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.
History
Epic was founded in 1979 by Judith R. Faulkner with a $70,000 investment. Originally headquartered in Madison, Wisconsin, Epic moved its headquarters to a large campus in the suburb of Verona, Wisconsin in 2005, where it employs 10,000 people as of 2019. 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.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. 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.
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.
The majority of U.S. News and World Report's top-ranked hospitals and medical schools use Epic. In 2003, Kaiser Permanente began using Epic for its electronic records system. Among many others, Epic provides electronic record systems for Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, Johns Hopkins Hospital, UC Davis Medical Center in Sacramento, and multiple campuses of the Mayo Clinic. 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. 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.
Criticisms and controversies
Data sharing
Care Everywhere is Epic's health information exchange software, which comes with its EHR system. 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. Epic says the yearly cost for an average-sized hospital is around $5,000 a year. However, after Congressional hearings, Epic and other major software vendors announced that they would suspend per-transaction sharing fees. 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. 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. 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. Share Everywhere was named Healthcare Dive's "Health IT Development of the Year" in 2017.
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.After 2.1 million records were transferred to it, it developed serious problems and the system became unstable. Ambulances were diverted to other hospitals for five hours and hospital consultants noted issues with blood transfusion and pathology services. Other problems included delays to emergency care and appointments, and problems with discharge letters, clinical letters and pathology test results. Chief information officer, Afzal Chaudhry, said "well over 90% of implementation proceeded successfully".
In July 2015, the BBC reported that the hospital's finances were being investigated. In September 2015, both the CEO and CFO of the hospital resigned. 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. 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."
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. On May 20th, 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 Epic's system was not designed to be translated between languages, 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.
An audit of the implementation that voiced concerns was published in June 2018. 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.