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Behind the Curtain

May 29, 2008
by Mark Hagland
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Epic's unwavering commitment to its unique values has created an unusual recipe for success. What's behind Epic's gains in the clinical IT sphere?

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 Headquarters

    Photo: Glenn Loos-Austin

    EPIC Headquarters

  • 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.
    EPIC Headquarters

    Photo: Anthony Guerra

    EPIC Headquarters

  • 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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hmmmmmmm.....are we sure you're not talking about MEDITECH?? these two "cults" sure are mighty identical.....

Having worked with the Epic software for a number of years, this is an accurate representation of my experience with Epic and their employees. The beauty of Epic has been the ability to "personalize" the product, as mentioned. My recent concerns have been with the implementation of their Model System, some of the personalization may be lost, and customers will be pushed to implement the Model System, as is. I am nurse who does Epic consulting work. I've noticed that hospitals who chose to use the Model System don't seem to know the application as well as they did prior to the Model System being offered. Granted, the Model System provides the client with a "starter set," but my recent experience with Epic employees is that they present the Model System as the only way to go. Workflows documentation, both current and future state, were key in determining the build when I began working with the Epic product. Recently I've heard Epic employees say that workflow analysis is not important, which concerns me a great deal. While Epic does hire the best and the brightest, I've been frustrated by several experiences with Epic employees who have never stepped foot inside of a hospital, and therefore have no idea how things operate, but present like they do, which is misleading to customers. I frequently remind customers that their implementation is their implementation and not Epic's and that they can push back if something doesn't feel right to them. I worked closely with an Epic Application Manager at one point who saw the value that consultants can bring to Epic implementations. She acknowledged that she didn't have hospital operations experience, but recognized that I did, and wasn't threatened by me or my knowledge. I, by no means had the software knowledge that she had either, but working together we were a great team. It was one of the best experiences that I have had with an Epic implementation. I valued her expertise and vice versa. Epic has always gone the distance in making sure that the customer gets what they need.

Nice looking campus.

Obviously the Epic culture works...working with their product and in the industry, I only have high regard for them. Other employers could learn a lot from their corporate is a relaxed environment of talented people who are empowered to be creative and to work to their full potential. They utilize young talent who know the meaning of "cutting edge" and have the "I can do anything" attitude. When you visit the campus you just say, "wow-I wish my company was like this." Who wouldn't like a sunroom and fireplace to help them feel more productive? And there is plenty of brain food with the large offering of organic and health food available on the "green" campus...they take care of their world, employees, and clients while making money doing it. I would say that should be a lesson learned for all.

whats that all about?
care to explain?
i'd be curious.