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96. epic part 2

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  • 1. H.I.S.-toryby Vince CiottiEpisode #96: Epic, Part 2© 2013 by H.I.S. Professionals, LLC, all rights reserved.
  • 2. An Epic Tale• The story of Epic starts with its founder, JudyFaulkner, with whom I have a bit in common:– She too came from Philly, where we bothremember dodging the red SEPTA trolleys!– We both were math majors, with Englishminors, she at Dickinson College in Carlisle,PA not too far from her father’s drug storeinErlton, South Jersey, near Haddonfield.– We both won scholarshipsin the ‘60s, butthat’s where the resemblance ends: I flunkedout of Temple & got drafted to ‘nam, comingback to school later to major in English Lit.– Judy studied Radiation Physics at University ofRochester – sound familiar? Neil PappalardoofMeditech came from Rochester and as we’llsee, had a surprising impact on Epic...
  • 3. It Was All in the Program…• When she showed up at U of Rochester, they expected her toprogram. She knew nothing about it so they gave her a Fortranbook and access to the computer for a week. She was on herown, and fell in love with it, feeling “like a kid playing with clay” –it was combination of language, math, and art: her 3 passions.• She earned a masters in math at the U. ofWisconsin in the frozen northlands, and won afully paid-up PhD in computer science. Shenever finished her dissertation, but years laterUW surprised her with an honorary doctorate.• So here’s another HIS vendor starting in the frozen north, besides:- IBM’s SHAS in Minnesota, Frank Poggio’sHMDS in Madison,Steve Click’s Dairyland in Wisconsin, CliniCom in Boulder,Meditech &Keane in Massachusetts, IDS in Vermont, PHAMISin Seattle, Lockheed’s MIS pilot at the Mayo Clinic in Minn...What is it with the frozen north and so many HIS start-ups??
  • 4. “Bi-Polar” Geographic Theory• Judy had noticed this trend in thenorthern origins of HIS vendorstoo, and we bandied about aninteresting theory that has manyhistorical/geographic parallels:– Think of how many countriesaround the world are splitbetween an industrial northvs. a more agricultural south:• US (Yankees vs. Rebels)• Italy (Milan vs Sicily)• Vietnam (Hanoi vs Saigon)• Korea (Pyonyang vs Seoul)– Are we on to something??
  • 5. Meditech Connection (“Epitech?”• Back to Epic, Judy took a class in “Computers in Medicine” taughtby UW’s Warner Slack, MD, who went to the Beth Israel MedicalCenter, an associate of Neal Pappalardofrom the MIT project thatgave the IT world its most contagious disease: MUMPS.• Even the acronym denotes its origins as oneof the only programming languagesdesigned specifically for Healthcare:Massachusetts General Hospital UtilityMulti-Programming System,the onlylanguage withits own “built-in” data base.• As you may remember, Pappalardo created his own version ofMUMPS that he used with his new start-up firm “MedicalInformation Technology,” (pun on his school?), which he calledMIIS, short for “MEDITECH’sInterpretive Information System.”And so Judy started her programming in MIIS, just like RonApprahamian did at Compucare (episode 69 at hispros.com).
  • 6. First Work Assignment• After grad school, she worked with John Greist MD, on a projectat the U. of W. to build a system to track clinical data over time.This was a radical idea in the early 70s, since there were no dbmsavailable back then (Ellison didn’t form Oracle until 1977…), onlya few small, unknown ones, such as the one from Beth Israel.• Judy built a system that put the patient at thecenter, surrounded by reports, displays, etc.Aninnovation was to place “exits” all through thecode so it could be easily customized.- This kept the source code sacrosanct, using exits to modify thesystem for individual clients. Most MIIS vendors without exitshad to change the source code itself to customize their systems.• She wrote 3 discrete data sets: (1) constants (eg: patient #), (2) datathat occasionally changed (eg: diagnoses), and (3) data that wasconstantly changing (eg: TPR). In essence, this structure is theunderpinning of the “Chronicles” data base Epic uses to this day!
  • 7. Careful How You Pronounce This…• You can visualize this time-oriented db structure by these chartspresented at the 1978 MUMPS User Group by Judy & colleagues:• As you might imagine, the acronym “PISAR” did not catch on…
  • 8. First Applications & Big Raise!• Somehow I had the impression that Judy started writing systemsfor her husband, a pediatrician, which explained Epic’s strongphysician practice modules. I was surprised to learn Gordon didn’tbecome an MD until long after he got his biology Ph.D., and Judywas well down the road toward writing applications for a numberof ancillary departments at the University Hospital, including:– Inpatient ICU, Psychiatry, Tumor Registry, OB Gyn, Rehab, andCardiology • So it was working with end users in thesevarious departments that taught her abouthealth care day-to-day inside operations.• These apps worked so well, she was given araise in 1975 from $5 to $10 an hour!• Even at this “high” rate, she didn’t earn much because she set thingsup in Chronicles so quickly, eg: Ophthalmology hired her to write asystem they thought would take 6 months, she finished it in 45minutes! So to start making a decent living, she formed a company:
  • 9. Human Services Computing, Inc.• In March of 1979, with $70K in capital partly raised by sellingsome “inside” stock, Judy formed HSC Inc, later changed to Epic.• There were 3 employees, each workingabout 1/2 of their time per day, so 1.5 FTEs.Their offices were in the basement of anapartment house pictured on the right.• Their first computer was a “monstrous” DGEclipse S/130 with an amazing 194 KB (kilo-bytes) of memory and a 50 Meg disk drive!• They bought used desks for about $50 each,and started writing systems for a number ofearly clients in MIIS and Chronicles, such as:- Green Bay Mental Health Center- Denver Children’s Hospital- Healthcare International (a chain)
  • 10. Early Mentors• Judy was guided in setting up her firm by 2 other HIS-tory heroes:– Dr. Phil Hicks, of LCI, the large-hospital LIS, who made her get:• (1) UW’s permission, (2) a lawyer and (3) an accountant.– Neal Pappalardoof Meditech, to whom Judy is indebted for hishelp in many areas besides MIIS, such as policies, forms, etc.• Indeed, that explains so many of the similarities betweenMeditech and Epic that I noted in an earlier episode (#16 onhispros.com):– Everyone resides near the corporate HQ, no “field” offices– No hardware sales, just software, implementation & support– Privately held, no Wall Street pressures for quarterly earnings– Hires a lot of young, bright college graduates, [note – notexclusive - about 1/3 of our hires are experienced] no outsiders• And to show her gratitude, that is why Epic has focused on larger
  • 11. One More “Super-CIO!”• Next week, we’ll pick up this “epic” tale with their amazinggrowth in the large hospital AMC/IDN market, but I must firstapologize for forgetting one of the best CIOs I worked with in myintro from last week, who kindly contributed the following:“You didn’t ask me about Judy and we are her second biggest customer afterKaiser! But alas, I would have told you the same: smart, diligent, hard-working, works to do the right thing and really listens to her customers. Ithink you were one of the influencers that made me reject Epic in the dayand I definitely resisted joining the Epic “cult.” But it has been good albeit awild ride since last we spoke. We signed with Epic at the end of 2010. Andhere I am 2.5 years later, going up Big Bang with 3 more hospitals on Epic thisweekend. We are up in almost all our ambulatory clinics (over 1900providers) and as of this weekend, LIVE in 17 acute care hospitals with 16more to go. It is not perfect and we have years of optimization work to makeit what we want it to be, but I don’t know of any other system that we couldhave implemented at the pace we are implementing and getting the resultswe are getting from a standard build of an integrated system.”Laureen O’Brien, Vice President and CIO, Providence Health & Services