Paying – Repeatedly – for Epic’s Walled Garden

Taxpayers have spent more than $38B (!) since 2011 on a backdoor electronic medical record subsidy [1]. Verona based Epic Systems lobbied [2] for these expenditures and has benefited greatly from this federal taxpayer largesse.

Interoperability, that is the ability to move your digital health data anywhere, was one of the arguments for this lavish spending.

However and unfortunately, Epic’s Founder and CEO, Judy Faulkner is now lobbying once again [3], this time to prevent such open movement. Her actions seek to reinforce Epic’s “walled garden” [4], that is creating roadblocks to data leaving their systems.

Curiously, former Wisconsin Governor Tommy Thompson is also advocating Epic’s walled garden position, to the detriment of entrepreneurs everywhere. [5]

Citizens pay for healthcare and therefore vendors such as Epic in many ways, from our local, state and federal taxes to exploding insurance premiums and co-pays.

The ability to move our data opens up many opportunities, including more cost effective services.

[1] $37,920,077,070 in Taxpayer Electronic Medical Record Subsidies: 2009 – January 2018.

[2] Mike Ivey:

Officials at Epic Systems are not commenting on a New York Times report Wednesday that the firm was central in lobbying Congress on a $19 billion “giveaway” (now $37B and growing) to convert all U.S. medical records from paper to computers.

[3] Epic’s CEO is urging hospital customers to oppose rules that would make it easier to share medical info.

[4] Walled garden, or closed platform.

[5] Tommy Thompson HHS’ new health IT rule would hurt Epic and Wisconsin’s economy. Tommy Thompson links: open secrets search

P.S. A few more links on Epic.

Airdrop trumps $40B taxpayer medical record subsidies.

Madison’s property tax base growth and the backdoor electronic medical record subsidy.

2007. Then Governor Jim Doyle’s failed $30M electronic medical record taxpayer subsidy proposal.

Apple and Microsoft representatives are set to join a meeting on Monday promoting patient access to health data.

A Letter to Ms. Judy Faulkner & Mr. Tommy Thompson.

This is what information blocking looks like boots on the ground.

These are the realities people face when they are living with life-altering, life-limiting, absolutely earth-shattering diagnoses.

While patients and their loved ones can’t get the information they need to make educated, empowered decisions about their care, even while actively dying, hospitals, EHR vendors like Epic, as well as MANY other entities, have ludicrously shared and sold the same patient information for commercial purposes, to “improve hospital operations”, for “re$earch”, leveraging the legal loopholes of HIPAA, stating all is legal, this is business as usual. Without needing informed, explicit patient consent. Without any effort dedicated to patient education, public awareness, and transparency under the guise of “Nothing to see here”.

As patients and carepartners, WE WILL NOT STAND FOR THIS A MOMENT LONGER.

Thank you Ms. Judy Faulkner, CEO of EPIC, for your recent letter urging some of the biggest hospital CEO’s and presidents to oppose the proposed rules to improve interoperability and grant patients access to their information. You have made it crystal clear that you are not aligned with the real-world unmet needs and the barriers patient and carepartners face daily. Thank you for illustrating what paternalism looks like in 2020.

Thank you, Mr. Tommy Thompson, former governor of Wisconsin, for your guest column on why the proposed health IT rules would be a detriment to EPIC and Wisconsin’s economy. You have made it crystal clear that the business priorities of Wisconsin are of a greater importance than legal rights and the sanctity and dignity of the lives of all the patients of this great country of the United States of America.

Thank you for helping me refocus. Thank you for helping me answer the questions and address the self-imposed imposter syndrome that can momentarily cloud one’s perception. The answer is: IT IS ALL WORTH IT.

Heather Landi:

“We’ve often looked at interoperability in a narrow view, which is just as a replacement for moving the patient’s chart. Modern computing and APIs offer a vastly richer and more empowering global computing environment. Well-built APIs can do almost anything that your creativity allows,” he said.

Before Rucker took the stage at Health Datapalooza, HHS Secretary Alex Azar also addressed the upcoming interoperability rules and the Trump administration’s commitment to putting “patients in charge of their data” and called out industry stakeholders who are “defending the status quo.” They are protecting a health records system that is “segmented and Balkanized,” he said.

“We have a serious problem—and scare tactics are not going to stop the reforms we need,” Azar said.

Dr. Bharani Padmanabhan:

John Ehrlichman authorized breaking into Dr. Fielding’s office on September 3rd, 1971, to steal Daniel Ellsberg’s medical chart. In those days, medical charts were confidential and access strictly controlled. Any break-in was physical and impossible to miss. Even if the government did steal your private chart, at least you knew about it.

Which is why Nixon’s lawyer, Egil Krogh, went to prison for 4 months for violating Dr. Fielding’s Fourth Amendment right.

One of the many lessons the government learned was that stealing medical charts needed to get easier. This eventually culminated in Executive Order 13335 (69 FR 24059) which ordered that all Americans must have their medical charts in electronic form.

Posted in Uncategorized.

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.

Epic Systems Clearing Storm Landscape Images







Judy Faulkner’s Epic Systems has grown explosively over the past decade. I thought it time to capture a few landscape images of Epic’s sprawling Verona, WI campus from nearby public roads (tap or click on the images above to view larger versions).

While certainly a fan of Epic’s growth, I am very disappointed that the most recent impetus has been driven by a significant federal “stimulus” tax credit:

Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR (electronic health record) Incentive Program.

. This means that we get to pay twice, once via our ever increasing health insurance fees and second, via taxes. I am unaware of any other industry that has a substantial per person automation tax incentive.

Fiscal indulgences, indeed.

Epic’s growth has begun to attract attention, particularly around system interoperability and Faulkner’s presence as the only industry representative on a federal panel overseeing the $19 billion EHR stimulus incentive.

A few links:

VA & Defense Department Developing Open Source Software Alternative to Verona’s Epic Systems

Kathleen Miller:

Electronic health record vendors Epic Systems and Cerner may face competition from a joint patient information-sharing network being developed by the Defense and Veterans Affairs departments, analysts said.

Prompted by President Obama’s push for medical facilities to adopt electronic records, hospitals may pay companies to modify the open-source code likely to power the government-developed system, rather than buying commercial systems, said Ed Meagher, former Veterans Affairs deputy chief information officer.

Epic Founder Judy Faulkner Named to US Government Health Information Technology Policy Committee

Lachlan Markay:

A federal committee that includes a major donor to President Obama and whose company stands to profit from the panel’s recommendations holds in its hands the future of health information technology policy.

Judith Faulkner, founder and CEO of Epic Systems Corp., secured a seat on a panel charged with recommending how $19 billion in stimulus money dedicated to health IT be spent, despite opposing a key administration position on the issue.

Faulkner and her company oppose the president’s vision for health IT, but Epic employees are massive Democratic donors. They’ve given nearly $300,000 to Democrats since 2006, according to the Center for Responsive Politics.

That may help explain both Faulkner’s appointment to the 13-member Health Information Technology Policy Committee as a representative for health IT vendors, and the accolades her company regularly enjoys from prominent Democrats.

The Federal Government should not be subsidizing Health Care Information Technology with our tax dollars. Organizations should choose automation services that make sense, for them, not for tax reasons….

Tension on Government Subsidized Electronic Medical Records; Comments from Verona’s Epic Systems

Steve Lohr:

The administration’s initiative takes on particular significance because this year is when the government begins spending billions of dollars to accelerate the adoption of computerized patient records.
The incentive payments, typically as much as $44,000 a physician, begin this year. But those payments require doctors to make “meaningful use” of “certified” electronic health records. The payments are staggered over five years, and to get the money physicians must use the technology for increasingly extensive record-keeping and reporting. The administration has not said whether a usability standard will be in the next stage of requirements, due by early next year.

The government says it is committed to working with technology companies, medical professionals and academics, to adopt the best approach. Yet common ground has been elusive so far.

At a meeting last month at the National Institute of Standards and Technology in Gaithersburg, Md., Janet Campbell, a software developer at Epic Systems, a supplier of electronic health records, expressed the industry’s concerns. Doctors are discriminating consumers, she said, and companies like hers work on improving their products in the marketplace every day.

the Government should NOT be using our tax dollars to subsidize health care automation. This approach never works.

GE Buys Epic Systems Competitor IDX

Ross Sneyd:

GE said the IDX acquisition would significantly its health care offerings and aid in its drive to accelerate the transition to electronic health records. IDX’s administrative, clinical and imaging products will complement GE’s Centricity-brand applications, the company said.

“GE and IDX have a shared vision on how to accelerate the adoption of electronic health records across the globe,” Joe Hogan, president and CEO of GE Healthcare, said in a statement.

Ivey takes a look at Madison (Verona’s) Epic Systems

Mike Ivey takes a useful look at Madison’s quiet technology giant (I don’t think there’s really any competition in the local tech sector), Epic Systems:

The company remains privately held by its employees – shares are repurchased when anyone leaves – and maintains it has no intention of ever making a public stock offering. The share price has gone from $14 in 1996 to over $100 today, making Faulkner one of the most successful, if not wealthiest, businesswomen in the state.

Still, Faulkner rarely grants interviews, doesn’t schmooze with the local tech crowd and has no intention of changing her approach. Faulkner has said the focus should always remain on the company and its mission to serve patients.

Software is a difficult business. Judy Faulkner and everyone at Epic deserve a great deal of credit for their success. Having said that, this next step is a big one, filled with sharks. I wish them well!