Epic Systems

Short description: Healthcare software company

Epic Systems Corporation

Type| Private
Industry| Information technology
Health informatics
Founded| Madison, Wisconsin, United States (1979)[1]
Founder| Judith Faulkner
Headquarters|

Verona, Wisconsin

United States

Key people

| Judith Faulkner, Founder & CEO
Carl Dvorak, President
Revenue| $2.9 billion (2018)[2]

Number of employees

| 10,000 (2019)[3]
Website| epic.com

Epic Systems Corporation, or Epic, is an American privately held healthcare software company. According to the company, hospitals that use its software held medical records of 78% of patients in the United States and over 3% of patients worldwide in 2022.[4]

## Contents

* 1 History
* 2 Product and market
* 3 Criticisms and controversies
* 3.1 Data sharing
* 3.2 UK experience
* 3.3 Danish experience
* 3.4 Finnish experience
* 3.5 Norwegian experience
* 3.6 COVID-19 response
* 4 See also
* 5 References
* 6 External links

## History

Epic headquarters in Verona, Wisconsin.

Epic was founded in 1979 by Judith R. Faulkner[5] with a $70,000 investment[6] (equivalent to $250,000 in 2019). Originally headquartered in Madison, Wisconsin, Epic moved its headquarters to a large campus in the suburb of Verona, Wisconsin in 2005,[7] where it employs 10,000 people as of 2019.[8] The campus has themed areas/buildings, such as a castle-like structure, a "Wizard Campus" that appears to be inspired by J.K. Rowling's Harry Potter, and a dining facility designed to mimic a train station.[9]

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.[10] The company also has offices in Bristol, UK; 's-Hertogenbosch, Netherlands; Dubai, United Arab Emirates; Dhahran, Saudi Arabia; Helsinki, Finland; Melbourne, Australia; Singapore; Trondheim, Norway; and Søborg, Denmark.[11]

## 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. MyChart is used in the USA and other countries to access doctors’ records and for billing purposes. It is used by 150 million patients across the US.[12]

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, Inc..

The company's competitors include Cerner, MEDITECH, Allscripts, athenahealth, and units of IBM, McKesson, and Siemens.[13][14]

The majority of U.S. News & World Report's top-ranked hospitals and medical schools use Epic.[15] In 2003, Kaiser Permanente began using Epic for its electronic records system.[13] Among many others, Epic provides electronic record systems for Cedars-Sinai Medical Center in Los Angeles , the Cleveland Clinic, Johns Hopkins Hospital,[13] UC Davis Medical Center in Sacramento, and all Mayo Clinic campuses.[16] 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 its buildings.[17] 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.[18]

In 2022 Emory Healthcare, Baptist Health and Memorial Hermann Health System all switched to Epic from Cerner. Epic seems to be preferred in large systems.[19]

## Criticisms and controversies

### Data sharing

Care Everywhere is Epic's health information exchange software, which comes with its electronic health record (EHR, or EMR) system.[20] A 2014 article in The New York Times interviews two doctors who said that their Epic systems wouldn'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.[21] Epic said the yearly cost for an average-sized hospital was around $5,000 a year.[20] However, after Congressional hearings, Epic and other major software vendors announced that they would suspend per-transaction sharing fees.[22] 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.[22] A 2014 report by the RAND Corporation noted the software was difficult and costly to use in conjunction with other billing systems.[23] 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.[24] Share Everywhere was named Healthcare Dive's "Health IT Development of the Year" in 2017.[25]

### 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.[26][27]

After 2.1 million records were transferred to it, it developed serious problems and the system became unstable.[28] Ambulances were diverted to other hospitals for five hours and hospital consultants noted issues with blood transfusion and pathology services.[29] Other problems included delays to emergency care and appointments, and problems with discharge letters, clinical letters and pathology test results.[27] Chief information officer, Afzal Chaudhry, said "well over 90% of implementation proceeded successfully".[26]

In July 2015, the BBC reported that the hospital's finances were being investigated.[30] In September 2015, both the CEO and CFO of the hospital resigned.[31] 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.[32] 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."[33]

### 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.[34][35] On May 20, Epic went live in the first hospital. Doctors and nurses reported chaos in the hospital and complained of a lack of preparation and training.[35]

Since some elements of the Epic system were not properly translated from English to Danish, 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 still not been fully integrated with Denmark's national medical record system. 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.[35]

An audit of the implementation that voiced concerns was published in June 2018.[36] At the end of 2018, 62% of physicians expressed they were not satisfied with the system and 71 physicians signed a petition calling for its removal.[35][37]

### Finnish experience

In 2012, the Hospital District of Helsinki and Uusimaa (HUS) decided to replace several smaller health record systems with one district-wide system created by Epic. It was called Apotti and would be used by healthcare and social services for the 2.2 million residents in the HUS area. The Apotti system was selected as the provider in 2015 and implementation started in 2018. By November 2022, the Apotti system had cost 625 million euros.[38]

After the implementation, complaints from healthcare workers, especially from doctors, started accumulating. The system was accused of being too complicated and that its convoluted UI was endangering patient safety. For example, one patient was administered the wrong chemotherapeutic drug due to an unclear selection menu in the system.[39]

In July 2022, a formal complaint demanding that the issues in the system be fixed or the system be removed entirely was sent to the Finnish health care supervising body Valvira. The complaint was signed by 619 doctors that use Apotti.[40]

### Norwegian experience

Central Norway started introducing Epic (branded “Helseplattformen”) in the winter 2023. After approximately two months, the public broadcaster NRK reported that around 25% of the doctors at the region's main hospital considered quitting their job, and that 40% were experiencing stress related health issues due to the new IT system.[41] Previously, health personell actively demonstrated against the software by marching though the city of Trondheim.[42] Due to the chaos ensuing the introduction, including 16.000 letters not being sent to patients, the Norwegian CEO of the Helseplattformen IT project, Torbjørg Vanvik, had her employment ended by the board.[43] Unexpected cost increases forced the authorities to decrease efforts in other areas, such as a planned initiative on mental health.[44] Employee representatives state that the public will receive ”significantly worse services“.[45]

### COVID-19 response

In 2020, the novel coronavirus pandemic spread in the United States. Epic Systems faced considerable criticism for their initial plan to have their 10,000 employees return to work on-campus.[46] Employees expressed concern about returning to the office, with the first group being required to return as early as August 10 while the pandemic continued to spread.[47] This plan was abandoned, and as of December 2020, employees were still able to work from home.[48] The plan had come about despite a Dane County public health order requiring remote work "to the greatest extent possible."[49] Criticism revolved in particular around the fact that employees were being ordered back to preserve the company "culture," despite CEO Judy Faulkner's admission that work was getting done remotely.[50] According to The Capital Times, who interviewed 26 Epic employees about the plan, "13 [employees] said they have knowledge of managers being demoted for expressing concern about the company’s plans to bring its nearly 10,000 workers back" to on-campus work, and all requested anonymity for fear of employer retribution.[51]

In a survey of over 400 Epic employees, 89% of respondents expressed dissatisfaction with how Epic was handling the pandemic.[52]

## See also

* Epic Systems Corp. v. Lewis

## References

1. ↑ Eisen, Mark (June 20, 2008). "Epic Systems: Epic Tale". Isthmus. http://www.thedailypage.com/isthmus/article.php?article=22980.
2. ↑ "#207 Judy Faulkner". Forbes. https://www.forbes.com/profile/judy-faulkner/#7acb4f733b81.
3. ↑ Arthur Thomas. "Epic Systems gearing up for yet another expansion in Verona". https://biztimes.com/epic-systems-gearing-up-for-yet-another-expansion-in-verona/.
4. ↑ Adams, Katie (April 12, 2021). "31 Numbers That Show How Big Epic, Cerner, Allscripts & Meditech Are in Healthcare" (in English). Becker's Hospital Review. https://www.beckershospitalreview.com/healthcare-information-technology/31-numbers-that-show-how-big-epic-cerner-allscripts-meditech-are-in-healthcare.html.
5. ↑ Eisen, Marc (June 20, 2008). "Epic Systems Corporation: An Epic timeline". Isthmus. http://www.thedailypage.com/isthmus/article.php?article=22984.
6. ↑ "Epic Systems soars with transition to electronic health records". http://archive.jsonline.com/business/epic-systems-soars-with-transition-to-electronic-health-records-b99642837z1-366328781.html.
7. ↑ Boulton, Guy (August 24, 2008). "Epic Systems' $300 million expansion tangible sign of success". Milwaukee Journal Sentinel. http://www.jsonline.com/news/wisconsin/32597729.html.
8. ↑ Thomas, Arthur (October 3, 2019). "Epic Systems gearing up for yet another expansion in Verona". Milwaukee Biz Times. https://biztimes.com/epic-systems-gearing-up-for-yet-another-expansion-in-verona/.
9. ↑ "A Corporate Campus Straight Out of a Fantasy Novel". http://www.atlasobscura.com/places/epiccampus.
10. ↑ Glaze, Jeff. "Epic Systems draws on literature greats for its next expansion" (in en). https://madison.com/news/local/govt-and-politics/epic-systems-draws-on-literature-greats-for-its-next-expansion/article_4d1cf67c-2abf-5cfd-8ce1-2da60ed84194.html.
11. ↑ "Epic - Contact". https://www.epic.com/contact.
12. ↑ "Paymentus Enhances Healthcare Billing and Payments Integration With Epic MyChart". Fintech Times. 6 October 2022. https://thefintechtimes.com/paymentus-enhances-healthcare-billing-and-payments-integration-with-epic-mychart/.
13. ↑ 13.0 13.1 13.2 Freudenheim, Milt (January 14, 2012). "Digitizing Health Records, Before It Was Cool". The New York Times. https://www.nytimes.com/2012/01/15/business/epic-systems-digitizing-health-records-before-it-was-cool.html?pagewanted=1&_r=1&smid=fb-share.
14. ↑ HealthLeaders. "Veritas Capital Closes Athenahealth Acquisition" (in en). https://www.healthleadersmedia.com/finance/veritas-capital-closes-athenahealth-acquisition.
15. ↑ Spitzer, Julie (August 16, 2018). "All of US News' top 20 hospitals use Epic". https://www.beckershospitalreview.com/ehrs/all-of-us-news-top-20-hospitals-use-epic.html.
16. ↑ "Mayo Clinic completes installation of Epic electronic health record" (in en-US). https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-completes-installation-of-epic-electronic-health-record/.
17. ↑ "Partners HealthCare's new computer system challenges some doctors, nurses - The Boston Globe". May 16, 2016. https://www.bostonglobe.com/business/2016/05/16/partners-healthcare-new-computer-challenges-some-doctors-nurses/1I4QsWGjCJ97xFmUbcDbaJ/story.html.
18. ↑ Gawande, Atul. "Why Doctors Hate Their Computers" (in en-US). The New Yorker. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers.
19. ↑ "Why big health systems are moving to Epic". Becker's Health IT. 17 October 2022. https://www.beckershospitalreview.com/ehrs/why-big-health-systems-are-moving-to-epic.html.
20. ↑ 20.0 20.1 Sullivan, Mark (December 8, 2014). "Saying Epic is a Closed System is an Oversimplification". Venture Beat. https://venturebeat.com/2014/12/08/saying-epic-is-a-closed-health-records-system-is-an-oversimplification/.
21. ↑ Creswell, Julie (September 30, 2014). "Doctors Find Barriers to Sharing Digital Medical Records". The New York Times. https://www.nytimes.com/2014/10/01/business/digital-medical-records-become-common-but-sharing-remains-challenging.html?_r=0.
22. ↑ 22.0 22.1 Caldwell, Patrick (October 2015). "EPIC FAIL. Digitizing America's medical records was supposed to help patients and save money. Why hasn't that happened?". Mother Jones. https://www.motherjones.com/politics/2015/10/epic-systems-judith-faulkner-hitech-ehr-interoperability.
23. ↑ Kobb, Enesha; Sauser, Kori (2014). Electronic Health Records. RAND. http://www.rand.org/content/dam/rand/pubs/research_reports/RR300/RR308/RAND_RR308.casestudies.pdf. Retrieved March 7, 2016.
24. ↑ Boulton, Guy (November 10, 2017). "Epic Systems lets patients share medical records with doctors around the world". Milwaukee Journal Sentinel. http://www.jsonline.com/story/money/business/health-care/2017/11/10/epic-systems-share-everywhere-medical-records-doctors/805805001/.
25. ↑ Muchmore, Shannon (December 4, 2017). "Health IT Development of the Year: Epic's Share Everywhere". https://www.healthcaredive.com/news/health-it-development-of-the-year-epics-share-everywhere/511124/.
26. ↑ 26.0 26.1 "Addenbrooke's Hospital paperless system's 'significant problems' reported". BBC News. November 24, 2014. https://www.bbc.co.uk/news/uk-england-cambridgeshire-30178011.
27. ↑ 27.0 27.1 "'Major incident' declared for flagship IT project". Health Service Journal. November 25, 2014. http://www.hsj.co.uk/hsj-local/acute-trusts/cambridge-university-hospitals-nhs-foundation-trust/major-incident-declared-for-flagship-it-project/5077079.article#.VJl7FF4gA.
28. ↑ "The NHS's chaotic IT systems show no sign of recovery". The Guardian. December 21, 2014. https://www.theguardian.com/technology/2014/dec/21/nhs-it-system-failings-addenbrookes-john-naughton.
29. ↑ "Addenbrooke's consultants reveal eHospital concerns in letter to management". Cambridge News. December 11, 2014. http://www.cambridge-news.co.uk/Addenbrooke-8217-s-consultants-reveal-eHospital/story-25546229-detail/story.html.
30. ↑ "Addenbrooke's Hospital's e-hospital finances investigated". BBC News. July 31, 2015. https://www.bbc.co.uk/news/uk-england-cambridgeshire-33735417.
31. ↑ "Addenbrooke's Hospital chief executive Keith McNeil resigns". BBC News. September 14, 2015. https://www.bbc.co.uk/news/uk-england-cambridgeshire-34249646.
32. ↑ "Addenbrooke's and Rosie hospitals' patients 'put at risk'". BBC News. September 22, 2015. https://www.bbc.co.uk/news/uk-england-cambridgeshire-34317265.
33. ↑ McBeth, Rebecca (February 25, 2016). "EPR implementation led to 'catastrophic loss of confidence'". Digital Health Intelligence Limited. https://www.digitalhealth.net/2016/02/epr-implementation-led-to-catastrophic-loss-of-confidence/'.
34. ↑ "Har brukt 2,8 milliarder på ny plattform: – Ikke mulig å tro at profesjonelle aktører er i stand til å lage et så elendig produkt" (in no). Digi.no. https://www.digi.no/artikler/har-brukt-2-8-milliarder-pa-ny-plattform-ikke-mulig-a-tro-at-profesjonelle-aktorer-er-i-stand-til-a-lage-et-sa-elendig-produkt/440508.
35. ↑ 35.0 35.1 35.2 35.3 Allen, Arthur. "Lost in translation: Epic goes to Denmark" (in en). POLITICO. https://www.politico.com/story/2019/06/06/epic-denmark-health-1510223.
36. ↑ "Report on Sundhedsplatformen". https://www.eurosai.org/en/databases/audits/Report-on-Sundhedsplatformen/.
37. ↑ Christensen, Mikkel Fyhn; Sturlason, Astrid Sofie (January 23, 2019). "Blå blok vil droppe Sundhedsplatformen: "Har gjort det værre for sundhedspersonale og patienter i stedet for at gøre det bedre"". https://www.berlingske.dk/content/item/1338165.
38. ↑ "Kuukausiliite | Näin Apotista tuli hengenvaarallinen epäonnistuminen" (in fi). 2022-11-05. https://www.hs.fi/kuukausiliite/art-2000009144930.html.
39. ↑ "Potilas joutui hengenvaaraan väärän syöpälääkkeen takia – lääkärit kertovat Ylelle, miten Apotin erilaisia ongelmia on peitelty" (in fi). 2022-08-06. https://yle.fi/uutiset/3-12558404.
40. ↑ "Yli 600 lääkäriä vaatii Apotti-järjestelmästä luopumista tai ongelmien korjaamista – poikkeuksellinen kantelu saapui Valviraan" (in fi). 2022-09-05. https://yle.fi/uutiset/3-12608890.
41. ↑ Lindsetmo, Ørnhaug & Opsal (2022-03-22). "70 leger er på jobbjakt: – Har en følelse av at ting ikke blir bedre". NRK. https://www.nrk.no/trondelag/70-leger-soker-aktivt-ny-jobb-ved-st.-olavs-hospital-etter-innforingen-av-helseplattformen-1.16348026.
42. ↑ "Demonstrerte mot Helseplattformen". NRK. 2022-10-17. https://www.nrk.no/trondelag/demonstrerte-mot-helseplattformen-1.16142412.
43. ↑ "Sjefen for Helseplattformen går av". NRK. 2023-03-09. https://www.nrk.no/trondelag/sjefen-for-helseplattformen-gar-av-1.16328152.
44. ↑ Hilde, Skjesol (2023-05-24). "Omstridt datasystem tapper landets fjerde største sykehus for penger - rammer satsing på psykisk helse". NRK. https://www.aftenposten.no/norge/i/WRdoa2/omstridt-datasystem-tapper-landets-fjerde-stoerste-sykehus-for-penger-rammer-satsing-paa-psykisk-helse.
45. ↑ Skjesol, Hilde (2023-02-04). "Drastiske kutt på landets fjerde største sykehus: – Vi kan ikke fortsette slik". Aftenposten. https://www.aftenposten.no/norge/i/on7qPW/drastiske-kutt-paa-landets-fjerde-stoerste-sykehus-vi-kan-ikke-fortsette-slik.
46. ↑ "Wisconsin-based Epic Systems ordering its 9,000-plus workers back to the office, though some employees fear 'untold deaths'" (in en). Chicago Tribune. https://www.chicagotribune.com/coronavirus/ct-biz-coronavirus-epic-systems-wfh-office-20200804-kq3zs2iewjdjrdlzkmrcp3e7fi-story.html.
47. ↑ Mesch, Shelley. "Epic Systems employees decry CEO's decision to call workers back to the office" (in en). Wisconsin State Journal. https://madison.com/wsj/business/epic-systems-employees-decry-ceos-decision-to-call-workers-back-to-the-office/article_9992c40c-c6e9-5c3e-842d-1e3cf5625ce4.html.
48. ↑ Farr, Christina (2020-08-10). "Epic Systems walks back plans requiring thousands of employees to return to work this week". https://www.cnbc.com/2020/08/10/epic-systems-walks-back-plans-requiring-employees-to-return-to-work.html.
49. ↑ "ORDER OF PUBLIC HEALTH MADISON & DANE COUNTY" (in en). Public Health of Madison and Dane County. https://www.publichealthmdc.com/documents/2020-07-07_Order_8.pdf.
50. ↑ Drees, Jackie. "Epic employees raise concerns over mandate to return to campus in September" (in en). Beckers Hospital Review. https://www.beckershospitalreview.com/ehrs/epic-employees-raise-concerns-over-mandate-to-return-to-campus-in-september.html.
51. ↑ Times, Natalie Yahr, Katelyn Ferral | The Capital. "Epic employees say coronavirus concerns met with retaliation, demotions" (in en). https://madison.com/news/local/health-med-fit/epic-employees-say-coronavirus-concerns-met-with-retaliation-demotions/article_7a7ce63e-4e56-5b57-a7f4-8c4dba286094.html.
52. ↑ Yahr, Natalie. "Epic makes national news as employees criticize planned return to campus" (in en). The Capital Times. https://madison.com/ct/news/local/neighborhoods/epic-makes-national-news-as-employees-criticize-planned-return-to-campus/article_8806d56a-0edb-56dc-95d5-1e6342ec4b8e.html.

## External links

* Epic, state's largest solar producer, to build own wind farm \- Milwaukee Journal Sentinel article
* Epic Systems feeling heat over interoperability \- Modern healthcare article
* Epic Systems, Leading Defense EHR Bidder, Slammed for Lack of Interoperability \- Nextgov article
* Patient records giant Epic Systems will take a big step into the cloud in 2015 \- VentureBeat article
* Cancer moonshot head recounts exchange with Epic’s Faulkner \- Politico article

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