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The Stepford Site Visit?

August 1, 2011
by Bobbie Byrne
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Fears of a robotic show-and-tell yield to a more reassuring reality

Some time ago, I heard that Epic had pulled down over a billion dollars in sales based on site visits to Evanston Northwestern Healthcare (now North Shore University Health System), on Chicago’s North Shore. I have no idea if that is true or not (but that does not stop me from quoting it). The real number could actually be much higher, since there was a point in time when all the Epic prospects went there for visits. During my time at Eclipsys, I would cringe when I knew that a prospective client was heading to Evanston, as I knew they would come away with a very positive Epic impression. At Eclipsys, we sometimes struggled with managing the site visit experience. I had heard that Epic was a master at it. I was expecting a very scripted, Stepford-wife like day, with Evanston parroting the Epic line. (For those of you who are not students of 1970s cinema and pop culture, a Stepford wife is a docile and submissive robot wife.)

So with this legacy, I was pretty excited for our own visit there. Evanston Hospital is not new territory to me. As it was a teaching affiliate to Northwestern Med School for many years, I spent time there as a medical student and a resident. I was an attending within the employed physician group there (note that I say “employed,” and not “owned,” physician group). Probably most importantly, my triplets were born there and lived their first month in Evanston’s NICU. However, it has been several years since I had roamed the halls, and I had never been on an official site visit there.

Scheduling the visit was a little challenging. North Shore has had some of their valuable staff pilfered off by other organizations and so they were not exactly thrilled for a local hospital to come on site to recruit. Once we gave the proper assurances, we had a deluge of Edward folks who wanted to attend. It killed me to tell an interested physician, who wanted to take his own personal time to attend, that we just did not have room for him. We finally got it down to the maximum of a dozen attendees: five physicians, six nurses and a sole revenue cycle representative. Of course, as my team tells me all the time, I “don’t count” as a physician, so I guess there were only four real physicians and one IT person.

From the moment we walked into the door of Evanston Hospital, our hosts could not have been more gracious. They fed us food that tasted nothing like hospital food. They touted the single patient record as the key to success. They assured us that Epic was a great partner. They reinforced their own executive involvement in the implementation. (Epic implementation metrics are part of their management incentive plan and for three years, it was the only metric on the plan.) They shared with us that Epic is there to solve problems. It is an asset to be leveraged, not a capital expense to be depreciated.

So mid-morning, I am feeling pretty good. After all, the IT staff and super-users in the conference room liked their system. Not sure that I thought this was too Stepford-like, it is expected for this group to be proud of their system. Of course, we like Magic too. I was looking forward to getting out on the floors.

We divided into groups based on specialty and interest. We would be escorted around to specific places (Ah-ha! I thought—this is how they hide all the deep dark secrets…they will only let us talk to the android robots who like the system!). Once again, I was wrong. We did have specific people at each location who were expecting us, but it was not staged. Every user took us through their workflow and expressed a very balanced opinion. They showed us the things that they like (very many things) and the things that they did not (just a few). We talked to many other clinicians. The most common opinion expressed across all the different departments was that they could not understand why we were even hesitating, was that, of course we should use Epic; it is great.

So, unable to find any fake or staged site visit set-ups, I wandered around to find some of my old clinical friends. I knew they would tell me the truth. I hit the jackpot when I found a former mentor in the NICU. She is a demanding physician with the highest sense of patient care quality. And wouldn’t you know it, even she liked the system! (Then she told me that it was a waste of an outstanding clinician that I had left practice for administration—which made me feel pretty good…) I saw my cousin in the ED. She is a tough “treat’em and street’em” nurse and she actually gushes a little when she talks about Epic.

So back to the conference room for a wrap up. The Edward team regrouped and shared some stories of what they had seen—from behavioral health to physician office to scheduling, everyone had the same feeling. This is the real deal --with no Stepford wife androids to be found.

Kudos to North Shore for doing such a fantastic implementation, and thank you for the hospitality.



I keep seeing many clients go through the painful process of gutting all their legacy systems and install Epic. You would think that the vendor that is losing the most market share would wake up and smell the Napalm. But they are suffering the same effects as pilots with visual disorientation. They fly right into the ground in a death spiral. For some reason they cant read their own dashboard reports and make some radical changes to keep their current clients happy and develop a true single record.

Here's my theory. Epic is well known for 'flooding' the hospital with staff, both during and after the install. I recently read on a blog where some 80% of the install staff are around long after go live.

So with that many bodies around giving almost immediate attention to anything that could go wrong it's easy to see that an end user would feel good about the vendor. Of course the facility gets billed for all of it and may pay dearly (as some other bloggers have noted) but the rank and file staff probably are not aware of the real costs. They are just happy to get the attention when they need it and pleased that administration is willing to invest in them. What I found during my years as a vendor was that when a system problem occurred 80% of the solution was just showing the client you were paying attention and were on top of it. You could tell them that the short term solution was some weird manual work around, but that was ok as long as you were there.

Now here's the kicker. What Epic has been able to do (and other companies not) is convince administration that a 'Mercedes' install is what they need and be ready to pay for. If the hospital is not, Epic will walk. If you are a public company chasing quarterly numbers walking is not an option, if you are a private company and can get a big upfront cash deposit walking is easy. So when the public company is told your install is too expensive, that company is very likely discount (or cut the hours down based on some flaky rationale), then six months later when problems arise no one is right there to pick up the pieces.

That's my story and I'm sticking to it!

I have the exact same question!! I used to think that since Eclipsys had a bunch of New York City sites, we could not put up our tough New Yorkers up against the nice Epic midwestern customers. But there is something very different here than geography. There is something in the Epic implementation that makes a difference I think.

Another great post...very interesting. So everybody loves Epic (well almost).

To me the most interesting part is this. You worked for a competing vendor for many years. Your description of the 'typical staged' site visit is realistic. I myself built and ran an HIT firm many years ago, and know that there is always at least one person (usually more) at a facility that is less than happy about the vendor and typically very vocal. Somehow they do not exist at Epic sites. I note you said the users were not 100% happy, but all very positive and seemingly realistic in their expectations.

How is it that Epic can accomplish this feat, yet other vendors can't. Why can't Eclipsys do this, McKesson, GE, etc ??? I don't expect a specific answer, but as a former vendor myself I know that getting everybody 'on board' at all levels is a monstrous task. To avoid the malcontent issue the vendor usually shepards the visitor around and jumps in when the malcontent appears. Not so with Epic.

I have some theories about how they accomplish this...but I'd like to hear your thoughts first.

Frank Poggio