User:Tuphoff1/Epic Systems Draft

Epic Systems Corporation, or Epic, is a privately held healthcare software company. According to the company, hospitals that use its software held medical records of 54% of patients in the United States and 2.5% of patients worldwide in 2015. In addition, as of 2018, Epic Systems is the Electronic Health Record (EHR) provider for each of the top 20 hospitals per the U.S. News & World Report Best Hospital rankings for 2018-2019. Globally, more than 250 million patients have a current record stored electronically by Epic.

History
Epic was founded in 1979 by Judith R. Faulkner with a $70,000 investment. Originally headquartered in Madison, Wisconsin, Epic moved its headquarters to a large campus in the suburb of Verona, Wisconsin in 2005, where it employs approximately 10,000 people as of 2019.

As of 2015, the company was in the fifth phase of campus expansion with five new buildings each planned to be around 100,000 square feet. The company also has customers and offices in Bristol, UK; 's-Hertogenbosch, Netherlands; Dubai, United Arab Emirates; Dhahran, Saudi Arabia; Helsinki, Finland; Melbourne, Australia; Singapore; and Søborg, Denmark.

Product and Market
Epic primarily develops, manufactures, licenses, supports, and sells a proprietary electronic medical record software application, known in whole as 'Epic' or an Epic EHR. The company offers an integrated suite of healthcare software centered on its Chronicles database management system. Epic's applications support functions related to patient care, including registration and scheduling; clinical systems for doctors, nurses, emergency personnel, and other care providers; systems for lab technologists, pharmacists, and radiologists; and billing systems for insurers.

Epic also offers hosted solutions for customers that do not wish to maintain their own servers; and short-term optimization and implementation consultants through their wholly owned subsidiary Boost Services.

The company's competitors include Cerner, MEDITECH, Allscripts, athenahealth, Homecare Homebase, and units of IBM, McKesson, Siemens and GE Healthcare. Epic and Cerner account for a combined 85% market share of the 500-bed category hospitals in the United States (Epic with a 58% share and Cerner with a 27% share).

The majority of U.S. News and World Report's top-ranked centers for specialties, hospitals, and medical schools use Epic. In 2003, Kaiser Permanente, the largest managed care organization in the United States, chose Epic for its electronic records system. Among many others, Epic provides electronic record systems for Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, The Mount Sinai Hospital, UC Davis Medical Center in Sacramento, multiple campuses of the Mayo Clinic, and Yale–New Haven Hospital.

Johns Hopkins Hospital announced in 2011 their plan to partner with Epic and use the EHR package across all of Johns Hopkins Medicine. Epic's software was first applied to only Johns Hopkins Outpatient Center in 2013 with a focus on ambulatory care. Today, Epic is the sole medical record system for nearly the entire enterprise, the only exception being Johns Hopkins All Children's Hospital. According the Johns Hopkins Medicine website, the successful integration of the Epic project allows for streamlined transfer of a patient's chart across multiple areas from which they receive care including emergency departments, ambulatory clinics and surgery areas, and 5 Johns Hopkins area hospitals.

On February 1, 2020, New York Presbyterian Hospital (NYP), the teaching hospital of Columbia and Cornell, completed its multi-year, ~$1 billion conversion of its EHR from Allscripts to Epic. Partners HealthCare began adopting Epic in 2015 in a project initially reported to cost $1.2 billion, which critics decried and which is greater than the cost of any of its buildings. By 2018, the total expenses for the project were $1.6 billion, with payments for the software itself amounting to less than $100 million and the majority of the costs caused by lost patient revenues, tech support and other implementation work.

Select Customer Wins
Alameda Health Systems (AHS) launched its Epic EHR in October of 2019 after a three-year implementation. With this specific customer win, Epic will begin servicing AHS's five hospitals that include nine facilities and employ roughly 1,100 physicians.

In November of 2019, CHI Memorial Hospitals in Tennessee, a hospital with over 700 affiliated physicians, transitioned to Epic Systems after a $67 million implementation that took roughly one and a half years. The move was initiated to increase interoperability as roughly 40% of CHI hospitals will be using Epic Systems.

On February 11 of 2020 Epic made one of its biggest moves to expand their market share as they became the official EHR provider for AdventHealth, a faith-based network of healthcare system with facilities in nine states across the United States. After initially signing a deal with Epic's rivals Cerner, Athenahealth and Homecare Homebase in 2002, AdventHealth has decided to make the five year transition to Epic Systems spanning 1,200 acute-care, physician-practice, ambulatory, urgent care, home health, and hospice sites.

Awards and Recognition
In 2020, Epic Systems was named by KLAS Research as the top overall software suite for the tenth year in a row. In the same annual awards, Epic won eight additional categories, including best in post-acute and ambulatory care hospitals and practice management. Above its competitors, Epic has been strongly praised for its business culture, loyalty, and relationships.

The Healthcare Information and Management Systems Society, or HIMSS, developed a model using a 0-7 scale to score hospitals worldwide based on their EHR capabilities, 7 being the highest rank. Of the 47 health organizations awarded Stage 7 by HIMSS, 79% use EpicCare software. Furthermore, 90% of Stage 7 physicians also use Epic.

Epic also won a Peer60 study as the top-ranked EHR system by physicians and c-suite executives.

Epic is also involved with the nation's leading research organizations. The top 16 NIH grant recipients, including Johns Hopkins University, University of Michigan, and University of Pittsburgh, all employ Epic Systems software.

Data sharing
Care Everywhere is Epic's health information exchange software, which comes with its EHR system. A 2014 article in The New York Times interviews two doctors who say that their Epic systems won't allow them to share data with users of competitors' software in a way that will satisfy the Meaningful Use requirements of the HITECH Act. At first, Epic charged a fee to send data to some non-Epic systems. Epic says the yearly cost for an average-sized hospital is around $5,000 a year. However, after Congressional hearings, Epic and other major software vendors announced that they would suspend per-transaction sharing fees. Epic customers must still pay for one-time costs of linking Epic to each individual non-Epic system with which they wish to exchange data; in contrast, Epic's competitors have formed the CommonWell Health Alliance which set a common Interoperability Software standard for electronic health records. A 2014 report by the RAND Corporation described Epic as a "closed" platform that made it "challenging and costly for hospitals" to interconnect with the clinical or billing software of other companies. The report also cited other research showing that Epic's implementation in the Kaiser Permanente system led to efficiency losses.

One major data privacy concern for Epic software has been over trade secrets among its third party companies that install their software. Specifically, the largest trade-secret lawsuit ever filed in US courts was filed by and granted to Epic against Tata Consultancy. Tata Consultancy is a third party systems integrator for Epic software implementations. On April 16, 2016 Epic was awarded a grand total of $940 million for Tata Consultancy illegally downloading a portion of Epic’s software, stealing confidential information and trade secrets, and then sharing it with Med Mantra, Epic’s competing healthcare software provider in India.

In September 2017, Epic announced Share Everywhere, which allows patients to authorize any provider who has internet access to view their record in Epic and to send progress notes back. Share Everywhere was named Healthcare Dive's "Health IT Development of the Year" in 2017.

UK experience
An Epic electronic health record system costing £200 million was installed at Cambridge University Hospitals NHS Foundation Trust in October 2014, the first installation of an Epic system in the UK.

After 2.1 million records were transferred to it, it developed serious problems and the system became unstable. Ambulances were diverted to other hospitals for five hours and hospital consultants noted issues with blood transfusion and pathology services. Other problems included delays to emergency care and appointments, and problems with discharge letters, clinical letters and pathology test results. Chief information officer, Afzal Chaudhry, said "well over 90% of implementation proceeded successfully".

In July 2015, the BBC reported that the hospital's finances were being investigated. In September 2015, both the CEO and CFO of the hospital resigned. Problems with the clinical-records system, which were said to have compromised the "ability to report, highlight and take action on data" and to prescribe medication properly, were held to be contributory factors in the organization's sudden failure. In February 2016, digitalhealth.net reported that Clare Marx, president of the Royal College of Surgeons of England and member of the NHS National Information Board, found that at the time of implementation, "staff, patients and management rapidly and catastrophically lost confidence in the system. That took months and a huge amount of effort to rebuild."

Danish experience
In 2016, Danish health authorities spent 2.8 billion DKK on the implementation of Epic in 18 hospitals in a region with 2.8 million residents. On May 20th, Epic went live in the first hospital. Doctors and nurses reported chaos in the hospital and complained of severe under preparation and training, Epic and its Danish partners insisted that normal testing and training were carried out.

Almost immediately, a major issue was identified: Epic's system was not designed to be translated between languages. Physicians resorted to Google Translate, as specific medical terms either do not exist in Denmark, or hold much different meanings in Danish as compared to English. For example, when inputting information about a patient's condition, physicians were given the option to report between the left and the "correct" leg, not the left and right legs. Another problem that surfaced involved integration with the national medical record system. This is meant to be accessed every time a patient is seen, but it took until 2019, three years after the initial installment, for the integration with the national system to be complete.

For many Danish physicians, these translational issues reflected a deeper issue. Epic Systems was designed specifically to fit the U.S. health care system and the many problems in Denmark showed that it may not be possible to apply Epic to such a dissimilar health care model. The vast differences in billing systems, specialties, inpatient and outpatient care, and more between the U.S. and Danish health care systems made the integration of the system difficult and problematic.

An audit of the implementation that voiced concerns was published in June 2018. At the end of 2018, 62% of physicians expressed they were not satisfied with the system and 71 physicians signed a petition calling for the system to be removed.

Social Responsibility
Under the company motto, "do good, have fun, make money," Judith Faulkner made it Epic Systems mission to give people a reason to come to Wisconsin as well as her personal mission to give back to the greater community. Personally, Faulkner has pledged to donate 99 percent of her accumulated wealth to The Giving Pledge, a campaign to entice wealthy people to contribute their wealth to philanthropic causes. . In 2013, Epic donated $30 million to the Dane Country Regional Airport, driving a much needed parking expansion. In 2005, Epic Systems also donated $200,000 of building material to support the expansion of Stoner Prairie Elementary in nearby Fitchburg, Wisconsin.