Epic is the nation's leading provider of electronic health record (EHR) software. According to an article by Becker's Health IT in 2020, Epic held 29% of the EHR market share. At that time, it also boasted more than 250 million patients with an active electronic medical record on the system. If you haven't heard the story behind Epic Systems, it is most certainly one of humble beginnings. Starting in the founder Judy Faulkner's basement in 1979, Epic has grown to the number one software in the KLAS.
Epic implementations at large health systems are notoriously nightmarish for all involved. Marked by lengthy training periods, frustrations, financial losses, and clinical inefficiencies, Epic implementation periods are said to take anywhere between three months and three years. In 2013, Maine Medical Center claimed a 13.4 million dollar loss citing a "botched" Epic implementation with a price tag of 160 million according to an article published in Becker's Health IT.
Despite the arduous process of getting into the Epic club, nearly 190 health systems went live on Epic between September and December 2020. Undeterred by the challenges of getting up and running on Epic, large health systems are dishing out upwards of 1 billion dollars to modernize their processes with Epic systems.
Epic's rise to the top has been blemished only by accusations that the company prioritizes profits over patients and its actions can be interpreted as attempts to monopolize the EHR market. According to Becker's Health IT, in 2013, Epic came under fire for declining to join the CommonWell Alliance designed to streamline information exchange among EHR systems.
Resistance to market collaborations and accusations of intentionally poor interoperability bubbled up again in 2019 when Epic's CEO emailed customers urging them to oppose HHS rulings permitting open APIs and enhancing patients' right to access and store their personal health information. At the time, Faulkner cited privacy concerns. Still, critics regarded the email as an attempt to assert and maintain control over health records and squash competition in the industry.
The software's functionality is undoubtedly extensive, and this fact is the number one cited reason most health systems give when asked why they switched to Epic. Everyone wants "one system that can do it all." This and the power of the masses. When everyone around you is switching to Epic, it's easy to follow the crowd. As Dr. John Halamka, former CIO of Beth Israel Deaconess Medical Center and current President of the Mayo Clinic Platform, said in his 2014 post, "No one got fired by implementing Epic." It has become a safe and popular choice among large health systems.
But Does Epic Really Do it All?
Epic may be the best of the EHR solutions for large healthcare organizations, but that doesn't mean that it lives up to the hype or the price tag it carries. Don't get me wrong, reviews of Epic by clinician users are generally pretty good. But let's remember that the relief of leaving behind an archaic system for many organizations is likely influencing their feelings about the shiny, new Epic solution. System satisfaction is all relative. After welcoming Epic, it is worth noting that the most common complaints about the system are related to the problematic onboarding, limited customizations, and overall "clunkiness" of the technology.
In his 2018 essay, Atul Gawande referring to the Epic system wrote: "that promised to increase my mastery over my work has, instead, increased my work's mastery over me." A system that is supposed to streamline workflows and improve the physician experience is, in some cases, doing the opposite. The extensive functionality can instead contribute to a disorganized mess of information and inbox items that overwhelm recipients. Gawande even goes on to associate cumbersome EHR tasks and documentation with an increased likelihood of physician burnout.
Historically, the patient-facing side of Epic, MyChart, has been scrutinized for its lagging user interface and limited functionality. MyChart has undergone a significant redesign in recent years with new features, improved aesthetics, and advanced usability. Epic has also relented to legislature requiring increased medical record access for its patient users with these changes.
As with most patient portals, MyChart provides patients access to their health data, including MD visit summaries, lab values, test results, and imaging impressions. This data is certainly handy, and giving the patient access to their health information is essential for empowering patients to direct their healthcare. However, these materials provide information that most patients have no clue how to use. Doctor's notes are written in medical jargon and serve only to confuse patients, not inform them. Once again, we are failing to provide patients with the information they need to truly understand and participate in their care plan.
Jack of all Trades, Master of None
My intention is not to put down Epic. Let's recognize the simple fact that facilitating all aspects of healthcare delivery across varying departments within extensive organizations is a tall order. I commend Epic for setting itself apart as a solution that can address each piece of the complex healthcare delivery puzzle with a comprehensive system. It has grown exponentially with very little marketing because the software speaks for itself, and it is an impressive solution. But the fact is, doctors are still frustrated, and patients are still yearning for more. So, what happens when Epic is still not enough?
The medical system has embraced a culture of specialization. When diagnosed with cancer, we want to see an oncologist. When diagnosed with heart disease, we want to see a cardiologist. Naturally, we seek care from those most qualified to provide it. Perhaps the same should be valid for digital health. Large EHRs like Epic that attempt to do it all and focus on the big picture lose sight of the little guy - the patient. It's possible that they are not the most qualified to support every single piece of the healthcare experience, especially the pieces that need to be more personalized. Can we blame them? It is impossible to be the best at everything.
You Have Epic but Still Have Problems… What now?
Despite the forward momentum in healthcare and the growth of these large EHR solutions, most organizations are still battling clinical inefficiencies and failing to provide the continuous, accessible care that patients need and desire. Given the immense popularity of Epic, it's no wonder the system has a hard time living up to the high expectations after implementation. It is worth mentioning that there are several other inherent problems in the healthcare system that stretch well beyond the software being used to facilitate care.
Even in organizations that have adopted Epic, clinician burnout is persistent. Many providers are disheartened by logistical challenges that prevent them from delivering the fulfilling care they wish to provide. Despite access to MyChart, patients continue to complain about the lack of continuity, poor communication, and spotty support they've grown accustomed to from their healthcare providers. The results of these persistent challenges are patient dissatisfaction, poor care plan adherence, suboptimal health outcomes, complications, and unnecessary hospitalizations.
But for organizations that just spent hundreds of millions or even billions of dollars on a system supposed to address these problems, it is hard to admit that more help is needed. Perhaps one system cannot provide the best solution for billing, charting, PHI management, provider workflows, and patient care. But maybe multiple, integrated solutions can.
Fueling a Culture of Patient & Provider Empowerment
The bad news - Epic didn't fix everything. The good news - there are other solutions. Open technology, integration capabilities, and industry cooperation can facilitate a better healthcare experience for providers, patients, and families. Digital transformation opens tremendous opportunities for dynamic, specialized, and innovative technology companies to deliver solutions designed to get to the root of these persistent problems and prioritize the patient and provider experience.
There has been a substantial and necessary shift in healthcare, leaving behind a culture of medical paternalism and rapidly ushering in a culture of patient empowerment. Patients have more choices about medical coverage, health institutions, treatments, and interventions than ever before. With this cultural shift comes a need for supportive technology developed with each patient's unique journey in mind. Patients may not choose what EHR their provider uses, but they should have a say in the applications they use to reach their health and wellness goals. Healthcare needs collaboration in the digital health space, not monopolization.
Support the Patient Journey with Comprehensive Virtual Care
Epic is not the answer to all problems, and it shouldn't be expected to be. If your organization is still grappling with daily patient care challenges and the large EHR system just isn't cutting it - there are other, innovative solutions to consider. Custom technology solutions crafted by passionate people who work collaboratively with you can solve even the smallest of problems and dramatically improve the healthcare experience.
The future of health is comprehensive virtual care. At Fitango Health, we specialize in enabling providers to deliver continuous, virtual, patient-centric care. We believe wholeheartedly that care shouldn't stop when patients leave the clinic and that simply giving patients access to their PHI is not enough. Patient portal technology alone does not provide patients with the tools they need to understand and engage with their care plan. I'd be willing to bet that most patients don't log into MyChart more than one or two times immediately following their medical visit. In this case, poor engagement with the technology could result from lagging adoption, inadequate familiarity with digital tools, and behavior deviation from the traditional healthcare experience.
Changing consumer behavior is no small task. But based on persistent frustrations and ongoing problems in healthcare, I'd say it's time for a change. Suppose we endeavor to change patient behavior in the name of empowerment, improved adherence, and better health outcomes; we must be willing to give patients the kind of digital experience they want and need.
The Fitango Health solution was created with the patient journey in mind. What information does the patient want after their visit? What is most important to the patient when they communicate with their doctor? How can we incorporate family members to give patients a robust support system? How do we monitor the health of a community to prioritize prevention and keep individuals healthier?
With the answers to these questions built-in, our solution closes the loop for a continuous patient journey and extends the reach of clinicians beyond the four walls of the clinic. Our population health mechanisms emphasize prevention and community health. We don't have to ask ourselves questions about billing, scheduling, and documentation because our solution focuses on the patient and the support they need between encounters.
Now that we've thoroughly reviewed reasons to consider adding a virtual care solution to your existing workflow with Epic, the next question is likely about how the two solutions can work together. We know how busy healthcare providers are and that double documentation would be highly disruptive to workload and efficiency. The Fitango Health solution is application programming interface (API) based, meaning it can communicate with other open technologies. Recall from above that Epic and other large EHRs are increasingly "open" to remain in compliance with regulations designed to improve patient access to PHI. Thus, the systems can share data, allowing them to work harmoniously and allowing you to better care for your patients.
If you are working on Epic or any other large EHR and still struggling to deliver the quality of care, you would like to provide - there is a solution. Digital Health is one of the fastest-growing markets, and there is no shortage of innovation in this space. At Fitango Health, we are passionate about helping providers and patients collaborate and communicate more effectively. We believe in contributing to a culture of empowerment in healthcare and embracing virtual health. If you are looking to transform care delivery at your organization, request a consultation and let us show you how our technology can work with Epic (or another EHR) to usher in the future of healthcare.
Written by: Jessica Cobb, PT, DPT, and Director of Business Development for Fitango Health