The Feasibility of Using the Epic EMR as a "Platform" to Extend Its Functionality

For a number of reasons, Epic has achieved a near monopoly of the EMRs installed in the largest U.S. hospitals (see: ShandsHealth Goes Live with Epic; Company Penetration of the Hospital Market; Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion). In my opinion, this trend poses a significant challenge for healthcare in general. Here's a quote from the first of these two notes describing the nature of this challenge:

Epic...has a reputation of closely controlling the installation and development of its EMR software products. This is the basis for its record of successful system installations and part of the appeal of the product to hospital CEOs and CIOs. Furthermore, the evolution of clinical hospital systems (e.g., EMRs, LISs, RISs, etc.) is a critical element in the overarching strategy of our rapidly expanding health systems. Within a few years, any significant discussion of healthcare  strategy in the U.S. will require the active participation and support of Judith Faulkner, the founder and CEO of Epic, and her executive team.

Epic's monopoly would possibly be of less concern if the Epic software could be used as a platform. Would there be an opportunity for other vendors to extend the functionality of the Epic system by providing software that would sit "on top" of it? I have discussed software platforms in a previous note (see: Understanding IT Platforms and Apple's Platform Strategy). Here's a quote from that note:

[A platform is] a product/system like Windows, Internet Explorer, Adobe Flash, or Java, upon which the developer or competitors can build new applications or other software. Control of such a platform enables a company to control the products that are subsequently built on top of it unless and until one of them itself constitutes another platform, allowing this development cycle to continue.

I think that the answer to this question is a definitive negative. Here's a few reasons why I think that the company would never allow other vendors to develop software to enhance its functionality in a way that some of its hospital clients might find desirable:

• As noted above, Epic exercises a high degree of control regarding the installation and development of its software; to allow other vendors "through the door" would cause an erosion of this control.
• One of the reasons for Epic's domination of the EMR market is its high performance. To allow other software to interoperate with its system would run the risk of degrading its own system response time.
• One of Epic's claims to hospital executives is that the company will provide all of the necessary EMR functionality for a hospital. To allow other vendors to extend the functionality of the Epic product would weaken this claim.
• One of the reasons why hospital CIOs favor an Epic "enterprise" solution (i.e., wall-to-wall Epic) is that it simplifies their job (see: Are You an Enterprise or Best-of-Breed CIO? Access to Cash May Make the Difference). They don't need to worry about integrating the Epic software with any "foreign" product. Why look for trouble?

Comments

[Health IT tech]

It might be working 'pretty good' with Epic for some, but how many other facilities out there have spent the money on an Epic system and have in fact had a need to utilize additional software, only to be told "it has to be one system?" http://www.meaningfulhitnews.com/2009/05/23/vendors-this-is-your-wake-up-call/

If the govt is going to divvy out cash to encourage EHR use, vendors' products had better be able to talk to one another. Otherwise, the govt may as well just dictate one system that every facility uses, and that certainly wouldn't be in anyone's interest but the govt's and that one vendor. In order to increase their efficiency and productivity and also provide more value to patients, many facilities want and need more choice and flexibility than that. As more and more open source technology and innovative niche 3rd party applications become available, I think it would be disastrous if a single proprietary system so heavily monopolized the market. We need more flexibility, not less.

[Doctors online]

I believe its working prety good with epic emr.