to understand the application on the language in high volume transaction environments. It's very powerful when it's used appropriately. It's widely used in the financial sector. Ameritrade's entire platform is based on it. Epic has long been converting their legacy modules to browser based the complete conversion will be complete in probably 3 more years.
Epic has come a long way since it's inception. It's not perfect, but when implemented by people who understand it, it has the ability to drive better care. For as long as I have been around there have been printed and hung all over their campus "Epic's 10 Commandments"; Number one is "Do not go public", number two is "Do not be acquired". Judy wasn't patting herself on the back, she was just saying what has been at their core since their inception "we're not for sale".
When someone says that Apple can do it all by themselves, it would be good, before saying that to realize that Apple buys over two dozen small companies a year - because they can’t do it all by themselves.
cramer was saying that this company already does a lot of what Apple is trying to do, and that acquiring it would save Apple a lot of time and effort, while also having an “in” with medical practitioners. That’s not wrong. Even if some don’t like the system, which medical system is universally loved? The answer is none.
so maybe buying this is a good idea, if they would sell. If they won’t sell, then it doesn’t matter. But sometimes, things change.
This won't change: In fact, it would be a VERY bad mix of oil and water. Apple focuses on making their (individual) customer's lives better (and derives its profits from the products that do that). Epic focuses on making their clients (meaning large healthcare organizations) richer.
Apple and Epic would make a Jekyll & Hyde like debacle. To say there would be no synergy would be a gross understatement. Cramer only understands profit -- so that's how he measures everything. So, to him, both companies are profitable so both are quality organizations with similar values. He's an ass.
That’s not true. For the system Apple is working on to survive, it needs to satisfy both ends. And what Apple is doing now, is working with the new standards for electronic medical storage and sharing. This isn’t something that Apple is developing out of thin air. Everyone needs to adhere to those standards. The only reason why it’s thought that Apple might succeed here is because of the large iPhone base they have, and that the base is more willing than average to use software such as this.
stop thinking of Apple as independent in everything. There is a lot they can’t do by themselves. In fact, most software they have is, at least, based on kernels of software they bought. Thinking otherwise just shows a strong lack of understanding of how Apple functions. Apple buys software companies, sometimes several, and reworks what they bought to get a final product that they can then sell, or give away. This goes back to their roots.
cramer isn’t an ass, though I suppose those who are themselves less than knowledgeable in these areas like to diss him. He’s right more often than wrong, and in that field, that’s a pretty good record. But Epic is a complex company. And yes, I know about the problems. But it’s interesting that no one else has been able to deliver. That’s not just because they were first, it’s because it’s been very difficult to do.
I work in a licensed Medical profession and am burdened with Epic for our medical charting system. It is awful, a dumpster fire during a zombie apocalypse. Navigation is an inconsistent, jumbled up mess and the interface redefines busy and cluttered. Phonetic search is the worst thing I have ever seen- ask any Physician trying to order exams in an ER- it makes Siri look like a genius. Search for ”ankle” will not consistently get you all of the various series options for Radiology exams for an ankle, nor will ”XR ankle” or ”CT ankle” or ”MR ankle” - search is all over the place.
Epic got big selling their product to an audience taking the least objectionable option- not something best in class. One of the many parts of the PPACA (Obamacare) was a mandate for EMR (charting) software and that drove the adoption of this awful product.
Cramer may have a TV show, but he also was pushing people to buy into the market during the meltdown of 2007-8. Jon Stewart did a famous takedown of his stock picking show over this very thing.
Apple under Steve Jobs could have done a better system, buy not so sure about Tim Cook’s Apple. If they cannot fix iTunes, I doubt they could fix Epic.
The part you miss is that Epic is bought by your hospital administrators to make more money for the hospital. It has nothing to do with improving health outcomes -- except as a coverup for the real reason.
I work in a licensed Medical profession and am burdened with Epic for our medical charting system. It is awful, a dumpster fire during a zombie apocalypse. Navigation is an inconsistent, jumbled up mess and the interface redefines busy and cluttered. Phonetic search is the worst thing I have ever seen- ask any Physician trying to order exams in an ER- it makes Siri look like a genius. Search for ”ankle” will not consistently get you all of the various series options for Radiology exams for an ankle, nor will ”XR ankle” or ”CT ankle” or ”MR ankle” - search is all over the place.
Epic got big selling their product to an audience taking the least objectionable option- not something best in class. One of the many parts of the PPACA (Obamacare) was a mandate for EMR (charting) software and that drove the adoption of this awful product.
Cramer may have a TV show, but he also was pushing people to buy into the market during the meltdown of 2007-8. Jon Stewart did a famous takedown of his stock picking show over this very thing.
Apple under Steve Jobs could have done a better system, buy not so sure about Tim Cook’s Apple. If they cannot fix iTunes, I doubt they could fix Epic.
I wish we would not have people think that Jobs was so wonderful in everything, because he wasn’t. This rise to cult status is absurd. Jobs made many boneheaded moves. Others had to fix his mistakes, and many of the best things Apple has done were done over his initial objections.
I am a hospital CIO and have implemented Epic at multiple sites (big systems, not small regional facilities). I hold no interest in any EHR company, nor do I receive any compensation from any of them, these are just my observations having been in this industry for a long time. When it comes to EHR's, in my humble opinion Epic is the best of them, but none are perfect. A couple comments about all the comments on this thread.
1. In my opinion most comments here are inaccurate, and demonstrate a lack of understanding of the platform or EHR systems in general.
2. Epic isn't about "wealthcare", I meet with Judy, Carl and the rest of the Epic leadership several times a year, and the fact is they always put patient outcomes first. Yes, they are expensive, but they have a very comprehensive solution which they spend a considerable amount of their revenues into R&D. Their ratio of income to R&D is likely the highest of any software vendor in any industry.
3. Absolutely physician fatigue with the EHR is real, this usually isn't a result of "bad software". There are massive CMS and other regulatory mandates which dramatically increase the data collection requirement burden on the physicians. These mandates are typically formed by large committees of academics and politicians who have little to no bedside experience. See the details for the 724 page regulation HHS just put out on data sharing. https://www.healthcareitnews.com/news/hhs-unwraps-new-information-blocking-rule
4. Secondly, poor implementations riddled with years of customizations are very real issue and dramatically increase keyboard time and flow of the UI. These poor implementations are the result of bad decisions relating to need, design and scope, not bad software. (this is largely consistent in all large package software platforms regardless of industry)
5. Adding to the poor usability of the application stems from technology decisions as health systems rationalize many specialized systems onto the Epic platform, while not learning about the epic functionality and trying to rebuild their legacy applications on to their new EHR platform.
6. Epic, just as all EHR companies are constantly evolving and innovating within their projects. Unfortunately many hospitals tend to try and build it rather than evolve with their vendor's roadmap. This leads to a huge administrative burden and a UX that doesn't flow through the platform. (this isn't just common to EHR platforms, ERP, HR, CRM and SFA all suffer similarly) It really is a lick of discipline..
7. Those critical of MUMPS again seem not to understand the application on the language in high volume transaction environments. It's very powerful when it's used appropriately. It's widely used in the financial sector. Ameritrade's entire platform is based on it. Epic has long been converting their legacy modules to browser based the complete conversion will be complete in probably 3 more years.
Epic has come a long way since it's inception. It's not perfect, but when implemented by people who understand it, it has the ability to drive better care. For as long as I have been around there have been printed and hung all over their campus "Epic's 10 Commandments"; Number one is "Do not go public", number two is "Do not be acquired". Judy wasn't patting herself on the back, she was just saying what has been at their core since their inception "we're not for sale".
That, at least, is the sales pitch.... Those actually responsible for heathcare rather than wealthcare know otherwise.
I am a hospital CIO and have implemented Epic at multiple sites (big systems, not small regional facilities). I hold no interest in any EHR company, nor do I receive any compensation from any of them, these are just my observations having been in this industry for a long time. When it comes to EHR's, in my humble opinion Epic is the best of them, but none are perfect. A couple comments about all the comments on this thread.
1. In my opinion most comments here are inaccurate, and demonstrate a lack of understanding of the platform or EHR systems in general.
2. Epic isn't about "wealthcare", I meet with Judy, Carl and the rest of the Epic leadership several times a year, and the fact is they always put patient outcomes first. Yes, they are expensive, but they have a very comprehensive solution which they spend a considerable amount of their revenues into R&D. Their ratio of income to R&D is likely the highest of any software vendor in any industry.
3. Absolutely physician fatigue with the EHR is real, this usually isn't a result of "bad software". There are massive CMS and other regulatory mandates which dramatically increase the data collection requirement burden on the physicians. These mandates are typically formed by large committees of academics and politicians who have little to no bedside experience. See the details for the 724 page regulation HHS just put out on data sharing. https://www.healthcareitnews.com/news/hhs-unwraps-new-information-blocking-rule
4. Secondly, poor implementations riddled with years of customizations are very real issue and dramatically increase keyboard time and flow of the UI. These poor implementations are the result of bad decisions relating to need, design and scope, not bad software. (this is largely consistent in all large package software platforms regardless of industry)
5. Adding to the poor usability of the application stems from technology decisions as health systems rationalize many specialized systems onto the Epic platform, while not learning about the epic functionality and trying to rebuild their legacy applications on to their new EHR platform.
6. Epic, just as all EHR companies are constantly evolving and innovating within their projects. Unfortunately many hospitals tend to try and build it rather than evolve with their vendor's roadmap. This leads to a huge administrative burden and a UX that doesn't flow through the platform. (this isn't just common to EHR platforms, ERP, HR, CRM and SFA all suffer similarly) It really is a lick of discipline..
7. Those critical of MUMPS again seem not to understand the application on the language in high volume transaction environments. It's very powerful when it's used appropriately. It's widely used in the financial sector. Ameritrade's entire platform is based on it. Epic has long been converting their legacy modules to browser based the complete conversion will be complete in probably 3 more years.
Epic has come a long way since it's inception. It's not perfect, but when implemented by people who understand it, it has the ability to drive better care. For as long as I have been around there have been printed and hung all over their campus "Epic's 10 Commandments"; Number one is "Do not go public", number two is "Do not be acquired". Judy wasn't patting herself on the back, she was just saying what has been at their core since their inception "we're not for sale".
That, at least, is the sales pitch.... Those actually responsible for heathcare rather than wealthcare know otherwise.
I am happy to hear some actual experience based details of your alternate theory. Are you a physician? I am curious how you know?
Epic is full of epic user problems. Just talk to any medical receptionist who’s had to transition to Epic. Why would Apple even consider wasting their money buying out this company? Work with them but be able to ditch them whenever they want to.
I worked as a developer at Epic early in my career.
Extremely outdated tech from the 1970s that nobody else in the world is using (like the MUMPS language etc.). Most of the effort at the place goes into managing that historic tech. I left because I would have been unemployable in the software industry after working there for a few years (though it was obvious that I could have earned a lot and it was going to capture the market). Then there is the development processes inspired from microsoft - deliver first and fix later.
EPIC was the first reasonably sized company who had a fairly comprehensive product ready when the EHR market caught heat in the 2000s. So, it zoomed past everybody else in market share. The software is unbelievably rickety inside.
I have a coworker that was a bit more recently a developer at Epic, and I have other sources of information to know that while they're not using something so old as MUMPS anymore, they still have a codebase the size of a modern complex GUI OS written in a language that's been End Of Lifed for over 10 years now, that's not got support for threading, and the Epic software is its own health-related platform unto itself.
And yes, if you were to find yourself employed to maintain/extend the old codebase in its current primary language, that would make you unemployable in doing anything else other than working with ancient codebases in dead languages, typically chosen by companies that are too cheap to do things the right way the first time in a language that has a long-term future.
Oh you mean 'Visual Basic'. That is the GUI/client part, the backend server is in MUMPS and most developers wouldn't be involved in that. You had to be pretty good to get into that team.
I don't imagine they would have transitioned out of that, it is too core to their product and transitioning out would probably kill the product. The core is written in 'M' and they use a post-relational database for the sparceness of the data and speed. All build management tools etc. needed to be built in-house since nothing is available commercially for such out-dated tech.
Their real boost came when kaiser decided to go with EPIC. That turned them into the big boy among the EHR aspirants back in the day.
I am a hospital CIO and have implemented Epic at multiple sites (big systems, not small regional facilities). I hold no interest in any EHR company, nor do I receive any compensation from any of them, these are just my observations having been in this industry for a long time. When it comes to EHR's, in my humble opinion Epic is the best of them, but none are perfect. A couple comments about all the comments on this thread.
1. In my opinion most comments here are inaccurate, and demonstrate a lack of understanding of the platform or EHR systems in general.
2. Epic isn't about "wealthcare", I meet with Judy, Carl and the rest of the Epic leadership several times a year, and the fact is they always put patient outcomes first. Yes, they are expensive, but they have a very comprehensive solution which they spend a considerable amount of their revenues into R&D. Their ratio of income to R&D is likely the highest of any software vendor in any industry.
3. Absolutely physician fatigue with the EHR is real, this usually isn't a result of "bad software". There are massive CMS and other regulatory mandates which dramatically increase the data collection requirement burden on the physicians. These mandates are typically formed by large committees of academics and politicians who have little to no bedside experience. See the details for the 724 page regulation HHS just put out on data sharing. https://www.healthcareitnews.com/news/hhs-unwraps-new-information-blocking-rule
4. Secondly, poor implementations riddled with years of customizations are very real issue and dramatically increase keyboard time and flow of the UI. These poor implementations are the result of bad decisions relating to need, design and scope, not bad software. (this is largely consistent in all large package software platforms regardless of industry)
5. Adding to the poor usability of the application stems from technology decisions as health systems rationalize many specialized systems onto the Epic platform, while not learning about the epic functionality and trying to rebuild their legacy applications on to their new EHR platform.
6. Epic, just as all EHR companies are constantly evolving and innovating within their projects. Unfortunately many hospitals tend to try and build it rather than evolve with their vendor's roadmap. This leads to a huge administrative burden and a UX that doesn't flow through the platform. (this isn't just common to EHR platforms, ERP, HR, CRM and SFA all suffer similarly) It really is a lick of discipline..
7. Those critical of MUMPS again seem not to understand the application on the language in high volume transaction environments. It's very powerful when it's used appropriately. It's widely used in the financial sector. Ameritrade's entire platform is based on it. Epic has long been converting their legacy modules to browser based the complete conversion will be complete in probably 3 more years.
Epic has come a long way since it's inception. It's not perfect, but when implemented by people who understand it, it has the ability to drive better care. For as long as I have been around there have been printed and hung all over their campus "Epic's 10 Commandments"; Number one is "Do not go public", number two is "Do not be acquired". Judy wasn't patting herself on the back, she was just saying what has been at their core since their inception "we're not for sale".
That, at least, is the sales pitch.... Those actually responsible for heathcare rather than wealthcare know otherwise.
I am happy to hear some actual experience based details of your alternate theory. Are you a physician? I am curious how you know?
I am a professional in the healthcare industry -- and the consensus is that EPIC and EHR's in general benefit the hospital and its profits rather than patients or those providing care. We are the people on the front lines who know -- and I can't remember ever hearing anything good about EHR's -- it's ALL negative.
While not "beholden to shareholders," I'm sure that Ms. Faulkner is beholden to the owners of Epic, whether it's a sole proprietorship, shareholders of a private corporation, or a partnership. I know that public companies can do stupid short sighted things to "make the shareholders happy," some of us shareholders of companies are quite happy with the company taking the long term vision into account.
I am a hospital CIO and have implemented Epic at multiple sites (big systems, not small regional facilities). I hold no interest in any EHR company, nor do I receive any compensation from any of them, these are just my observations having been in this industry for a long time. When it comes to EHR's, in my humble opinion Epic is the best of them, but none are perfect. A couple comments about all the comments on this thread.
1. In my opinion most comments here are inaccurate, and demonstrate a lack of understanding of the platform or EHR systems in general.
2. Epic isn't about "wealthcare", I meet with Judy, Carl and the rest of the Epic leadership several times a year, and the fact is they always put patient outcomes first. Yes, they are expensive, but they have a very comprehensive solution which they spend a considerable amount of their revenues into R&D. Their ratio of income to R&D is likely the highest of any software vendor in any industry.
3. Absolutely physician fatigue with the EHR is real, this usually isn't a result of "bad software". There are massive CMS and other regulatory mandates which dramatically increase the data collection requirement burden on the physicians. These mandates are typically formed by large committees of academics and politicians who have little to no bedside experience. See the details for the 724 page regulation HHS just put out on data sharing. https://www.healthcareitnews.com/news/hhs-unwraps-new-information-blocking-rule
4. Secondly, poor implementations riddled with years of customizations are very real issue and dramatically increase keyboard time and flow of the UI. These poor implementations are the result of bad decisions relating to need, design and scope, not bad software. (this is largely consistent in all large package software platforms regardless of industry)
5. Adding to the poor usability of the application stems from technology decisions as health systems rationalize many specialized systems onto the Epic platform, while not learning about the epic functionality and trying to rebuild their legacy applications on to their new EHR platform.
6. Epic, just as all EHR companies are constantly evolving and innovating within their projects. Unfortunately many hospitals tend to try and build it rather than evolve with their vendor's roadmap. This leads to a huge administrative burden and a UX that doesn't flow through the platform. (this isn't just common to EHR platforms, ERP, HR, CRM and SFA all suffer similarly) It really is a lick of discipline..
7. Those critical of MUMPS again seem not to understand the application on the language in high volume transaction environments. It's very powerful when it's used appropriately. It's widely used in the financial sector. Ameritrade's entire platform is based on it. Epic has long been converting their legacy modules to browser based the complete conversion will be complete in probably 3 more years.
Epic has come a long way since it's inception. It's not perfect, but when implemented by people who understand it, it has the ability to drive better care. For as long as I have been around there have been printed and hung all over their campus "Epic's 10 Commandments"; Number one is "Do not go public", number two is "Do not be acquired". Judy wasn't patting herself on the back, she was just saying what has been at their core since their inception "we're not for sale".
He is talking from Judy's book, i.e. Epic corporate BS. 1. Most of the opinion are pretty accurate in terms of the technology (or lack of) being used by Epic. They relay on InterSystem cache and Microsoft Visual Basic (not pre dot net version) for most of their UI stuff. They host a IE browser control in there VB app and call it WebApp. However, the web app is based on some ancient ASP.NET and JS stuff written by a group of people, who wrote the VB UI and had absolutely no idea how to modern webapp works. The result is a Frankenstein hybrid of VB and IE host web page and VB Win32 UIs. 2. Epic is all about "Judy" and "Carl", if they they you otherwise, you are being brain washed 3. People do the real work i.e. take care of patient absolutely hate Epic, it's a tool for administers to monitor how fast a Physician can finish a appointment, and save hospital money. The bottom line is make hospital money. 4. Customization is not a problem but poor software design (by amateurs in the company since early on but still have a heavy grip on any software design decision) and implementation. 5. Same as 4 6. EHR, CRM, HR, SFA all sucks, you know why? It's all about Money! No one cares they actually improves users' quality of life, it just need to be not suck bad enough so users still pay for their sh*t. These fields have a high barrier of entry and lack of competition leads to crapy products. 7. MUMPS is a great programming language and database backend in the 70's, but technology has since advanced there are better alternatives out there (I am not talking about Oracle SQL).
>> I have been around there have been printed and hung all over their campus "Epic's 10 Commandments";
You've been drinking too much of Judy and Carl's kool aid. You need to be very wary of any company that invoke anything remote close to " xyzzy Commandments", it usually has some sinister motive to it, especially it's Capitalized "Commandments".
"Do not go public", "We are not for sale"
Who reaps the ultimate benefit? Who's being accountable to whom? Who has ultimate control?
For people signing Judy's praise you need put down the kool aid.
Epic is full of epic user problems. Just talk to any medical receptionist who’s had to transition to Epic. Why would Apple even consider wasting their money buying out this company? Work with them but be able to ditch them whenever they want to.
Yes. My doctor agrees wholeheartedly. Spends more time filling in records/forms than spending time with patients (he said). He alluded to the system being broken and ultimately detrimental to the patient recovery time & rate.
Fucking insurance companies. And this mentality of profits before people.
Yeh, that's what everybody is missing about this: Electronic Health Records had great potential, but as implemented, have little or nothing to do with healthcare --- and everything to do with Wealthcare (mostly for the hospitals and other large organizations).
They do very, very little for the patient. They do very, very little for the physician (at best!)
But, what they do very well is help large organizations generate profit.
And that is why EPIC says they WON"T EVER MAKE DEALS and WON"T EVER BE SOLD.
... Because they are a central player in the healthcare scam ravaging this country and driving it into bankruptcy.
......... Very simply: they don't want to kill the goose laying the golden eggs. Omerta!
EHR has great potential to help medical care and patients, but unfortunately, its true reason for existence is not for patients or clinical care. The EHR exists for billing, actuaries and for regulation. There is a spiral occurring - the government was told that 'modernizing' health records and converting to an EHR would allow for better tracking and quality improvement. Now that we have an EHR, various organizations say 'great, now we can track...' and there is an ever increasing, endless onslaught of documentation requirements to 'document quality care.' On top of this, insurance companies are saying 'we won't pay unless you document in this way.' The end result is providers spend more and more of their time documenting not for clinical care but to satisfy billing and regulatory requirements. Beyond that, because there are so many requirements and missing one can mean a denied payment, the only way to make sure you satisfy all the requirements is by using a template that includes all the required elements for every entity that is auditing the chart, whether they are relevant or not. The end result is the chart is packed full of random notes that are all templates, virtually meaningless, and so full of random information that you can't find what's actually relevant.
I work in healthcare and I had a patient who came in to the ER with gall stones. She had an endoscopy one day and was going to have her gall bladder removed the next. Before her surgery she had been in the hospital less than 48 hours and had 48 separate notes in her chart. Of those, only one or two had any meaningful information.
So true. It's a complete disaster. Between the billing/documentation issues and defensive writing (eg leaving out any information that is not absolutely necessary to avoid getting sued), every case I review from an ER seems to involve deciphering codes and looking for hidden information, like reading Dan Brown book but without the excitement.
I am a hospital CIO and have implemented Epic at multiple sites (big systems, not small regional facilities). I hold no interest in any EHR company, nor do I receive any compensation from any of them, these are just my observations having been in this industry for a long time. When it comes to EHR's, in my humble opinion Epic is the best of them, but none are perfect. A couple comments about all the comments on this thread.
1. In my opinion most comments here are inaccurate, and demonstrate a lack of understanding of the platform or EHR systems in general.
2. Epic isn't about "wealthcare", I meet with Judy, Carl and the rest of the Epic leadership several times a year, and the fact is they always put patient outcomes first. Yes, they are expensive, but they have a very comprehensive solution which they spend a considerable amount of their revenues into R&D. Their ratio of income to R&D is likely the highest of any software vendor in any industry.
3. Absolutely physician fatigue with the EHR is real, this usually isn't a result of "bad software". There are massive CMS and other regulatory mandates which dramatically increase the data collection requirement burden on the physicians. These mandates are typically formed by large committees of academics and politicians who have little to no bedside experience. See the details for the 724 page regulation HHS just put out on data sharing. https://www.healthcareitnews.com/news/hhs-unwraps-new-information-blocking-rule
4. Secondly, poor implementations riddled with years of customizations are very real issue and dramatically increase keyboard time and flow of the UI. These poor implementations are the result of bad decisions relating to need, design and scope, not bad software. (this is largely consistent in all large package software platforms regardless of industry)
5. Adding to the poor usability of the application stems from technology decisions as health systems rationalize many specialized systems onto the Epic platform, while not learning about the epic functionality and trying to rebuild their legacy applications on to their new EHR platform.
6. Epic, just as all EHR companies are constantly evolving and innovating within their projects. Unfortunately many hospitals tend to try and build it rather than evolve with their vendor's roadmap. This leads to a huge administrative burden and a UX that doesn't flow through the platform. (this isn't just common to EHR platforms, ERP, HR, CRM and SFA all suffer similarly) It really is a lick of discipline..
7. Those critical of MUMPS again seem not to understand the application on the language in high volume transaction environments. It's very powerful when it's used appropriately. It's widely used in the financial sector. Ameritrade's entire platform is based on it. Epic has long been converting their legacy modules to browser based the complete conversion will be complete in probably 3 more years.
Epic has come a long way since it's inception. It's not perfect, but when implemented by people who understand it, it has the ability to drive better care. For as long as I have been around there have been printed and hung all over their campus "Epic's 10 Commandments"; Number one is "Do not go public", number two is "Do not be acquired". Judy wasn't patting herself on the back, she was just saying what has been at their core since their inception "we're not for sale".
I appreciate your perspective and your willingness to share your thoughts. But I'm going to have to strongly disagree with your defense of Epic, or any of the main EMRs out there.
As I mentioned in a recent post, I've worked with Epic (albeit many years ago), and I currently work with 3 different EMR systems, in inpatient and outpatient settings, at three different hospitals. I'm a specialist physician faculty at a medical school that does consults as well as regular patient care.
All of the EMRs I have worked with have horrible UIs, with clumsy design, are unintuitive, have inconsistent and nonsensical icons, and have very poor output of information that makes it very difficult to convey meaningful patient narratives (eg horrible formatting/layout, terrible templates that constrain and obfuscate information). I could go on. The doctors are pragmatic, busy, and don't have the time it takes to compile the multitude of tiny things that add up to make these systems unwieldly and unusable. So administration is content to just keep the status quo. And in my experience, when I do make a list of complaints, they're not addressed.
In short.. yes, Epic and other EMRs work. A tricycle works too (or, to Epic's credit, a bicycle). But I think I'm going to stick with my car to get around. It's a sad state of affairs when the best we can offer doctors and patients are the equivalent of bicycles.
Completely agree Patchie, but it needs medical professionals to push harder. I understand that caring comes first, but in our technical world they have to get involved in acquiring the UX tools they (and their patients) need.
As mentioned in a previous post, II've been designing and building EHRs, all my life, and the news is this:
* Yes EHRs are complex, but it's all doable. ICU is one module, cardio is another . . . design to the needs of the professional and link them together - one step at a time. * All current major electronic health record systems in the US have wonderfully efficient, easy-to-use,billing modules. The Patient part as you note - Shared health information, history, charting, recent health care encounters - absolutely terrible. * The main problem (in countries where the patient, rather than profit, is supposed to come first) is an apparent lack of will by medical practitioners to get into the technical details. For example, in Canada, Alberta's attempt at a Shared Health Record failed because there were 14 EMR vendors in the province and no one (Doctors, vendors) wanted to make the financial/intellectual/work effort to connect their isolated systems.
Bottom-line? EMRs are doable: - but they need medical professionals to stand up and say "we demand this!"
Completely agree Patchie, but it needs medical professionals to push harder. I understand that caring comes first, but in our technical world they have to get involved in acquiring the UX tools they (and their patients) need.
As mentioned in a previous post, II've been designing and building EHRs, all my life, and the news is this:
* Yes EHRs are complex, but it's all doable. ICU is one module, cardio is another . . . design to the needs of the professional and link them together - one step at a time. * All current major electronic health record systems in the US have wonderfully efficient, easy-to-use,billing modules. The Patient part as you note - Shared health information, history, charting, recent health care encounters - absolutely terrible. * The main problem (in countries where the patient, rather than profit, is supposed to come first) is an apparent lack of will by medical practitioners to get into the technical details. For example, in Canada, Alberta's attempt at a Shared Health Record failed because there were 14 EMR vendors in the province and no one (Doctors, vendors) wanted to make the financial/intellectual/work effort to connect their isolated systems.
Bottom-line? EMRs are doable: - but they need medical professionals to stand up and say "we demand this!"
Good points. But, physicians and nurses can't demand anything.
They are employees who do what they are told, how they told and when they are told. To be allowed to work in a hospital they must toe the line.
Yes, that is funny indeed. Jim Cramer is a nutball. EPIC is like a hospital operating system. It is a vast, enormous, complex monstrosity that requires lots of customization and above all a whole lot of training. Every single employee needs to be trained how to use EPIC, it runs the entire hospital and in many cases multiple hospitals working together. EPIC ties into everything. Apple has no reason to buy EPIC but they could cut a deal to better interface with the EPIC systems and iOS Healthkit.
Comments
There will be a good EMR one day. It's inevitable. But it won't be at the behest of some parochial health minister.
But the last sentence is also applicable to Apple as they begin to import that Garbage into their own health app and users iPhones. When the data is garbage, it doesn't matter how pretty the front end is or even how well it works. GIGO (Garbage In, Garbage Out) still rules and always will.
Navigation is an inconsistent, jumbled up mess and the interface redefines busy and cluttered. Phonetic search is the worst thing I have ever seen- ask any Physician trying to order exams in an ER- it makes Siri look like a genius. Search for ”ankle” will not consistently get you all of the various series options for Radiology exams for an ankle, nor will ”XR ankle” or ”CT ankle” or ”MR ankle” - search is all over the place.
Epic got big selling their product to an audience taking the least objectionable option- not something best in class. One of the many parts of the PPACA (Obamacare) was a mandate for EMR (charting) software and that drove the adoption of this awful product.
Cramer may have a TV show, but he also was pushing people to buy into the market during the meltdown of 2007-8. Jon Stewart did a famous takedown of his stock picking show over this very thing.
Apple under Steve Jobs could have done a better system, buy not so sure about Tim Cook’s Apple. If they cannot fix iTunes, I doubt they could fix Epic.
1. In my opinion most comments here are inaccurate, and demonstrate a lack of understanding of the platform or EHR systems in general.
2. Epic isn't about "wealthcare", I meet with Judy, Carl and the rest of the Epic leadership several times a year, and the fact is they always put patient outcomes first. Yes, they are expensive, but they have a very comprehensive solution which they spend a considerable amount of their revenues into R&D. Their ratio of income to R&D is likely the highest of any software vendor in any industry.
3. Absolutely physician fatigue with the EHR is real, this usually isn't a result of "bad software". There are massive CMS and other regulatory mandates which dramatically increase the data collection requirement burden on the physicians. These mandates are typically formed by large committees of academics and politicians who have little to no bedside experience. See the details for the 724 page regulation HHS just put out on data sharing. https://www.healthcareitnews.com/news/hhs-unwraps-new-information-blocking-rule
4. Secondly, poor implementations riddled with years of customizations are very real issue and dramatically increase keyboard time and flow of the UI. These poor implementations are the result of bad decisions relating to need, design and scope, not bad software. (this is largely consistent in all large package software platforms regardless of industry)
5. Adding to the poor usability of the application stems from technology decisions as health systems rationalize many specialized systems onto the Epic platform, while not learning about the epic functionality and trying to rebuild their legacy applications on to their new EHR platform.
6. Epic, just as all EHR companies are constantly evolving and innovating within their projects. Unfortunately many hospitals tend to try and build it rather than evolve with their vendor's roadmap. This leads to a huge administrative burden and a UX that doesn't flow through the platform. (this isn't just common to EHR platforms, ERP, HR, CRM and SFA all suffer similarly) It really is a lick of discipline..
7. Those critical of MUMPS again seem not to understand the application on the language in high volume transaction environments. It's very powerful when it's used appropriately. It's widely used in the financial sector. Ameritrade's entire platform is based on it. Epic has long been converting their legacy modules to browser based the complete conversion will be complete in probably 3 more years.
Epic has come a long way since it's inception. It's not perfect, but when implemented by people who understand it, it has the ability to drive better care. For as long as I have been around there have been printed and hung all over their campus "Epic's 10 Commandments"; Number one is "Do not go public", number two is "Do not be acquired". Judy wasn't patting herself on the back, she was just saying what has been at their core since their inception "we're not for sale".
stop thinking of Apple as independent in everything. There is a lot they can’t do by themselves. In fact, most software they have is, at least, based on kernels of software they bought. Thinking otherwise just shows a strong lack of understanding of how Apple functions. Apple buys software companies, sometimes several, and reworks what they bought to get a final product that they can then sell, or give away. This goes back to their roots.
cramer isn’t an ass, though I suppose those who are themselves less than knowledgeable in these areas like to diss him. He’s right more often than wrong, and in that field, that’s a pretty good record. But Epic is a complex company. And yes, I know about the problems. But it’s interesting that no one else has been able to deliver. That’s not just because they were first, it’s because it’s been very difficult to do.
I don't imagine they would have transitioned out of that, it is too core to their product and transitioning out would probably kill the product. The core is written in 'M' and they use a post-relational database for the sparceness of the data and speed. All build management tools etc. needed to be built in-house since nothing is available commercially for such out-dated tech.
Their real boost came when kaiser decided to go with EPIC. That turned them into the big boy among the EHR aspirants back in the day.
1. Most of the opinion are pretty accurate in terms of the technology (or lack of) being used by Epic. They relay on InterSystem cache and Microsoft Visual Basic (not pre dot net version) for most of their UI stuff. They host a IE browser control in there VB app and call it WebApp. However, the web app is based on some ancient ASP.NET and JS stuff written by a group of people, who wrote the VB UI and had absolutely no idea how to modern webapp works. The result is a Frankenstein hybrid of VB and IE host web page and VB Win32 UIs.
2. Epic is all about "Judy" and "Carl", if they they you otherwise, you are being brain washed
3. People do the real work i.e. take care of patient absolutely hate Epic, it's a tool for administers to monitor how fast a Physician can finish a appointment, and save hospital money. The bottom line is make hospital money.
4. Customization is not a problem but poor software design (by amateurs in the company since early on but still have a heavy grip on any software design decision) and implementation.
5. Same as 4
6. EHR, CRM, HR, SFA all sucks, you know why? It's all about Money! No one cares they actually improves users' quality of life, it just need to be not suck bad enough so users still pay for their sh*t. These fields have a high barrier of entry and lack of competition leads to crapy products.
7. MUMPS is a great programming language and database backend in the 70's, but technology has since advanced there are better alternatives out there (I am not talking about Oracle SQL).
>> I have been around there have been printed and hung all over their campus "Epic's 10 Commandments";
You've been drinking too much of Judy and Carl's kool aid. You need to be very wary of any company that invoke anything remote close to " xyzzy Commandments", it usually has some sinister motive to it, especially it's Capitalized "Commandments".
"Do not go public",
"We are not for sale"
Who reaps the ultimate benefit? Who's being accountable to whom? Who has ultimate control?
For people signing Judy's praise you need put down the kool aid.
As I mentioned in a recent post, I've worked with Epic (albeit many years ago), and I currently work with 3 different EMR systems, in inpatient and outpatient settings, at three different hospitals. I'm a specialist physician faculty at a medical school that does consults as well as regular patient care.
All of the EMRs I have worked with have horrible UIs, with clumsy design, are unintuitive, have inconsistent and nonsensical icons, and have very poor output of information that makes it very difficult to convey meaningful patient narratives (eg horrible formatting/layout, terrible templates that constrain and obfuscate information). I could go on. The doctors are pragmatic, busy, and don't have the time it takes to compile the multitude of tiny things that add up to make these systems unwieldly and unusable. So administration is content to just keep the status quo. And in my experience, when I do make a list of complaints, they're not addressed.
In short.. yes, Epic and other EMRs work. A tricycle works too (or, to Epic's credit, a bicycle). But I think I'm going to stick with my car to get around. It's a sad state of affairs when the best we can offer doctors and patients are the equivalent of bicycles.
As mentioned in a previous post, II've been designing and building EHRs, all my life, and the news is this:
* Yes EHRs are complex, but it's all doable. ICU is one module, cardio is another . . . design to the needs of the professional and link them together - one step at a time.
* All current major electronic health record systems in the US have wonderfully efficient, easy-to-use, billing modules. The Patient part as you note - Shared health information, history, charting, recent health care encounters - absolutely terrible.
* The main problem (in countries where the patient, rather than profit, is supposed to come first) is an apparent lack of will by medical practitioners to get into the technical details. For example, in Canada, Alberta's attempt at a Shared Health Record failed because there were 14 EMR vendors in the province and no one (Doctors, vendors) wanted to make the financial/intellectual/work effort to connect their isolated systems.
Bottom-line? EMRs are doable: - but they need medical professionals to stand up and say "we demand this!"