Epic Electronic Medical Record Implementation: $100,000,000 for Stanford Hospital in 2005

Marc Andreessen and Jorge Conde podcast 25 minutes:

I don’t remember exactly probably a hundred (million) to Epic or something like that. And then I’d say 300 we went out for integration bids. And this is where I almost started crying. It was Perot systems, Ross Perot systems, which was the follow-up (to EDS). Ross Perot’s company, which is now owned by Dell.

And so yes, it’s a 400 million dollar project, Perot systems. I remember this was 2005. I think we started the Epic implementation and they were very excited. They’re starting the demo and I was very excited because I was like, wow, this is like a new house, probably to (garbled) be mobile.

This is when smartphones are starting to take off. This is mobile. And this sensor is like all this stuff that’s going to be great and it was like they were super excited because they had just moved to the Windows 95 UI. Right in 2005. It was like the big upgrade from Windows 3.1 and I was like, oh my God.

And so but you know, as you know, like is 20, which is 2019 and it’s still right. It’s obviously still it’s still the same thing, right? Yeah, we have an incredibly entertaining thing about epic is that they are so; you know out here it’s like out here there’s a big focus on software interoperability.

And so it’s like can one piece of software work with another this whole concept….. There’s entire companies now, they’re called API companies that build basically software building blocks you plug together, there’s open source and so out here, it’s just this constant process of everybody building on everybody else’s creativity and kind of the the whole thing rises except for epic which has an absolute prohibition on third-party integration.

(Epic) does not tolerate it. (They) will sue you if you attempt to integrate with it.

Taxpayers have spent nearly $40B (!) in backdoor electronic medical record subsidies since 2011. One of the goals of our extravagant taxpayer expenditures, part of the Obama era “stimulus”, was interoperability.

Airdrop trumps $40B emr subsidies.

Madison’s property tax base growth since 2011.

Design, experience and customer retention

I recently attempted to help a family member book a very long distance journey. We settled on Lufthansa.

However and unfortunately, their app and website could not complete the booking.

We then called the airline. They could not book the trip at the posted not small price (still published days later). They offered a 3X $ option, which we declined.

Another airline/alliance was selected for the journey.

LH is not unique in channel pricing conflict. I’ve experienced this on other airlines. Their app should be superior.

That is not the case today.

While navigating Lufthansa’s digital experiences, I encountered a terrible “app” screen, shown below.

The discovery was timely and became my contribution to Luke Wroblewski’s hostile experience league.

Hairballs are easy to create.

Olivier Krueger’s recent Linkedin post:

Idea < -- > App

Eric Lynn and I shared experiences with 22 entrepreneurs at a recent Friday lunch.

The setting, L’Etoile’s (Graze) private room was ideal: quiet and spacious.

The discussion was quite enjoyable if not illuminating.

Topics included tech platforms, money, brand, on boarding, user experience, ghosting, minimum viable product, out or insourcing, choosing a tech partner along with legal, tax and IP experiences.

I mentioned Ecclesiastes 11:4: [1]

Whoever watches the wind will not plant; whoever looks at the clouds will not reap.

(If you wait for perfect conditions, you will never get anything done.)

Appropriately 4 of the 22 participants simply showed up, rather than queue through the registration/waitlist process. It is good to show up.

We organized the lunch as part of the 10th Forward Fest.

Explore L’Etoile’s Capitol square space in amuz.

[1] Bethel’s Mike Brown referenced this passage during a recent message on uncertainty.

My Verse app.

“Firmware 2.0”

Spectre. Halide. FiLMiC. LumaFusion. Pixelmator. DarkRoom. PTGui. Videoleap. Lightroom. Capture One. Olympus Image Share. Flickr. Instagram. Vimeo.

I’ve become familiar with these product names – most are apps on my iPhone or iPad – through frequent use. The brand names illustrate how much digital imagery has evolved with the rise of the iPhone.

In fact, iPhone dominates Flickr’s list [1] of most popular cameras.

And, so it was, that I felt a bit nostalgic, if not sad when I noticed a Nikon advertisement placed on Amazon’s dpreview.com [2]

“Learn more about Firmware 2.0”.

Nikon. Oh, Nikon.

I’ve owned and used 6006, 8008, N80, E2, E2n, D1, D1x, D2H, D3 and D500 camera bodies along with interesting lenses, including the 17-35, various fisheyes and some long glass.

The “Firmware 2.0” text presence in an advertisement (!) illustrates the enormous challenge firms face as software eats the world [3] if not them.

Modern cameras and lenses are incredibly capable, assuming a customer masters confusing menus and buttons and manages via a miracle to connect their iPhone. Sony’s iOS app, to choose just one example, is an embarrassment that diminishes the utility of their cameras.

The iPhone, too, is a remarkable camera, supported by best in class hardware, software and a platform where developers create interesting combinations, such as the Spectre app [4].

Can the traditional camera and lens brands compete in a software eats everything world? [5]

I wish I was more optimistic.

P.S. Nikon’s Tokyo Museum is worth a visit. Tap to explore in amuz.

1. Flickr’s camera beauty contest.

2. Amazon acquired dpreview.com in 2007. I find the forums useful, but Amazon’s aesthetic is rather dated.

3. Why Software is Eating the World – Wisconsin native Marc Andreessen.

4. Spectre’s long exposure capability is interesting and very easy to use. A recent capture:

5. Camera & Imaging Products Association (CIPA) sales reports.

6. The world in 2013.

Madison Gas & Electric Substation Explosion

July 19, 2019

Traffic was moving slowly after breakfast with friends Friday Morning. I glanced around and noticed a rather dark, large smoke plume originating to my west.

While in traffic, my first thought was that the Sylvee had gone up in flames. The source turned out to be a Madison Gas & Electric substation. Fortunately, no one was injured. Curiously, I’ve seen no mention of this incident on their website.

I recorded a short video clip and captured a few images while moving slowly in Madison’s isthmus:

Madison Gas & Electric customers pay the highest rates in Wisconsin [https://www.zmetro.com/pdf/2019/wis_avg_res_electric_bill_2018_2019.xlsxxlsx comparison], up to 44% more than other Wisconsin utility customers. Why?

Madison Gas & Electric was embroiled in a lobbying scandal some years ago, sending money to a Kansas Democrat Party organ.

Airdrop trumps $40B Taxpayer Medical Record Subsidies

I recently compiled a bit of long term, personal medical history along with an image or two prior to meeting a new physician. I sought to share this digital information efficiently, and save everyone time, if not money.

However and unfortunately, Epic Systems’ My Chart app (Madison, WI based UW Health implementation) lacks the ability to ingest and share patient sourced images or documents…..

A few days later, in clinic, I used iOS’s AirDrop to share the text and graphics to the physician’s iPhone. While helpful, the lack of patient sharing tools meant that a clinic visit was required along with ever increasing deductibles.

Many healthcare providers share personal medical record data via the iPhone’s health app.

However and unfortunately, $3.65B UW Health’s Epic medical records cannot be shared to my iOS health app.

We continue to pay more for less.

The lack of interoperability is a reminder that US taxpayer’s now $40B back door electronic medical record subsidy has been a failure. Costs have exploded and we citizens lack data portability, despite the legislation’s requirement:

The HITECH Act set meaningful use of interoperable EHR adoption in the health care system as a critical national goal and incentivized EHR adoption.[7][8] The “goal is not adoption alone but ‘meaningful use’ of EHRs—that is, their use by providers to achieve significant improvements in care.”[9]

There are pockets of innovation. One Medical’s app supports video visits:

Thankfully, the visit was of no consequence, other than time and money.

Additional reading:

Death By 1,000 Clicks: Where Electronic Health Records Went Wrong

Madison’s Property Tax Base Growth; $38B+ Federal Taxpayer EMR Subsidy

Stillborn 2007 Wisconsin $30M EMR subsidy.


A reader asked me to write tonight about the Health Information Technology for Economic and Clinical Health Act, which is about as far from something I would like to write about as I can imagine, but this is a full service blog so what the heck. The idea behind the law is laudable — standardized and accessible electronic health records to allow any doctor to know what they need to know in order to treat you. There’s even money to pay for it — $30 billion from the 2009 economic stimulus that you’d think would have been spent back in 2009, right? Silly us. Now here’s the problem: we’re going to go through that $30 billion and end up with nothing useful. There has to be a better way. And I’m going to tell you what it is.

Russ Britt:

The costly flaws in U.S. digital health-data plan

Design, Brand, Leadership and Vision

Walking around SC Johnson’s impressive Racine campus recently, I turned a corner and this image lay in front of my camera.

Shift, focus, focus again – quickly as time is short – capture.

I found the fusion ideal: VW’s superb GTI and the Frank Lloyd Wright designed Research Tower are symbiotic.

To wit:

Wright called his design a “helio-lab,” or sun-lighted laboratory. At the building’s dedication, he said he hoped it would be a “flower among the weeds” of typical, “drab” structures built for business.

CAR magazine’s Good, Bad and Ugly on the GTI:

GTI is your dad when he was wild, young and free. After seven generations, VW has this hot-hatch thing nailed.

Pondering this random scene, my thoughts returned to driving some rental Toyota’s in Japan last year. Fine cars and well sorted interfaces with my iPhone, but, they were not a GTI. There may be hope, after President Akio Toyoda recently decreed “no more boring cars”.

VW appears to understand stimulants. Our youngest – no car fan – recently messaged me a link to “Hello Light”:

That said, she did speak well of a European VW Polo’s iPhone support during a recent rental.

Design, well done, adds incredible value to experiences and perceptions.

P.S. Wright’s impressive tower apparently cost four to five times the proposed budget. Wright and VW share tortured paths.

P.S2. I’ve owned a 2013 GTI since new. It is a (very) fun car to drive and has been more reliable than expected.

P.S3. SC Johnson’s (free!) architectural tour is rather impressive, from the knowledgeable guides to the visual stimulation. I find their approach to brand building quite interesting and, perhaps somewhat aligned, if not symbiotic, with Volkswagen’s.

P.S4. Mr. Toyoda has tapped into a fascinating and tension filled topic: Mission – let’s call it design – vs. Organization – let’s call it operations. The tension between mission and organization was recenlty exposed in several articles that discussed Jony Ive’s departure from Apple – and the quick reaction, which continues.

P.S5. For those unable to visit in person, the amuz app (amuzapp.com) features a number of Wright destinations, including SC Johnson’s headquarters and research building along with the nearby Wingspread estate.