A recent article discussed Epic's authorization of its EMR to run on Intel x86 servers with open-source Linux (see: Epic Systems authorizes EHR system to run on Intel x86 Linux). What was most interesting about the piece was the speculation and hints within it about Epic's overarching strategy. Below is an excerpt from the article:
Epic Systems Corp., one of several dominant EHR vendors for large hospitals, recently authorized implementations of its EHR system on Intel x86 servers running open-source Linux, virtualized to VMware. Prior to that, Epic ran exclusively on AIX and UNIX servers. The move could signal the software company's attempt to expand its customer base by adding more medium-sized hospitals to its present mix, which includes the largest hospitals, physician groups and academic medical centers. Linux servers are cheaper to purchase -- and maintain, too, since Linux administrators are more plentiful, especially in smaller cities. The announcement came early in May at an Epic Systems Roundtable meeting at its Verona, Wis., campus, after extensive testing by third-party service providers VMware and Dell. Those companies will offer implementation services to hospitals who buy into the system, which they also do for customers of Epic competitors such as Cerner Corp. Dell also provides other services, such as Epic disaster recovery and physician/nurse order-entry helpdesks....[Frank] Nydam [VMware director of healthcare business development] added that cost isn't the only factor driving smaller providers to consider Epic, but interoperability concerns too. If a local hospital's patients typically seek specialty care at a large Epic customer such as Kaiser Permanente or the Cleveland Clinic, it would be more straightforward to exchange patient data when they're on the same system....
"We're excited about this kind of a move; to do this kind of thing is a little out of Epic's character," said Jamie Coffin, vice president and general manager of Dell Healthcare & Life Sciences. "They see it -- I think -- as a way to reach customers that are much smaller than they've historically reached." Gartner analyst Wes Rishel, who sits on the Office of the National Coordinator for Health IT's Privacy & Security Tiger Team with Epic CEO Judith Faulkner, doesn't necessarily see the move to Linux servers as a significant market play for more customers. After all, Rishel points out, server hardware is just a small slice of an Epic implementation budget that includes support, provider training, software purchase and other costs. Furthermore, he added, hospitals in smaller cities may find it challenging to locate IT specialists versed in running VMware on Linux. He does concede, however, the idea of running Epic on Linux servers has potential to expand the EHR system's reach into more hospitals, especially at a time when competitor Allscripts is enduring internal strife."I don't see it as creating any significant shift in market position or anything like that," Rishel said. Later, he added, "But I can't deny that it's a possibility."
Here's what I personally take to be significant elements of Epic's business strategy inferred from this article and other notes I have posted:
- Start to compete more vigorously in the mid-size hospital sector. A component of this strategy, previously discussed, was to use its large hospital customers as Epic hosting sites for smaller hospital (see: Epic Helps Convert Its Large Hospital Customers into Epic Hosting Sites/Consultants). Running Epic on Linux servers which are less expensive also goes to this same agenda. I have speculated before that its arch rival, Cerner, is also starting to compete in mid-size hospitals (see: Is Cerner Modifying Its EMR Business Model?). It helps that Allscripts is in turmoil.
- Outsource work to other reliable IT companies, when feasible. Of course, the MUMPS/Cache software engine is at the heart of the EPIC EMR, which is a product of privately held InterSystems. For the Beaker LIS, instrument interfaces and rules are managed by Data Innovations software. VMware and Dell now join the list of companies that Epic and its customers have come to depend on. The latter we learn above provides disaster recovery and physician/nurse order-entry helpdesk services.
- Provide a de facto clinical-data-exchange "standard" among Epic client hospitals. I have speculated about this goal in previous notes (see: A Reader Comments on Epic Interoperability and Care Everywhere; More on Epic's (Non)-Interoperability and the Recent NYT Puff Piece). Frank Nydam of VMware makes this same point regarding Epic in the excerpt above: "If a local hospital's patients typically seek specialty care at a large Epic customer such as Kaiser Permanente or the Cleveland Clinic, it would be more straightforward to exchange patient data when they're on the same system."