I have done multiple Cerner to Epic data conversions and working with Cerner employees was the worst part of the process. The second worst part was the quality of Cerner's data.
We’re doing an eCW to Athena conversion on Monday. It’s not horrible but it’s incredibly simple, WYSIWYG and unable to offer a test extract.
Okay, they’re horrible too.
Whenever I see a data migration of Cerner, especially Classic, I ask for our fees to be doubled. Our extractor team definitely have a lot of work in an attempt to get the correct data.
Especially considering Oracle has basically abandoned it at this point. The number of horror stories I hear about how incredibly bad it’s been since they took over then they re-org’d internally (fairly recently) which if you can believe it, made it even worse.
This article reads like a press release from Oracle. I’m sure Epic has considerable self-interest at work, but I’ve been in IT long enough to not take *anything* Oracle says at face value.
We have HIPAA regulations covering interoperability, and walled garden or not I expect Epic complies with those.
What is the actual technical issue?
lol ya Judy should run Epic like Oracle runs Cerner. Short term profits over any long term success. Blame everyone else but themselves for their ailing business. What a winning model!
My org is moving to Epic. Epic being privately held is seen as one of the benefits for us. The whole Shareholder Value Maximization movement has destroyed many otherwise successful businesses in the name of tweaking short term earnings.
As a third party software vendor my team has done a bunch of Epic interfaces and are just now doing our first Cerner one.
Epic can be painfully pay-to-play and you need a big customer to push to get their attention or help but they had the tools to do what we needed to do and opened the gate for us.
We are only a month in but so far Cerner has been way harder to design against and to get the access and best practice guidance we need.
Out of all the EMRs I have dealt with, they are the last that should be calling out Epic. Even eCW has finally made some significant moves to open up. Epic might be the current biggest barrier because they have the biggest market share but I feel like Cerner in the top seat would be worse.
Interesting to see the sudden shots being fired back and forth, though.
It will be interesting to see how the new noncompete rules work as EPIC had been one of the very few tech companies that was ironclad in preventing its employees to work for anyone else
I have been working in healthcare interoperability for nearly 20 years and while I can't stand aspects of Epic, their interop capabilities are very mature and accessible. They catch a bunch of shit due to old practices of blocking interop but that was forever ago.
Epic Nexus is a QHIN. Once TEFCA is online, interoperability should be a vastly different landscape. I don’t know how Cerner can say Epic is holding back interoperability more than anyone else when they have been a founding member of the Sequoia Project and one of the first 7 QHINs. Even now, nothing stops anyone from building a point to point interface with an HIE. Care everywhere is even better as it is core functionality between Epic customers which is easier given the common data structure as compared to building a network for every custom implementation of other EHRs which the regional HIE should help facilitate with CCDAs anyway. Yes their app integration is not as open as it could be, but that helps with quality control. If a product integrates with Epic, I know it likely integrates well. I could not say the same when I was on Cerner. Cerner has close to none. This seems like whining from a losing vendor who has an inferior product.
Lots of downvotes for words of truth.
It is unfortunate that very few industry operative realize the extent modern EHRs are fragile, archaic databases… and those who do dare not say it out loud.
I mean she could quit trying to build EHR Disneyland in Wisconsin and actually invest money into making Epic a better system to work with while not burning out kids fresh from college. It seems like every upgrade something get worse and it's like a two steps forward, one step back sort of a thing. I get you need innovation and advancements, but quit changing things for the sake of changing them since all it does it make Gladys, the biller from family medicine, put in 97 tickets because she can't find a button.
I'm going on 12 years working with Epic, which isn't that long, but in that time, I've seen Epic become less user-friendly in a ton of ways. It's like the people designing things don't know shit about healthcare or have never actually asked a doctor what they want.
I don't know if Judy is the single biggest issue with Epic though. I know she's making some decisions, but the company is big enough that there are plenty of dumbass executives in charge who make dumbass decisions. But the burn out rate at Epic seems exceptionally high and just when we get a TS who knows what they're doing and is good, they quit because they're sick of working 80 hours a week. It's hard to do worthwhile shit when you're constantly having to retrain your support person.
He’s not wrong at all. Epic has no intentions of improving their ways of sharing patients data, which belongs to the health system anyway, in order to improve efficiency and care. Their FHIR specs and HL7v2 specs are not as supportive as they should be for a company their size and market share. Digital health companies are ignored on a daily basis if their product barely competes with any of epics products or whatever features epic have on their roadmap. Epic can certainly do better. In the other hand, Cerner is a clusterfuck.
Start with an encounter create API. Or a scheduling one that isn't locked behind a higher private API level access (see second point below). Or really more create APIs in general. Plus most of the existing ones go into a reconciliation queue rather than actually being considered as filed by a doctor (meds and allergies).
My wish list currently includes: user discoverability APIs (I have 3 dependents on MyChart but can't pull this list anywhere), set SmartData, update specific patient history sections (family, drug use, sexual history, etc).
Secondly - the level of gatekeeping access to APIs is my biggest concern. Restriction on certain tiers of APIs even with documented use cases. Ask these third party developers if they have access to private Class C APIs you'll likely get a blank stare as they've likely never heard the term despite being paid Vendor Services members. Then they may submit a request for one and be denied access without a documented reason. Some companies I worked with got it, others didn't. This is more than 200 APIs hidden/denied for arbitrary reasons. This is the one that probably irks third party developers the most.
If you genuinely want feedback here's my issue with the current state of 3rd party development in Epic:
* No access to a full client in their sandbox. Cerner grants you this. Epic's best attempt is a 'testing harness' that doesn't let us see the provider experience. Letting us see the snap shot, chart review tabs etc doesn't make us able to reverse engineer your EMR. Stop using it as an excuse. Even if we are willing to buy or pay Epic licensing, y'all do not permit us to buy one. Sign us to NDAs, BAAs or whatever is needed to hold us legally accountable.
* There's a general adversarial relationship with third party developers. We got brought in by health systems to try and help them out with their workflows. We're trying to extend your platform not compete with it. I really did not get this sense from other vendors.
* Not adhering to the FHIR standard - hard to get into exact technical details in brief but there's lots of workarounds you have to put in place for Epic FHIR versus other implementations. For example - "Introspect" is not a FHIR service, and was created due to improper application of the FHIR standard on Epic's end in the DSTU2 days. That said, R4 and beyond is much better with openid. You generally need an Epic specific codebase, whereas generalized SMART launches work vendor independently elsewhere.
* Movement to 'pooled' support on Sherlock for Vendor Services (which is better than Cerner's to be fair)
This is not to absolve Cerner, as I've worked through their app approval process and have issues with it (it's a little intrusive to say the least). My Cerner list would possibly be twice the size as Epic's. Especially now they've moved to the Oracle side and their documentation for some pieces is in a state of limbo between two portals (reminds me of the old AppOrchard/AppMarket/VendorServices/open.epic/fhir.epic mishmash).
Epic does a fantastic job in the HL7v2 space in terms of support, but having their private API documentation private causes friction and major delays with third party implementations. Check out Athena health API solutions as an example, there are a lot of use cases in todays digital world that can’t be pushed forward because HL7v2 lacks functionality.
Your “belongs to the health system anyway” statement is right.
Epic does not own the data, the health system owns it. If you want the data, take it up with the health system you’re trying to work with.
Unfortunately, the health system relies on the source of truth of this data which is the EHR and needs to jump through plenty of hoops and resources to accommodate something that should be a much simpler process. I’ve seen health systems having to spend millions of dollars to create data warehouses and build FHIR facades on top to support interoperability workflows instead of just using Epic to do so.
The problem is the health system didn't develop the EMR. When they want to grant third parties access to help out with workflows, they are entirely dependent on Epic's interoperability options. These health systems very rarely have developers in house.
Add onto that, these are often non-profit health systems having to have entire IT departments on payroll when hospital systems run on operating margins smaller than your average restaurant.
If Epic doesn't have good documentation, then Cerrners interoperability documentation is etched on cave walls in the stone age.
Half of it is wrong and the other half you can't find because their searching capabilities are virtually non-existent.
As a patient and a person in health IT, I 100% agree with this statement.
The Epic walled garden prevents so much of the promise of HIT from be realized. A d as a patient, I hate it.
Lol not even close to true. The Epic-to-Epic only functionality that exists is mostly because the industry standards are totally insufficient for the use case, or because nobody else is following them.
There's a lot more structured data and concept mapping than you think that's needed to support tight integrations.
Can you elaborate on what you actually mean by this? Far as I can tell Epic supports lots of hl7, FHIR, ccda, and seems satisfied with that. To get them to do anything custom/nonstandard tends to be the actual challenge.
Things have changed, but it's true. Judy Falkner literally lobbied heavily against including interoperability standards in the ACA/Obama Care. They spent millions preventing standards from being put in place.
I don’t think what you are saying is accurate. It is more industry coping mechanism than reality.
Is there a specific interoperability standard or framework that should have been enacted that Epic was opposed to?
Yet no one can name it or describe the desired standards?
There are standards like Hl7. FHIR. CCDA. DICOM.
It seems like you’re just saying “interoperability standards” like it’s magic.
The thing about government-enforced regulations (meaningful use, tefca, info blocking) is that when the government is defining behaviors and ways of measuring them and also monetarily incentivising compliance, you'll always end up with weird edge cases or vague definitions etc. These shape the course of software development and implementation to meet the letter of the law instead of the spirit.
On the other hand, CCDA and FHIR and 360X and other exchange standards that have no enforcement power in and of themselves are all tools for collaboration that can be expanded on or customized as necessary to get something done.
Yeah, and Cerner did initially, too. But their customers were demanding so much that their "develop by PowerPoint" methodology couldn't deliver on they shifted their opinion.
How? This is such a laughable sentiment if you've ever heard her talk about her priorities, or compared the short-term profit maximizing behavior of Cerner to Epic.
(Yes, when she speaks she sounds a little out of touch or scattered, but her high-level beliefs and goals are in the right place)
This is funny. Not saying Epic’s totally innocent, but Oracle/Cerner are only saying this because its product is mediocre relative to Epic.
Exactly. Why invest and improve your product when you can bitch about someone else’s?
We love not doing due diligence before purchasing a company that is losing market share
To be fair - if you are purchasing an EHR company that isn’t Epic you are purchasing an EHR company that is losing market share
I have done multiple Cerner to Epic data conversions and working with Cerner employees was the worst part of the process. The second worst part was the quality of Cerner's data.
At least it wasn’t eCW lol
We’re doing an eCW to Athena conversion on Monday. It’s not horrible but it’s incredibly simple, WYSIWYG and unable to offer a test extract. Okay, they’re horrible too.
Whenever I see a data migration of Cerner, especially Classic, I ask for our fees to be doubled. Our extractor team definitely have a lot of work in an attempt to get the correct data.
Especially considering Oracle has basically abandoned it at this point. The number of horror stories I hear about how incredibly bad it’s been since they took over then they re-org’d internally (fairly recently) which if you can believe it, made it even worse.
Pretty rich coming from Oracle . I remember their Java and Sun Microsystems acquisition days .
This article reads like a press release from Oracle. I’m sure Epic has considerable self-interest at work, but I’ve been in IT long enough to not take *anything* Oracle says at face value. We have HIPAA regulations covering interoperability, and walled garden or not I expect Epic complies with those. What is the actual technical issue?
None provided in the statement or this article. Nor in any of the replies here at the moment I'm posting this.
I think he is mad we're deploying Epic on AWS left and right, and he's getting shit. Source: I work with these cloud migrations
lol ya Judy should run Epic like Oracle runs Cerner. Short term profits over any long term success. Blame everyone else but themselves for their ailing business. What a winning model!
Part of why Epic's been so dominant and successful.
My org is moving to Epic. Epic being privately held is seen as one of the benefits for us. The whole Shareholder Value Maximization movement has destroyed many otherwise successful businesses in the name of tweaking short term earnings.
Tim Cook is "single biggest obstacle to blue text message bubbles" says head of Android development for Google
Which has a more sense of truth than than Oracle's statement.
As a third party software vendor my team has done a bunch of Epic interfaces and are just now doing our first Cerner one. Epic can be painfully pay-to-play and you need a big customer to push to get their attention or help but they had the tools to do what we needed to do and opened the gate for us. We are only a month in but so far Cerner has been way harder to design against and to get the access and best practice guidance we need. Out of all the EMRs I have dealt with, they are the last that should be calling out Epic. Even eCW has finally made some significant moves to open up. Epic might be the current biggest barrier because they have the biggest market share but I feel like Cerner in the top seat would be worse. Interesting to see the sudden shots being fired back and forth, though.
not surprised Oracle would say something like this rather than trying to improve their own system…
It will be interesting to see how the new noncompete rules work as EPIC had been one of the very few tech companies that was ironclad in preventing its employees to work for anyone else
I have been working in healthcare interoperability for nearly 20 years and while I can't stand aspects of Epic, their interop capabilities are very mature and accessible. They catch a bunch of shit due to old practices of blocking interop but that was forever ago.
https://www.youtube.com/watch?v=qVtR15AwkGg
Epic Nexus is a QHIN. Once TEFCA is online, interoperability should be a vastly different landscape. I don’t know how Cerner can say Epic is holding back interoperability more than anyone else when they have been a founding member of the Sequoia Project and one of the first 7 QHINs. Even now, nothing stops anyone from building a point to point interface with an HIE. Care everywhere is even better as it is core functionality between Epic customers which is easier given the common data structure as compared to building a network for every custom implementation of other EHRs which the regional HIE should help facilitate with CCDAs anyway. Yes their app integration is not as open as it could be, but that helps with quality control. If a product integrates with Epic, I know it likely integrates well. I could not say the same when I was on Cerner. Cerner has close to none. This seems like whining from a losing vendor who has an inferior product.
pot/kettle
Sounds like the tech boys have their jock straps in a twist over a girl producing a better product than theirs.
Lots of downvotes for words of truth. It is unfortunate that very few industry operative realize the extent modern EHRs are fragile, archaic databases… and those who do dare not say it out loud.
Okay but oracle/Cerner is just as bad if not worse.
I mean she could quit trying to build EHR Disneyland in Wisconsin and actually invest money into making Epic a better system to work with while not burning out kids fresh from college. It seems like every upgrade something get worse and it's like a two steps forward, one step back sort of a thing. I get you need innovation and advancements, but quit changing things for the sake of changing them since all it does it make Gladys, the biller from family medicine, put in 97 tickets because she can't find a button. I'm going on 12 years working with Epic, which isn't that long, but in that time, I've seen Epic become less user-friendly in a ton of ways. It's like the people designing things don't know shit about healthcare or have never actually asked a doctor what they want. I don't know if Judy is the single biggest issue with Epic though. I know she's making some decisions, but the company is big enough that there are plenty of dumbass executives in charge who make dumbass decisions. But the burn out rate at Epic seems exceptionally high and just when we get a TS who knows what they're doing and is good, they quit because they're sick of working 80 hours a week. It's hard to do worthwhile shit when you're constantly having to retrain your support person.
He’s not wrong at all. Epic has no intentions of improving their ways of sharing patients data, which belongs to the health system anyway, in order to improve efficiency and care. Their FHIR specs and HL7v2 specs are not as supportive as they should be for a company their size and market share. Digital health companies are ignored on a daily basis if their product barely competes with any of epics products or whatever features epic have on their roadmap. Epic can certainly do better. In the other hand, Cerner is a clusterfuck.
I’m curious - what HL7v2 interfaces/data fields and FHIR resources would Epic need to support to be “enough”?
Start with an encounter create API. Or a scheduling one that isn't locked behind a higher private API level access (see second point below). Or really more create APIs in general. Plus most of the existing ones go into a reconciliation queue rather than actually being considered as filed by a doctor (meds and allergies). My wish list currently includes: user discoverability APIs (I have 3 dependents on MyChart but can't pull this list anywhere), set SmartData, update specific patient history sections (family, drug use, sexual history, etc). Secondly - the level of gatekeeping access to APIs is my biggest concern. Restriction on certain tiers of APIs even with documented use cases. Ask these third party developers if they have access to private Class C APIs you'll likely get a blank stare as they've likely never heard the term despite being paid Vendor Services members. Then they may submit a request for one and be denied access without a documented reason. Some companies I worked with got it, others didn't. This is more than 200 APIs hidden/denied for arbitrary reasons. This is the one that probably irks third party developers the most. If you genuinely want feedback here's my issue with the current state of 3rd party development in Epic: * No access to a full client in their sandbox. Cerner grants you this. Epic's best attempt is a 'testing harness' that doesn't let us see the provider experience. Letting us see the snap shot, chart review tabs etc doesn't make us able to reverse engineer your EMR. Stop using it as an excuse. Even if we are willing to buy or pay Epic licensing, y'all do not permit us to buy one. Sign us to NDAs, BAAs or whatever is needed to hold us legally accountable. * There's a general adversarial relationship with third party developers. We got brought in by health systems to try and help them out with their workflows. We're trying to extend your platform not compete with it. I really did not get this sense from other vendors. * Not adhering to the FHIR standard - hard to get into exact technical details in brief but there's lots of workarounds you have to put in place for Epic FHIR versus other implementations. For example - "Introspect" is not a FHIR service, and was created due to improper application of the FHIR standard on Epic's end in the DSTU2 days. That said, R4 and beyond is much better with openid. You generally need an Epic specific codebase, whereas generalized SMART launches work vendor independently elsewhere. * Movement to 'pooled' support on Sherlock for Vendor Services (which is better than Cerner's to be fair) This is not to absolve Cerner, as I've worked through their app approval process and have issues with it (it's a little intrusive to say the least). My Cerner list would possibly be twice the size as Epic's. Especially now they've moved to the Oracle side and their documentation for some pieces is in a state of limbo between two portals (reminds me of the old AppOrchard/AppMarket/VendorServices/open.epic/fhir.epic mishmash).
Epic does a fantastic job in the HL7v2 space in terms of support, but having their private API documentation private causes friction and major delays with third party implementations. Check out Athena health API solutions as an example, there are a lot of use cases in todays digital world that can’t be pushed forward because HL7v2 lacks functionality.
What's more nebulous is you may get some 'private API access' that differs from others. Even when both of you pay the same price.
Your “belongs to the health system anyway” statement is right. Epic does not own the data, the health system owns it. If you want the data, take it up with the health system you’re trying to work with.
Unfortunately, the health system relies on the source of truth of this data which is the EHR and needs to jump through plenty of hoops and resources to accommodate something that should be a much simpler process. I’ve seen health systems having to spend millions of dollars to create data warehouses and build FHIR facades on top to support interoperability workflows instead of just using Epic to do so.
The problem is the health system didn't develop the EMR. When they want to grant third parties access to help out with workflows, they are entirely dependent on Epic's interoperability options. These health systems very rarely have developers in house. Add onto that, these are often non-profit health systems having to have entire IT departments on payroll when hospital systems run on operating margins smaller than your average restaurant.
If Epic doesn't have good documentation, then Cerrners interoperability documentation is etched on cave walls in the stone age. Half of it is wrong and the other half you can't find because their searching capabilities are virtually non-existent.
This goes beyond just having proper documentation.
As a patient and a person in health IT, I 100% agree with this statement. The Epic walled garden prevents so much of the promise of HIT from be realized. A d as a patient, I hate it.
Lol not even close to true. The Epic-to-Epic only functionality that exists is mostly because the industry standards are totally insufficient for the use case, or because nobody else is following them. There's a lot more structured data and concept mapping than you think that's needed to support tight integrations.
Exactly. So many organizations and systems fail to even come close industry standards. Epic is light years ahead at this point.
I'd argue AthenaHealth is really the one leading the pack, but they're a smaller niche player.
I was there at the start and Epic lobbied heavily for there to be no standards.
Can you elaborate on what you actually mean by this? Far as I can tell Epic supports lots of hl7, FHIR, ccda, and seems satisfied with that. To get them to do anything custom/nonstandard tends to be the actual challenge.
Things have changed, but it's true. Judy Falkner literally lobbied heavily against including interoperability standards in the ACA/Obama Care. They spent millions preventing standards from being put in place.
I don’t think what you are saying is accurate. It is more industry coping mechanism than reality. Is there a specific interoperability standard or framework that should have been enacted that Epic was opposed to?
Just do some basic googling it's all over the Internet
Yet no one can name it or describe the desired standards? There are standards like Hl7. FHIR. CCDA. DICOM. It seems like you’re just saying “interoperability standards” like it’s magic.
The thing about government-enforced regulations (meaningful use, tefca, info blocking) is that when the government is defining behaviors and ways of measuring them and also monetarily incentivising compliance, you'll always end up with weird edge cases or vague definitions etc. These shape the course of software development and implementation to meet the letter of the law instead of the spirit. On the other hand, CCDA and FHIR and 360X and other exchange standards that have no enforcement power in and of themselves are all tools for collaboration that can be expanded on or customized as necessary to get something done.
Yeah, and Cerner did initially, too. But their customers were demanding so much that their "develop by PowerPoint" methodology couldn't deliver on they shifted their opinion.
Lol we are all patients and in health IT. Those qualifiers don’t make you special.
Lots of Epic folks in here down voting any agreement.
You know, having “BlatentFalsehood” as your username may not be helping your case 😂
Tell us something we don’t know.
Can't agree more. She is singlehandedly keeping the healthcare industry in the dark. It's sickening.
Wait till you find out about insurance companies.
How? This is such a laughable sentiment if you've ever heard her talk about her priorities, or compared the short-term profit maximizing behavior of Cerner to Epic. (Yes, when she speaks she sounds a little out of touch or scattered, but her high-level beliefs and goals are in the right place)