Boston hospitals go Epic: Hear from a holdout

In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic.   Boston Medical Center is replacing Eclipsys (Allscripts) with Epic.   Lahey Clinic is replacing Meditech/Allscripts with Epic.  Cambridge Health Alliance and Atrius already run Epic.   Rumors abound that others are in Eastern Massachusetts are considering Epic.  Why has Epic gained such momentum over the past few years?

Watching the implementations around me, here are a few observations:

1.  Epic sells software, but more importantly it has perfected a methodology to gain clinician buy in to adopt a single configuration of a single product.   Although there are a few clinician CIOs, most IT senior management teams have difficulty motivating clinicians to standardize work.  Epic’s project methodology establishes the governance, the processes, and the staffing to accomplish what many administrations cannot do on their own.

2.  Epic eases the burden of demand management.   Every day, clinicians ask me for innovations because they know our self-built, cloud hosted, mobile friendly core clinical systems are limited only by our imagination.   Further, they know that we integrate department specific niche applications very well, so best of breed or best of suite is still a possibility. Demand for automation is infinite but supply is always limited.   My governance committees balance requests with scope, time, and resources.   It takes a great deal of effort and political capital.   With Epic, demand is more easily managed by noting that desired features and functions depend on Epic’s release schedule.   It’s not under IT control.

3.  It’s a safe bet for meaningful use stage 2.   Epic has a strong track record of providing products and the change management required to help hospital and professionals achieve meaningful use.  There’s no meaningful use certification or meaningful use related product functionality risk.

4.  No one got fired by buying Epic.   At the moment, buying Epic is the popular thing to do.   Just as the axiom of purchasing agents made IBM a safe selection,   the brand awareness of Epic has made it a safe choice for hospital senior management.   It does rely on 1990′s era client server technology delivered via terminal services that require significant staffing to support, but purchasers overlook this fact because Epic is seen in some markets as a competitive advantage to attract and retain doctors.

5.  Most significantly, the industry pendulum has swung from best of breed/deep clinical functionality to the need for integration.   Certainly Epic has many features and overall is a good product.   It has few competitors, although Meditech and Cerner may provide a lower total cost of ownership which can be a deciding factor for some customers.   There are niche products that provide superior features for a department or specific workflow.   However,  many hospital senior managers see that accountable care/global capitated risk depends upon maintaining continuous wellness not  treating episodic illness, so a fully integrated record for all aspects of a patient care at all sites seems desirable.  In my experience, hospitals are now willing to give up functionality so that they can achieve the integration they believe is needed for care management and population health.

Beth Israel Deaconess builds and buys systems. I continue to believe that clinicians building core components of EHRs for clinicians using a cloud-hosted, thin client, mobile friendly, highly interoperable approach offers lower cost, faster innovation, and strategic advantage to BIDMC.  We may be the last shop in healthcare building our own software and it’s one of those unique aspects of our culture that makes BIDMC so appealing.

The next few years will be interesting to watch.   Will a competitor to Epic emerge with agile, cloud hosted, thin client features such as Athenahealth?   Will Epic’s total cost of ownership become an issue for struggling hospitals?   Will the fact that Epic uses Visual Basic and has been slow to adopt mobile and web-based approaches provide to be a liability?

Or alternatively, will BIDMC and Children’s hospital be the last academic medical centers in Eastern Massachusetts that have not replaced their entire application suite with Epic?   There’s a famous scene at the end of the classic film Invasion of the Body Snatchers, which depicts the last holdout from the alien invasion becoming a pod person himself.  At times, in the era of Epic, I feel that screams to join the Epic bandwagon are directed at me.

John Halamka is chief information officer, Beth Israel Deaconess Medical Center and blogs at Life as a Healthcare CIO.

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  • MarylandMD

    Ease of use? Provider workflows? Provider efficiency? Staff efficiency? Sad how none of those aspects figure into the equation here…

  • guest

    Hang in there. It’s my (hopefully not naive) belief that there’s a huge anti-EPIC backlash coming, driven by those of us who are still interested in providing decent clinical care to our patients.

    One thing that might help would be for someone to actually do a study on these systems. It constantly amazes me that, in an era where a significant part of my day is spent documenting that what I do is “evidence based,” another significant part of my day is spent slaving over an EMR which, to the best of my knowledge, has never been scientifically proven to have an association with good care.

  • Elvish

    No one got fired for buying EPIC, despite the fact that they have pushed their institutions to the verge of bankruptcy by doing so.

  • John Dzivak

    If you do give in, please leverage your position and require Epic becomes SMART platform compliant within 1 year of signature as condition of contract!

  • Ben

    Dr. Halamka what would be the best way to deal with this issue of Epic taking over and not really being a good emr/ehr? Have you or your hospital studied the effects of your system on the staff and overall health of your patients? Does it compare to Epic. I am not am Epic guy, in fact I can’t stand Epic, just wanted to know what you think in regards to alternatives.

  • betsynicoletti

    Not a comfortable place to be: the last hold out.