“For most companies,” she continues, “their number-one concern is returning revenues to shareholders. And so Judy's never had to sell out. And it really allows you to do the right thing. And she is so geared towards doing the right thing. And her philosophy has been, if I hire smart people and focus them towards doing the right thing, it will work out.”
“So instead of hiring jaded people,” adds Costin, who in her past job led implementations of all the largest core-clinical vendors' products, “she hires the best and the brightest right out of school, and grooms them in a culture of focusing on the customer.”
The strategy of using smart young people straight out of college or graduate school is probably the company's most controversial, judging from conversations with those in the industry, and it appears to cut both ways.
“The people they hire are very intelligent people, but they don't have healthcare experience,” notes Christine Booker, a partner with the Dallas-based ACS Healthcare Solutions, who is helping to lead an extensive Epic implementation at a multi-hospital system in Southern California (which, she declined to specify). “And that leads clients to go back after the initial Epic implementation and spend a considerable amount of time doing what they call optimization.”
One inherent weakness in hiring people without healthcare backgrounds, says the Pasadena, Calif.-based Booker, is that, “The young people, as consultants, can't say, based on their experience in healthcare, that, yes, this or that is the best way to use this application in your organization.” Also, she adds, “The whole Epic certification they require has caused the IT staffing salaries to get very far out of whack on the client side, because you need staff with Epic certification in every single area. So these people are now leaving the client organizations, and they are commanding some very high salaries.”
That said, Booker quickly adds, “I think that their product is probably the best in terms of all the electronic medical records out there. It is absolutely the most integrated product out there. It's fully integrated; it has the ability to create standards for documentation in patient care that will allow the hospital to be that much more proactive if it's implemented appropriately.”
What's more, it is on the implementation side that Epic really shines, say observers. Gerry Bartley — president of Healthcare Informatics Associates (HIA), an Infologix company, and executive vice president and managing director of healthcare consulting at Infologix HIA, Bainbridge Island, Wash. — says he's never been involved in an Epic implementation that failed.
“The difference is that they have a methodology. Sometimes, it's very rigid; and that's an objection. And you have to push back sometimes.” But, he says, the intense preparation prior to actual implementation work is a strong differentiator for the company.
The question of excessive rigidity came up during the Epic EMR implementation at Children's Hospital of Philadelphia (CHOP) recently, reports Brian Wells, who was an IT project director at CHOP during that hospital's recent implementation period. As the CHOP organization neared the target go-live date of two years from inception, Wells, who in September 2007 became CTO at the University of Pennsylvania Health System, also in Philadelphia, says, “Epic was pushing us to get to the go-live on time. We ended up delaying the go-live by seven weeks, which isn't much on a two-year project, because we needed to test. But if we had listened to them, we would have had a rougher go-live. And that's because they tend to be working hard with multiple go-lives, so if a customer slips that complicates them.”
That having been said, Wells says of Epic's young, but “energetic” people, “They will do everything they can to help you be successful. And they're also Midwestern; they're very friendly and gentle. The advice I was given was, if Epic tells you something three times, you'd better take it seriously. Because that's how they do it; they will keep coming back at you with questions and issues. And they do a monthly status report and review, a kind of report card with how your project is going.”
Carl Dvorak, Epic's executive vice president, and the company's clear second-in-command, says, “I haven't heard the word ‘rigidity’ used before. We have over 100 major projects in process right now. What we've learned is that we can look at past projects, and within a zone of safety, we can tell when that project will be ready to go live or not. For many of our clients, it's their first major project like this. People who want to wait or stall to go live want to achieve a better outcome. And I've found that by delaying, usually they're not ensuring a better outcome. At the end of the day, if the organization truly understands and they decide they want a few more months, we understand.” Besides, he adds, “Our people don't get a bonus for finishing up early.”