Epic CEO in exclusive ViVE panel: We can now interoperate with the world

I heard that Judith Faulkner, the billionaire founder of Epic Systems, who has almost unrivaled EHR market share in the US, was hanging out alone at the inauguration ViVE Conference kicks off Sunday in Miami. As part of Monday’s event, I’ll be on stage interviewing David Feinberg of Cerner, CEO of America’s No. 2 EHR provider, and think maybe Faulker wants her voice too. I contacted an Epic spokeswoman.

So, on Tuesday, March 8, which also happens to be International Women’s Day, I had the opportunity—for the first time—to hear directly from one of the most prominent women leaders in healthcare in ViVE’s media lounge.

Faulkner is unlike any other top CEO I’ve interviewed. Most of them are surrounded by an entourage of one or more corporate communications professionals. Even lower-level leaders from Amazon and elsewhere try to often seek the blessings of media relations experts before they answer questions. Faulkner came alone. It helps that Epic isn’t a public company, so her comments don’t move the market in some way, but they’re still noticeable. When the interview ended and I asked her why she was alone and not with the PR person, she took a dramatic look from side to side to emphasize the point, smiling and retorting, “Why not?”

As a woman, but as a journalist, I admire her talent. But throughout the conversation, it became clear that she doesn’t tolerate criticism of Epic. She believes she is building the best EHR in the world and is as steadfast in protecting Epic as a mother protects her children. Therefore, she cannot admit that the EHR she developed in Wisconsin was flawed in any way or form. Whether this is an advantage or a disadvantage is up to you. Below is an edited version of the conversation based on the topics we discussed.

interoperability

MedCity News: I guess the main criticism of Epic and EHR is that it’s a closed system. A specific criticism of Epic is that it’s not particularly interoperable, and that’s the path we’re currently on. So do you agree with these criticisms? how do you want to do it?

Faulkner: My husband is a pediatrician. I came home one day and found him very upset. There are some problems with his child…as long as she is cared for. But she and her parents went to another city and got sick. They took her to the emergency room and she died. He said over and over again that if she only had her records, she would have survived.

So I went to HIMSS and said, “When are they going to standardize so we can interoperate?” HIMSS said, “Don’t hold your breath.”

I go back to Epic and I said we won’t be able to interoperate, but we’re smart people because we can standardize among our customers and maybe governments will follow suit. So we wrote Care Everywhere. This was somewhere in 2004-2005.

It took us about two years to write it and then nobody would use it.

They said it was too dangerous. So in the end we got some people to use it and they started talking about it and then it was like wildfire. The CEO who came to our user group meeting said the only reason he decided to use it was because his CIO came up to him and handed him some documents saying, “We need this software,” so he signed it. And said if he knew what he was going to sign, he would never have signed it. It took a few years for people to start using it.

So they exchanged data, they talked about it, and they said it was great. We went to every customer (Faulkner knocked the table three times) and we made every customer take it. We retrofitted it to an older version so that no one in the whole of America was without it.

Now we have helped the government set the standard. Their standards are pretty much the same as what we do.

MedCity News: But it’s a closed system, right? I think the point they’re trying to make now in the healthcare system is that it’s not just a matter of Epic systems talking to each other. You need to have other entities talk to Epic.

Of course. Now, 50% of our transactions are with non-Epic, and many other entities we communicate back and forth. We exchange 9 million patient records every day. No one comes close to this, and if you look at Cerner, be very careful – they advertise documents not patients. So you need to know how many patients it represents, not how many files. We do more than anyone else.

Then, when Faulkner brought it back to interoperability, the conversation turned to other topics covered below.

Faulkner: I was talking to a customer and he said, “My Epic site can communicate with any Epic site in the world. And my Cerner site can’t communicate with the Cerner site across the street.” We said, “Then , if they can’t communicate with it, how can we communicate with it?” And we said to our employees, “Stop that as an excuse. Even if others can’t, we have to figure out a way to communicate with them.” [pounds table lightly]

So we created something called Share Everywhere [holds up her phone and opens her MyChart medical record].

Share anytime, anywhere – wherever you go in the world with internet, you can exchange your records and send data back. So when I hear that others can’t do it themselves, I don’t want us to keep saying, we can’t do it. So with Share Everywhere, you can give the clinician at Eiffel Tower someone who has nothing but that computer – no Epic, no Cerner, no Allscripts, nothing – you can give him a code, information will be passed back and forth.

So we can now interoperate with the world.

But my more important point – we invented interoperability and spread it to everyone.Somehow there is this [perception that] “We don’t interoperate.”

In fact, this sentiment must be widespread. At the Vive, I heard from a healthcare executive something I’d heard before, “Every instance of Epic.” I repeated it to Faulkner, and she said she didn’t know what that meant . When I say I mean there is no guarantee that a clinic that has Epic installed can talk to another clinic in town that also has Epic installed. “That’s not true,” Faulkner countered.

So I decided to find others at ViVE to share their experiences with EHR and interoperability. The senior executive, who uses both Epic’s and Cerner’s EHR systems, did not want to be made public. In comments, the executive countered Faulkner’s assertion that Epic’s EHR is interoperable with Cerner’s system.

that is not real. These systems are not designed to be platforms that are easy to connect with others, whether it’s another EHR or a new feature that a startup has to access. And while we’ve shifted somewhat in our tools to support providers and patients, we haven’t really achieved interoperability.

Hospitals have to invest in expensive middleware, the same middleware you need to effectively connect to startups for EHRs to communicate with each other. Or you must invest in a large IT department to create highly customized, integrated solutions that require extensive maintenance.

Yes, they can eventually talk to each other, but you need to invest a lot of resources to get to that place, and it’s not a walk in the park.

artificial intelligence

Medical City News: Let’s talk about artificial intelligence.I think there are some Epic’s missteps with AI related to sepsis prediction. So I think some people want you to describe how you came up with these algorithms because the power of artificial intelligence is very powerful, for better and for worse. So, what lessons have you learned from this?

Faulkner: Let me back it up a bit. AI has always been around. When software starts, artificial intelligence starts. As I stand by the elevator, I think, there is artificial intelligence in the elevator to determine which one should come to you. So artificial intelligence is everywhere. There are two kinds of AI. One is to look at something and remind you that your doctor will prescribe medication for someone allergic to it, and the AI ​​says no, don’t do it. We have tons of these alerts going out all the time. Another kind of AI is digging through all the information and trying to figure out what conclusions I can draw from the information so I can help people draw. With regard to sepsis, what do you mean by blunder?

MedCity: This is mine found onlineThe tool, known as the Epic Sepsis Model, is part of Epic’s EHR, and the University of Michigan School of Medicine in Ann Arbor found that its output was better than what the vendor reported when used on a large retrospective sample of 27,000 adults “Much worse” Michigan patients.

Faulkner: I don’t think it’s actually being applied. It is applied theoretically. big difference.

A very competent spokesperson provided more details on Epic’s sepsis model via email after the interview.

1. Complete models, mathematical formulations and precision measurements are available to every customer.
2. The authors use a hypothetical approach. They don’t take analytics into account and need to be tweaked to get the best results before actual deployment.
   
3. To predict who was likely to contract sepsis, the model was trained on patients with past clinical diagnoses of sepsis.
4. The University of Michigan is still using Epic’s sepsis model at their hospital as part of nurse screening.