Is Epic the “Microsoft” of Healthcare?

Iltifat Husain, MD from iMedicalApps has penned an interesting article about Apple’s partnership with Epic being a game changer for patients. For those keeping track at home, I’ve predicted something very different with the Apple – Epic partnership. I’m quite skeptical that anything will come from it. Although, I was even more struck by Iltifat’s description of Epic:

If your hospital is currently changing its EMR, more than likely, it’s going to Epic. Epic has essentially become the Microsoft for EMRs.

While there’s no arguing that Epic has done very well and has a large portion of the EHR market, I think it’s far from fair to say that Epic is the de facto choice for hospitals. In fact, many hospitals don’t even get that choice because of Epic’s business practices.

One thing I keep learning more and more is that healthcare is very regional. Maybe where Dr. Husain practices medicine Epic is the Microsoft of that community. However, there are other communities where this just isn’t the case. In fact, I have a story waiting in the hopper for my site Hospital EMR and EHR that talks about the Nashville EHR community. I think we have to be really careful generalizing our regional biases.

We’ll see how this plays out over time, but I don’t think Epic has quite reached Microsoft like dominance in the EHR industry. What do you think? Should I be giving Epic more credit than I’m giving them? Also, let me be clear. Epic has done amazing. Although, Microsoft created a relative monopoly in multiple product lines.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

10 Comments

  • All the separate devices is a nightmare and all have to comply with HIPPA and FDA MDDS. Some do not. Also, everyone will not want just to know what their health status is, but be able to manage a personal emergency. I am best known as the inventor making possible the Automatic Heart External Defibrillator (AED) and have been awarded patents that cover this space including aspects of Next Generation 911 (NG911). For Apple or Google to enter this space without this will result in an uncomplete solution(s) for these applications, and it’s now patented in multiple patents. People need to know if what they are experiencing is serious or life threatening or innocuous in nature. For details unfolding on this visit: http://bit.ly/TAaiHF

  • I have to agree with you on this, John. Epic has done well and deserves credit for it, but as I recall we saw Microsoft with 90%+ market shares in areas such as US corporation PCs at their peak (and it’s not much lower today). Epic isn’t close to that in terms of overall healthcare market share, and even their large share in the hospital / IDN market doesn’t give them the level of dominance described.

    The collaboration with Apple is interesting, but HealthKit will likely be focused on connecting various wearables with iOS (i.e., let my device talk to my phone). The real key is getting that data into the hands of the HCP, to help inform and facilitate HCP – patient interaction and through that, patient care. Perhaps we’ll see some ability to use patient generated data by the HCP within an Epic system through this, but even that is a stretch at present and it does nothing to help the vast majority of patients whose HCPs use a non-Epic system. Rather than an alliance with any ONE EHR supplier, I instead hope to see consumer products companies opening up their APIs and systems in a way that allows those most interested in meeting HCP and patient needs compete based on the merits of how well they can develop solutions. Epic could certainly be a great partner in that scenario if they chose to be, but I think our most useful and advanced ways of connecting the patient with the HCP using digital tools may come from smaller companies, perhaps working with the backing and support of large players representing many facets of the healthcare system.

  • I agree that healthcare is regional. For example, Southern California is what many of us call “Cerner Country” whereas Northern California is “Epic Country”. NextGen has ambulatory care / CHC / Medical Group locked in.

  • I too do not think the Epic despite their name and feelings are at the level of world dominance yet alone Intergalactic dominance. Like anything else they are a tool/software package with many moving parts that are constantly being morphed to meet new and every changing issues. To be that kind of Microsoft I think they need to develop standards that are leading the industry. Not just doing what everyone else is doing which is following the bouncing ball. Yes I think they are gaining ground regionally when one large system adopts it and everyone else around them jumps on board thinking they have a product and services that are a utopia. By no means do they have it close to being right. They are just the 800 lb gorilla for the moment and will outlive most of the competition which is a shame. Great companies should be the lost leaders, setting standards, welcoming greater partnerships, inclusive of interoperability in a more seamless manner rather than promising the moon and charging for it.
    God help us if they do get the VA contract. Not that they would do any worse than VA Vista but not sure if they would do any better. Product is good, training and implementation leaves a lot to be desired.
    I am anxious to see how Cerner and GE and McKesson continue to tackle the issue of attempted world or galactic dominance by Epic. Lots of good products and companies out their. They are not Microsoft of and IBM. Maybe that will change.

  • It’s the Apple of EHRs! One person in control of company & system. They were able to capture & monopolize the market with their take-it or leave-it product. They didn’t offer any options – they simply could guarantee what they sold you would work.

  • Ivan,
    Interesting comparison. Will they take a similar path that the closed Apple did? Ie. get close to death because of their closed system and then start to thrive with some other innovations that thrive in the closed world?

  • John,
    From a “marketing” perspective, Judy Faulkner seems to have mirrored Steve Jobs with Apple. In his last interview, Jobs admits he didn’t care about the consumer, and it’s safe to assume the same for her. Yet consumers were desperate for their products simply because they were reliable.

    Although neither were concerned with pleasing the consumer, Jobs was passionate about his product and relied on his products to please the customers. (Remember, he introduced us to Apps & the cloud, and he started Apple down that path. Apple is clearly lost without him.) Judy on the other hand has been more concerned with manipulating politics to secure a position on the federal committee that regulates her products. Rather than improve her product, she’s protected her monopoly and scammed our country’s healthcare systems.

  • This is an interesting comparison. Even so, there are a couple of ‘holes’ in the logic.
    1) EMR’s are in all healthcare settings. Epic is not. One glaring example is the Post Acute Market. Behavioral Health may be another.
    2) Most of the currently identifiable HealthCare software vendors received their core funding because of government subsidies via the ACA (funding which caused Post Acute settings and other providers in a no funding situation). What will happen when the government funding decreases and hospitals can no longer afford to pay the sometimes outrageous subscriptions the Vendors are asking?
    3) Apple and Microsoft sold their products directly to the consumer–who then created ways to become even more productive with these products. Epic and Cerner and MediTech and such sell to Hospital Organizations, not directly to the patient. Maybe this analysis would be more appropriately compared to the IBM corporate model of last century–and to be clear, IBM is certainly still around and learned, over time, how to sell to the ‘rest of us’.
    4) Regardless, I truly believe that Epic has had a positive influence on our HealthCare IT path thus far. Between reliability, stability, education, and etc…they have made a positive difference and they have a potential to continue to make this positive difference in the future.

  • “Most of the currently identifiable HealthCare software vendors received their core funding because of government subsidies via the ACA” – totally wrong on two counts

    Actually EHR”s were here long before the Accountable Care Act. HIMSS for example just had their 50 year anniversary and the industry was a multi-billion dollar one for years..

    BTW the current reimbursement/ funding for HITECH was part of the jobs bill the year prior and isn’t connected to the ACA at all.

  • Sherry, you are totally correct that the HITECH was part of the ARRA not ACA. Thanks for that clarification.

    Regarding the EHR and the 50 year anniversary of HIMSS (yes, I am a member), I agree that EHR’s were present in the past. However, statistics show in the five year period from 2008 to 2013, physician use of (any) EHR increased from ~42% to 78% (36 % increase in 5 years (reference below). This boost in usage happened, I believe, as a direct result of the funding provided in the HITECH Act. This funding resulted in a tremendous increase dollars available for HealthCare software vendors–but only if they were in the Acute Care or (Ambulatory) Physician environments.
    One could possibly do an analysis of Software vendors within these environments versus those primarily in Post Acute or Behavioral Health areas to better perform a comparison of the secondary effects of the HITECH Funding on software vendors. However, the intention here is to look to the future and ask how the pricing structure some software vendors have in place might continue? Will we have an increase in value that is reimbursable? Some of this may happen with new payment models (ACO or Bundled Payments). If so, how do we incorporate ‘all’ of healthcare so the value is achieved?

    1) NCHS Data Brief No. 143, January 2014 http://www.cdc.gov/nchs/data/databriefs/db143.pdf

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