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EpicUGM Insights, Announcements (Epic API), and Pictures

Posted on September 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week has been the annual user group for Epic EHR users, otherwise known as Epic UGM. @VinceKuraitis aptly noted that the Epic user conference had 15k attendees and yet it only produced 188 tweets the first day of the conference. I’m not sure if this is a reflection of Epic users view of social media or Epic users fear of sharing what’s happening. The limited tweets aside, there were still a number of interesting tweets and pictures coming out of the event. Plus, some interesting quotes from the Madison paper I think you’ll enjoy.


Look at the crowds for registration. I wonder when Epic will outgrow Madison and need to move the event to Las Vegas. We’d certainly welcome them here. Although the local paper said that the event is the second biggest tourism engine in the area (World Dairy Expo beats it out).


Deep Space was the theme of the conference and also is the name of the enormous 11,400 seat underground auditorium on Epic’s campus. More pictures of the auditorium below. It’s also worth noting that Judy did the keynote dressed as a Na’vi from the movie “Avatar.”

Now for some tweets with pictures of the auditorium:


Soon the Epic conference will pass HIMSS on attendance. Not likely, but it is interesting that there were only 297 healthcare organizations. I wonder how many people organizations like Kaiser brought to the event.


This is a really interesting tweet. First, it’s interesting that Judy is talking about meaningful use stage 4. Does this mean there will be an MU stage 4? Second, what happened to MU stage 2? I’m pretty sure most aren’t worried much beyond MU stage 2 right now.


This likely deserves a blog post of its own. Although, this comment is really interesting in the context of Epic. Does this mark a fundamental shift in the products that Epic develops?

What I think will be the biggest announcement coming out of Epic UGM 2013 is the new Epic API. While it definitely falls short of what most of us would love to see Epic do with an API, at least it’s a start. The focus of the API seems to all be around getting all of the various health and wellness app data into the EHR. Here’s a good description of who they want to use the Epic API:

Are you a manufacturer of a consumer-facing monitoring device? We have an API for that.

Have you developed a health or wellness-related tracking app or portal? Clinicians need that information.

We’ve designed open.epic to make it gosh-darn simple to integrate the data you collect into your patients’ medical records. Interested?

I believe this will be a great opportunity for many developers. We’ll see how it plays out long term. I’m a little surprised that the Epic API doesn’t include interoperability which Epic is doing more and more. I guess they see it as a separate initiative.

The local newspaper covered the Epic UGM event as well and offered a few other insights into what was said at the conference:

“We’ve just gone over the 51 percent mark. You take care of a little over half of the patients in this country,” Faulkner said. Worldwide, nearly 2.4 percent of the population is covered by electronic health records created by Epic.

I’m sure we’ll be hearing Epic users quote this 51% number a lot more.

Epic, with $1.5 billion in 2012 revenue and 6,800 employees, will keep growing as its customers grow, Faulkner said, adding that clients are loyal. “To us, it’s a lifetime relationship,” she said.

I think Judy might be right for many Epic customers. The lock in to Epic for many of these large organizations is strong.

I guess the 15,300 attendee number is interesting when you think that 6,800 of them could be employees. Although, no doubt it is a really important and interesting event in the healthcare IT world. Judy seems to be softening on media coverage of Epic. It seems like Judy and Epic have decided to start becoming a larger part of the conversation. I wonder if a blogger could attend the event next year.

Adding Insult To Injury, Sutter’s Epic EMR Crashes For A Day

Posted on August 30, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The Epic EMR at Northern California’s Sutter Health crashed earlier this week, leaving the system inaccessible for an entire day, reports Healthcare IT News. The system, which cost Sutter nearly $1 billion, went offline at approximately 8AM, locking out doctors, nurses and staff from accessing vital information such as medical lists and patient histories.

The crash followed a few days after planned downtime of eight hours which was scheduled to take place due to implement an upgrade.  During that period nurses could still read med orders and patient histories but had to record new data on paper and re-enter it later into the system, Healthcare IT News notes.

During the unplanned outage this week, the Epic system was offline at several Sutter locations, including Alta Bates Summit Medical Center, Eden Medical Center, Mills-Peninsula Hospital, Sutter Delta, Sutter Tracy, Sutter Modesto along with several affiliated clinics, the magazine said.

The outage drew the ire of the California Nurses Association, which called this incident “especially worrisome.” But the CNA notes that the crash is hardly the first time there’s been a concern over the Epic rollout. Nurses at Sutter have been complaining for months about alleged safety problems with the Epic system, notes the Sacramento Business Journal.

According to the CNA, more than 100 nurses had previously filed complaints at Alta Bates Summit, arguing that the Epic system was hard to use, and that computer-related delays had adversely affected the ability of nurses to monitor patients properly.

Sutter nurses’ complaints included the following:

• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.
• A nurse who was not able to obtain needed blood for an emergent medical emergency.
• Insulin orders set erroneously by the software.
• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.
• Lab tests not done in a timely manner.
• Frequent short staffing caused by time RNs have to spend with the computers.
• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.
• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.
• Patient information, including vital signs, missing in the computer software.
• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.
• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.
• Inadequate RN training and orientation.

Sutter officials, for their part, are not having any of it. Hospital spokeswomen Carolyn Kemp called the allegations that Epic was causing problems “shameful,” and argued that the accusations are arising because the hospital system is involved in a labor dispute with the CNA.

Meanwhile, Sutter execs are turning up the heat on nurses whom they feel aren’t using the EMR properly. According to Healthcare IT News, leaders have been scolding nurses whom they believe have not been entering all billable services into the EMR, which resulted in a loss of $6,000 in a single week, according to a July memo obtained by HIN.

Sutter’s spokesperson, Bill Gleeson, offered this official response:

Sutter Health undertook a long-planned, routine upgrade of its electronic health record over the weekend. There’s a certain amount of scheduled downtime associated with these upgrades, and the process was successfully completed. On Monday morning, we experienced an issue with the software that manages user access to the EHR. This caused intermittent access challenges in some locations. Our team applied a software patch Monday night to resolve the issue and restore access. Our caregivers and office staff have established and comprehensive processes that they follow when the EHR is offline. They followed these procedures. Patient records were always secure and intact. Prior to Monday’s temporary access issue, our uptime percentage was an impressive 99.4 percent with these systems that operate 24/7. We appreciate the hard work of our caregivers and support staff to follow our routine back-up processes, and we regret any inconvenience this may have caused patients. California Nurse Union continues to oppose the use of information technology in health care but we and other health care provider organizations demonstrate daily that it can be used to improve patient care, convenience and access. While it’s unfortunate the union exploited and misrepresented this situation, it comes as no surprise given the fact that we are in a protracted labor dispute with CNA.

Interesting EMR Interface Prototype

Posted on August 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love when doctors and medical students talk about their first encounter with EHR software. In this case, I came across a medical student who ran into Epic in the hospital and writes about it in this post. Here’s his initial response to it:

I took the training module for it and the moment it loaded, I was bewildered. My monitor had turned into a wormhole and was suddenly displaying software built in the 1990s. I stared for 30 minutes at what was basically a wall of text, trying to find my way around small buttons and clogged sub-screens. I hadn’t even learned how to use Epic yet and I was already frustrated. Perhaps it’s because Epic was a platform built upon billing practices that made it so confusing. Either way, I was done before I had even begun.

The great part is that he wasn’t just complaining about the experience. He decided to create a prototype of what he thought an EMR interface could look like. Here’s his video prototype:

Obviously, it’s lacking a lot of detail, but I love his fresh take on how you could navigate the information in the EHR. We need more people who aren’t clouded with current EHR design to offer design suggestions like this.

Why BIDMC Is Shunning Epic, Developing Its Own EMR

Posted on July 31, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Though its price tag be formidable and installation highly complex, the Epic EMR is practically a no-brainer decision for many hospitals.  As Beth Israel Deaconess Medical Center CIO John Halamka notes, things are certainly like that in the Boston metro, where BIDMC’s competitors are largely on Epic or in the process of installing Epic.

Why are Halamka’s competitors all going with Epic?  He proposes the following reasons:

*  Epic installs get clinicians to buy in to a single configuration of a single product. Its project methodology standardizes governance, processes and staffing in a way that hospitals might not be able to do on their own.

* Epic fends off clinicians’ request for new innovations that the hospital staff might not be able to support. IT merely has to tell clinicians that they’ll have to wait until Epic releases its next iteration.

* Epic is a safe investment for meeting Meaningful Use Stage 2, as it has a history of helping hospitals and providers achieve MU compliance.

* CIOs generally don’t get fired for buying Epic, as it’s the popular move to make, despite being reliant on 1990s era client-server technology delivered via terminal services that require signficant staffing to support. (Actually, it does happen but it’s still rare.)

*  These days, hospitals have moved away from “best of breed” EMR implementations to the need for integration across the enterprise.  As Halamka notes, such integration is important in a world where Accountable Care/global capitated risk is becoming a key factor in reimbursement, so having a continuous record across episodes of care is critical. Epic seems to address this issue.

But BIDMC is a holdout. As Dr. Halamka notes in his blog, BIDMC is one of the last hospitals in Eastern Massachusetts continuing to build and buy components to create its own EMR. He’s convinced that going with the in-house development method — creating a cloud-hosted, thin client, mobile friendly and highly interoperable system — is ultimately cheaper and allows for faster innovation.

In closing, Halamka wonders whether his will end up being one of the very last hospitals to continue an ongoing EMR development program.  I think he’s answered his own question: it seems likely that BIDMC’s competitors will keep jumping on the Epic bandwagon for all of the reasons he outlines.

Will they do well with Epic?  Will they find later on that the capital investment and support costs are untenable? I think we’ll have the answers within a scant year or two. Personally, I think BIDMC will have the last laugh, but we’ll just have to see.

Open vs Closed EHR Systems with Jonathan Bush

Posted on June 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday I had a video interview scheduled with Jonathan Bush from athenahealth. It was going to be broadcast live on my burgeoning EHR Videos website (Subscibe for EHR Video Email Updates) using the Google Plus Hangout technology. Everything was set until Google Plus HOA (Hangouts On Air as they’re called) wouldn’t load. It was a system wide problem and so we were unable to broadcast the interview. However, Jonathan and I were able to see each other and so we just did a more traditional interview about the subject of open vs closed EHR systems.

As you can imagine Jonathan had plenty to say on the subject of open versus closed EHR systems. We started the discussion discussing the business model of closed EHR systems and how looking at many EHR companies that seemed to be a very good business model. I asked him what was so bad about being closed.

Jonathan then told me that a closed EHR system is a great business model for the software vendor if you can get it. However, he said that as the product category matures the closed systems will get disrupted by more open options. In fact, at one point in our conversation he suggested that once some of the players become truly open, the other EHR vendors will have to follow along.

I was offered one caveat by Jonathan. He was curious if Epic was the exception to this rule. He wondered if Epic had so much money that they could last well beyond most companies. This cash could provide them the runway and opportunity to reinvent themselves along with those companies trying to disrupt them. Although, the most powerful comment made in regards to Epic was when he suggested that Epic has clients that benefit from Epic’s closed nature as well.

Another powerful comment he made was, “Affordable sounds like decline.” The concept is really interesting. Basically, so many EHR vendors have been able to charge an outrageous premium with amazing margins for their EHR software. If they were to choose to lower their price, many could misinterpret that decision as the company cutting prices to increase sales that have dropped off. Certainly the argument can be made that EHR vendors don’t need to charge what they do. However, image is important and could be influenced by a price drop.

While it’s always fun to talk about Epic with Jonathan, I also pressed him on why athenahealth wasn’t more open in the things they do. Couldn’t some of the same arguments made against closed EHR systems be applied just as easily to athenahealth? For example, why isn’t the athenahealth API more open?

In one of his more contemplative responses, Jonathan acknowledged that athenahealth was heading down the path of closed EHR systems. He saw that they were headed in a similar direction with their business model and so they had to decide if that’s the direction they wanted to continue or if they wanted to move towards a more open EHR model. He mentioned their More Disruption Please program and how the number of companies they were working with in that program was a sign of their move to be more open.

Jonathan admitted that the athenahealth API wasn’t where it should be, but that the goal was to have an API for every surface area of athenahealth. I wish we had this comment on video so we could really hold him to it. I love the idea of every surface area of an EHR being available through an API.

I also pressed Jonathan a little bit about CommonWell and whether it would be open to everyone and anyone that wanted to participate. He responded, “We expect every single maker of health information technology to obtain a key for every patient they have and see where that patient has been.” That was a pretty broad statement about openness. He did suggest that CommonWell was the right approach of knowing where the data was stored as opposed to storing every single person’s data in every clinic. It had to be a distributed patient records model.

Jonathan did also tell me that they’d recently got a call from Epic to work with them to build API connections with all the information in Epic. We’ll see if this is a step towards a more open Epic. Although, it still seems to follow the same pattern Judy discussed when she called Epic the most open EHR system she knew. She’s ok opening up with strategic partners.

I ended the conversation with me asking Jonathan what could be done to make the business model of being open work in healthcare. He mentioned two topics that deserve more time and their own dedicated post: a repriced athenaclinicals based on order and anti kick back laws as an obstacle for exchange of information. Both were preventing a market for health information. Our time ran out so I couldn’t dig into these subjects more. I’m going to see if Jonathan or someone from athenahealth would be willing to do a couple future guest blog posts on the subject.

As you can see, I covered a lot of ground with Jonathan in the 10 minutes we had. Imagine if we’d had the full 30 minutes. Plus, you could have heard it straight from him. I’m certain we’ll be inviting Jonathan back for another interview in our series of EHR Videos.

Amazing Epic Discussion on Google Plus

Posted on August 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As many of you probably know, I started a new Hospital EMR and EHR website that follows a similar pattern to EMR and HIPAA & EMR and EHR, but focused on the technology used in a hospital with the EHR being at the center (most of the times). The site has been growing like crazy with the wonderful Katherine Rourke posting most of the content.

However, one thing I found really interesting was that I took this post about Epic Possibly Being Victim of its Own EMR Success and posted it on Google Plus (UPDATE: You’ll need to add me to your Google Circle so I can add you to my EMR circle to see it. I forgot I only shared it with my EMR google circle and I can’t see how to make it public). I’ve just been dabbling around in Google Plus, and so I was surprised by the results.

In the post itself, there have been 6 comments about Epic EMR’s success. That’s really not a bad number of comments for such a new Hospital EMR blog.

However, the astounding part is that my thread on Google Plus that links to the post has already had 40 comments on it with some amazing insight from those commenting.

It’s still really early in the life of Google Plus. Maybe it’s early and the novelty of Google Plus is what’s currently providing the great discussion. I’ll have to seriously consider how I can incorporate that discussion into future blog posts.