{"id":18165,"date":"2016-11-18T16:48:02","date_gmt":"2016-11-18T21:48:02","guid":{"rendered":"https:\/\/digital.hbs.edu\/platform-rctom\/submission\/when-epic-digitization-is-not-so-epic\/"},"modified":"2016-11-18T16:48:02","modified_gmt":"2016-11-18T21:48:02","slug":"when-epic-digitization-is-not-so-epic","status":"publish","type":"hck-submission","link":"https:\/\/d3.harvard.edu\/platform-rctom\/submission\/when-epic-digitization-is-not-so-epic\/","title":{"rendered":"When Epic Digitization is Not So Epic"},"content":{"rendered":"

Building an Epic industry<\/b><\/span><\/p>\n

You might not have heard of Epic Systems, but their software has likely made it possible for you to get the treatment you needed if you\u2019ve ever visited a CVS Minute Clinic, Kaiser Permanente, or large teaching hospital. Epic is the leading electronic medical record (EMR) provider in the U.S.–with 12.4% market share in 2016–in part because it was founded in 1979 before \u201cdigitization\u201d was a business phenomena, and more recently because of wide scale health care reform that has invested over $20B in technologies to improve patient outcomes [1, 2]. Epic has continued to grow because of its ability to function in hospital and clinic settings alike, though its critics claim it lacks the dynamism and transparency needed to be a robust tool. This prompts the question; when can we move beyond praising digitization itself and begin to demand more from tech enabled products?<\/span><\/p>\n

When operating models and the operating room don\u2019t mix<\/b><\/span><\/span><\/p>\n

As the first EMR, Epic\u2019s software has become the \u201c\u2018de facto standard among the more complex academic health centers and multispecialty medical groups,\u2019 says Dr. John D. Halamka, chief information officer of Beth Israel Deaconess Medical Center and a professor at the 性视界 Medical School. [3]\u201d While traditional network effects rely on the market to link an increase in one stakeholder group–hospitals and clinics–to drive the increase in another–number of patients in the system–policy also played a huge role in Epic\u2019s network growth. In order to meet the interoperability standards laid out by the Centers of Medicare and Medicaid Services, providers have been incentivized to adopt EMRs that enable secure transfer of patient data across traditional silos like points of care or networks, per the timeline below [4]:<\/span><\/span><\/span><\/p>\n

\"cms\"<\/a><\/p>\n

What\u2019s notable about this plan? It worked: from 2008 to 2014 the percentage of hospitals using digital records shot up from 9.4 to 75.5 [5]. To that end, hospitals and clinics alike have often found their hands tied to join Epic\u2019s network in order to share patients with health care giants that can afford the system\u2019s price tag. <\/span><\/span><\/p>\n

Is digitizing enough to \u201cdo good?\u201d<\/b><\/span><\/p>\n

Though Epic prides itself on an operating model that focuses on attracting best in class talent and incorporating end-user feedback, those on the other side of the screen frequently share dissenting opinions. Further cementing that Epic\u2019s value proposition is that users should only ever learn to use an Epic EMR, in 2008, 28 of the software giant\u2019s competitors formed the CommonWell Health Alliance Partnership in order to promote interoperability amongst various providers [6]. Epic\u2019s abstention signaled its focus on user acquisition so that information could be traded within the confines of its own records and not beyond; what\u2019s more, Epic charges hospitals and clinics a fee to transfer limited information to non-Epic records and, prior to a 2014 Senate hearing, charged patients $2.35 per year to request access to their own medical record requests [7].<\/span><\/span><\/p>\n

According to employees, Epic\u2019s business model offers its users a comprehensive electronic platform to store, access, analyze, and transfer patient related data. The product, to them, is maximizing health care outcomes and inherently holistic and good in nature–just look at the heart related imagery they use to define their product [8]:<\/span><\/span><\/p>\n

\"heart\"<\/a><\/p>\n

These same employees, however, are quick to share the business\u2019s true operating model: \u201cIf you called up any of Epic\u2019s almost 10,000 employees in the middle of the night and asked them the motto, they would recite without hesitation, \u2018Do Good. Have Fun. Make Money.\u2019 In that order,\u201d says Peter DeVault, EPIC’s vice president of interoperability [9]. <\/span><\/span><\/p>\n

It\u2019s no wonder then that Epic\u2019s customers take issue with a software that is purported to provide value in the form of seamless information storage, analysis, and sharing but instead creates major road blocks that are counterproductive to a system reliant on patients seeing multiple doctors over their lifetime. In 2014, one physician told the New York Times \u201cwe\u2019ve spent half a million dollars on an electronic health record system about three years ago, and I\u2019m faxing all day long. I can\u2019t send anything electronically over it,\u201d while in 2015 another touted, \u201cwhat you hear is that, if you were to buy the best of breed no one would ever choose Epic…but using Epic is easier than trying to piece together better options from various software vendors\u201d [10]. In a world where health record digitization has become the norm, Epic\u2019s value is its begrudging network rather than a sleek product. The firm must focus on its first mission–to do good–and recognize that digitizing records is not the benevolent service it once was. Epic must do more to enable interoperability and ease of use that will truly build a health care system that values patient outcomes through data sharing.<\/span><\/span><\/p>\n

Words: 800<\/span><\/p>\n

Citations<\/span><\/span><\/p>\n

    \n
  1. Caldwell, P., 2015. We’ve Spent Billions to Fix Our Medical Records, and They’re Still a Mess. Here’s Why.. Mother Jones, [Online]. Available at: http:\/\/www.motherjones.com\/politics\/2015\/10\/epic-systems-judith-faulkner-hitech-ehr-interoperability [Accessed 14 November 2016].<\/span><\/span><\/li>\n
  2. SK&A, (2016), EHR Vendor Market Share By Practice Size [ONLINE]. Available at: http:\/\/www.skainfo.com\/reports\/physician-ehr-software-usage [Accessed 14 November 2016].<\/span><\/span><\/li>\n
  3. Freudenheim, M., 2012. Digitizing Health Records, Before It Was Cool. The New York Times, 14 January 2012. Available at: <\/span>http:\/\/www.nytimes.com\/2012\/01\/15\/business\/epic-systems-digitizing-health-records-before-it-was-cool.html<\/span><\/a> [Accessed 14 November 2016].<\/span><\/span><\/li>\n
  4. American Hospitals Association, (2015), CMS Medicare and Medicaid EHR Incentive Programs Milestone Timeline [ONLINE]. Available at: http:\/\/www.aha.org\/advocacy-issues\/hit\/mu\/overvw-time.shtml [Accessed 14 November 2016].<\/span><\/span><\/li>\n
  5. Charles, D. , Gabriel, M. , Searcy, T. , 2015. Adoption of Electronic Health Record Systems among U.S. Non Federal Acute Care Hospitals: 2008-2014 . ONC Data Brief, [Online]. 23, 1-10. Available at: https:\/\/www.healthit.gov\/sites\/default\/files\/data-brief\/2014HospitalAdoptionDataBrief.pdf [Accessed 14 November 2016].<\/span><\/span><\/li>\n
  6. McCann, E., 2015. Epic trades jabs with CommonWell Health Alliance. HealtchareITNews, 14 November 2016. <\/span>http:\/\/www.healthcareitnews.com\/news\/epic-vs-commonwell-showdown<\/span><\/a><\/span><\/li>\n
  7. U.S. Senate Committee on Health, Education, Labor & Pensions. (2015). America\u2019s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care. [Online Video]. 17 March 2015. Available from: http:\/\/www.help.senate.gov\/hearings\/americas-health-it-transformation-translating-the-promise-of-electronic-health-records-into-better-care. [Accessed: 14 November 2016].<\/span><\/span><\/li>\n
  8. Epic Systems. 2016. Clinics. [ONLINE] Available at: http:\/\/www.epic.com\/software#Clinicals. [Accessed 14 November 2016].<\/span><\/span><\/li>\n
  9. Caldwell, P., 2015. We’ve Spent Billions to Fix Our Medical Records, and They’re Still a Mess. Here’s Why.. Mother Jones, [Online]. Available at: http:\/\/www.motherjones.com\/politics\/2015\/10\/epic-systems-judith-faulkner-hitech-ehr-interoperability [Accessed 14 November 2016].<\/span><\/span><\/li>\n
  10. Creswell, J., 2014. Doctors Find Barriers to Sharing Digital Medical Records. The New York Times, 30 September 2014. Available from: http:\/\/www.nytimes.com\/2014\/10\/01\/business\/digital-medical-records-become-common-but-sharing-remains-challenging.html<\/span><\/a>. [Accessed: 14 November 2016].<\/span><\/span><\/li>\n<\/ol>\n

     <\/p>\n

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    Epic was on the digitization forefront when it was founded in 1979 and has become a billion dollar business as a result. 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