When readers of HCI were asked what vendor they most wanted to read about, respondents picked one company by a wide margin (see graphic on page 28). The results weren't surprising, as one clinical information systems vendor has a truly unusual profile, and its very unusualness has given it a certain cachet. What's more, that company is different not just in one way, but in many. It has a unique operating methodology, sales approach, market strategy, history, and culture. It's even been described by some over the years as a “cult.” That company? The Madison, Wis.-based Epic Systems Corporation.
Of course, there are ways in which Epic does resemble its competitors. It sells corporately designed clinical systems software, which it implements in patient care organizations; it has a team of internal software developers and a team of implementers; and it competes with other core-clinical companies for the same essential base of customers, in both the inpatient and outpatient spheres (though Epic started in the outpatient sphere and moved into the hospital, while most have done the opposite). And it makes money — lots of money ($500 million in annual revenues as of late 2007 — see Epic's entry in the HCI 100, page 52).
But one quickly runs into a host of intriguing differences that make Epic different from the other major EMR and core-clinicals vendors in healthcare.
Epic almost never advertises, and relies almost entirely on word-of-mouth recommendations to market itself.
Epic does retain salespeople, but they make no commissions on sales, and act more like advisers and consultants than traditional salespeople.
Epic turns away potential business. Indeed, prospective customers meeting with Epic representatives find they are being evaluated as much as they are evaluating. Epic executives regularly turn down potentially lucrative contracts with hospital, medical group and health system organizations if executives don't believe those organizations can implement successfully.
Epic executives have evolved a very specific implementation process over time, one that involves intensive pre-implementation analysis and planning, but then focuses very strongly on meeting go-live dates. And in contrast to the pattern with most large vendors, Epic executives and implementers strongly discourage delays. This process is so rigorous that it has sometimes sparked charges of “rigidity,” a rare phenomenon in the healthcare IT world.
Rather than seeking experienced healthcare IT professionals, Epic relies on hiring a large corps of the brightest young, just-out-of-college IT professionals for its programming and implementation positions. The organization has worked to build a culture of dedicated, loyal employees with a generally uniform approach to development and implementation. The downside, many say, is that this team generally lacks deeper knowledge of the patient care processes. All employees are also virtually required to move to Madison and work out of the corporate headquarters.
Epic never grows through acquisition, but rather relies on internal development, in extreme contrast to all its competitors among the largest clinical IS vendors. This has not only been the case with the company's move into the inpatient world, but for product expansion as well. For example, executives confirm Epic may someday add PACS to its offering, but will only do so if the technology is developed internally.
Most of all, Epic has a very unusual corporate culture, one that intrigues and sometimes puzzles those who encounter it or hear about it, and which was described by one interviewee as “unique and funky.” That culture emanates to an extraordinary degree from the personality of the company's visionary, media-averse founder and CEO.
Given this unusual combination of characteristics, policies and strategies, it's no wonder Epic has become the most talked-about IT vendor in the industry. Indeed, the combination is so odd in certain ways that it would seem to be a recipe for market failure. Whoever heard of not advertising? Of turning away lucrative business contracts? Of making all its employees move to snowy Wisconsin? Of requiring masses of employees at its customer organizations to become formally certified in the mastery of its software? Of refusing to ever acquire another company? Yet, for a variety of reasons, Epic has within the past several years grown at staggering rates, and become one of the most successful EMR vendors in healthcare IT.
As it turns out, an unusual combination of strategic vision, cultural rigor, market strategy, and sheer luck have combined to make Epic an odd-duck success, and give it a unique mystique in the industry. The question is: Where to begin unraveling the Epic mystery?
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