Epic answers (well, answers some) questions

When Marc Eisen set out to write a cover story about Epic Systems Corp., he knew working with the famously insular tech company would be a challenge. But he did get a few questions answered.

As mentioned in my October issue cover story, “The Future of Madison’s Epiconomy,” Epic Systems Corp. is famously insular and used to setting the terms of its engagement with reporters. I’ve periodically written about Epic since 2002 and in the past interviewed top executives. But not this time.

I requested an interview in mid-May and was told in early June it would be “easiest” for me to submit written questions. You’ll find those questions and verbatim answers below. After the furor erupted over Epic’s plans to re-open the campus amidst the pandemic, I submitted additional questions. You’ll find them at the end of this story. Epic chose to answer only one.

After the cover story was written and in galley form awaiting printing, Epic did offer to arrange an interview. This was appreciated but our deadline had passed.

(A version of the following questions were submitted June 4, 2020 and answered on July 2, 2020.)

What are some of the biggest challenges and opportunities facing Epic?
Our greatest challenge and opportunity will continue to be helping health care organizations around the world succeed with their patient care missions, support their staff and operate sustainably. During the pandemic, we’ve helped our customers address many challenges like opening field hospitals, adding beds to existing facilities, expanding testing and tracking COVID-19 data.

Please explain where Epic sees itself going in the next five to 20 years in regards to market innovation.
A few things we’ll be working to expand in the future include:

• Epic Health Research Network, a journal designed for rapid sharing of knowledge to help solve medical problems. Studies published on EHRN are based on electronic health record data — spanning millions of patients — to accelerate research. Recent reports have examined delays in routine cancer screenings during the pandemic and associations between pre-existing conditions and COVID-19 severity.
• “Hey Epic,” a voice assistant that lets clinicians ask the system questions like, “What was the patient’s last cholesterol result?” and instruct it to order medications and perform other tasks. In the future, clinicians will be able to complete their notes and other documentation for some visits only by speaking – without using the mouse or keyboard.
• Artificial Intelligence helps clinicians make sense of thousands of pieces of patient data generated every minute coming from machines that monitor heart rate, blood pressure, temperature and more. There’s too much data for the human brain to process, but algorithms can take all of that complexity and turn it into understandable, actionable suggestions.
• Payer Platform automates data sharing and collaboration between payers and health care organizations. For example, when a doctor orders a procedure, the patient’s insurance company will be able to approve it electronically, reducing administrative work and helping patients get the care they need sooner. We see opportunities to continue to improve sharing across all parties to drive better outcomes at a lower cost.

What does Epic consider its most satisfying successes?
We’re proud to help health care providers save lives and keep their patients healthy. As our customers share their outcomes, we pass along what they’ve learned to other customers so that more patients can benefit.

What is Epic’s response to the May 4, 2020, article in The New Yorker that criticizes electronic health records? Physician “burnout” is a big issue in health care. Various studies blame the extra hours that docs put into EHR record-keeping as a major cause of their burnout.
The article highlights the factors that add to doctors’ work. Health care organizations use EHRs to collect information they are required to submit to groups like regulators and insurers, and this often results in physicians being asked to document information not directly related to patient care. Our developers work continually to automate these tasks and make the system easy to use.

Studies from KLAS, an independent research firm that interviews thousands of clinicians, have shown that the three most important things for physicians to be successful with Epic are 1) personalizing the system via its many configuration settings so that it works as the physician would like it to, 2) good training, and 3) an agile health system that continuously improves workflows, turns on new features and makes decisions quickly.

What is the status of the trust and medical foundation that [Epic founder Judith] Faulkner announced in 2015 as the inheritor of her stock? Has the Epic Heritage Foundation been created?
A trust has been established to support Epic’s long-term goal to remain private and employee-owned. A foundation has been established for charitable giving.

What’s the total size of the campus?
The campus is more than 1,000 acres total, with about 225 acres developed so far.

How many building phases have there been? How many square feet constructed and acres developed?
There have been seven building phases. This includes five office campuses, the Learning Center for customer training, and the Deep Space auditorium. Together, they cover more than 8 million square feet. Geothermal heating and cooling, underground parking and sustainable building materials help us reduce environmental impact.

Which architect(s) do you work with?
The architect is Cunningham Group from Minneapolis.

Are Epic staffers eligible to buy stock at a certain point? If yes, do they have to sell the shares when they depart?
Our stock program recognizes the commitment and dedication of our staff by giving those who have been at Epic for at least two years the opportunity to become owners. When staff depart, Epic can purchase back stock.

Does the company match staff donations, fund their donations, or simply serve as a conduit for employee gifting?
We give back to the community through volunteering, company-wide drives and annual donations to hundreds of nonprofits. We focus on supporting education programs for underserved populations and programs that provide medical assistance for low income, underinsured or at-risk populations. For our annual giving program, we offer a long list of charities ranging from food pantries here in Dane County to international disaster relief organizations. Each staff member gets to vote on how Epic allocates donations.

Epic is frequently accused of not sharing data with other systems. Critics argue that patients should be in charge of their personal data in a similar way that individuals can direct their financial info to be shared with third parties. They also say that opening the EHR data stream will greatly facilitate new apps that will parse the data and unlock new life-saving treatments. That Epic selfishly seems to think that the data is Epic’s. What say you?
Epic’s software allows secure data sharing with other systems using national interoperability standards. Our customers exchange over 5 million patient charts every day and nearly 2 billion per year. More than 40% of these exchanges are with groups using other systems.

We support connections with apps through standards called SMART on FHIR, and we publish the standards that we use online.

Patients can choose to share information from their Epic medical records through MyChart with any care provider in the world that has internet access.

App Orchard is disliked by some app developers who say Epic’s fees and revenue-sharing cut are both too high and undeserved. They say Epic provides no real help to them in making sales to health systems, so why should Epic be taking a cut of revenue?
App Orchard provides a variety of resources and support for app developers. Epic staff help them design their applications to integrate with our software. We provide documentation, tutorials and classroom training as well as test data, simulators and other tools to help them build and test their products.

To help app developers learn more about connecting with Epic, we provide webinars and discussion forums, and we host an annual developers’ conference.

Customers are free to choose apps that best meet their needs. When a customer chooses an app from the App Orchard library, Epic supports both the customer and the developer during the installation process.

Does Epic feel that its EHRs have produced the financial savings that were originally envisioned when the feds began subsidizing the conversion from paper records?
Our software supports our customers’ financial health in many ways. For example, Bellin Health in Green Bay uses Epic to manage its value-based care model, which focuses on wellness and managing chronic conditions. This helps their patients stay healthy and saved $1.4 million in one year.

Duke University Health System in North Carolina reduced the time patients spend in the hospital to treat complex conditions, saving $20 million over five years.

Moody’s financial data shows that organizations that switch to Epic improve their operating margins after installing our software.

For example, organizations that switched from one large EHR vendor had an average increase of 18% three years after installing Epic which improved to 41% five years after installing Epic. Organizations that switched from another large EHR vendor had an average increase of 38% three years after installing Epic which improved to 100% five years after installing Epic.

(The questions below were submitted on Aug. 28, 2020.)

Epic caught flack for its initial return-to-campus plan. What did the public and staff not understand about the urgency?
We were meeting continually with Public Health Madison and Dane County throughout the summer, sharing in detail our reopening plan. They repeatedly said that we had never been in violation of any part of the health order. In fact, they told us they intended to come visit our campus in person as the plan progressed. The letter we received from PHMDC on Aug. 7, one business day before our phased plan was scheduled to begin, was abrupt, unexpected and not representative of what we considered to be an open and collaborative process. (Answered Sept. 8, 2020.)

Under pressure from its staff and public health officials, Epic has since revamped and slowed (and/or adjusted) its return to campus. To quote a truism from veteran jazz artist Ben Sidran: “Life’s a lesson.” What lessons has Epic learned from this episode?
(Not answered.)

Other major IT companies with impressive campuses like Epic’s have embraced remote working as a safer yet productive way to carry out business. Why did Epic feel this alternative strategy was less than desirable for its work?
(Not answered.)

Because of the COVID-19 emergency, many hospitals and health centers are reporting big-time revenue declines and are cutting expenses by delaying electronic health record projects. Has this trend affected Epic’s revenue stream? Might Epic have to resort to layoffs as a result?
(Not answered.)

Epic announced a major internal consolidation recently. Are other major changes at Epic in the works?
(Not answered.)

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