Until recent years, a large percentage of EMR deployments in hospitals failed. By this I mean that the selected system was never installed or ran so poorly that is was quickly replaced or merely tolerated. I myself was a close observer of at least two such debacles during my career. Such failures are not confined to healthcare (see: Modeling the Costs of IT System Failures Globally). However, the number of such EMR failures seems to have declined recently, particularly as Epic has taken the lion's share of new contracts in large and complex hospitals (see: Does Epic Exercise a Near-Monoply for EMRs in Larger U.S. Hospitals?). Epic's reputation on the street is that its deployments rarely fail and that this is one of the major elements in its success.
Mr. HIStalk posted a list recently recently of the reasons why hospital software deployments often fail (see: Monday Morning Update 7/30/12). It's listed below:
Unless every vendor’s implementation has been a disaster, it can’t be their fault alone (i.e., one successful comparable client means the stuff basically works). The main problems usually involve:
- Lack of customer technical and implementation resources
- Poorly developed, self-deceiving project budgets that don’t support enough headcount, training, and hardware to get the job done right;
- Letting IT run the project instead of getting users involved, which is especially problematic if the corporate IT people are clueless
- Unreasonable and inflexible timelines as everybody wants to see something light quickly up after spending millions
- Expecting that just implementing new software means clearing away all the bad decisions (and indecisions) of the past and forcing a fresh corporate agenda on users and physicians, with the vendor being the convenient whipping boy for any complaints about ambitious and sometimes oppressive changes that the culture just can’t support
- Sloppy contracting on the client’s side, since I’ve seen hundreds of contracts and am often amazed that the interests of the vendor weren’t legally aligned with those of their customer via a few standard terms and conditions.
I find it interesting that Mr. HIStalk focuses in his note on failures and missteps on the part of hospitals and their leadership rather than a faulty product from the vendor. As he says: Unless every vendor’s implementation has been a disaster, it can’t be their fault alone. I tend to agree with him on this. All of the major EMRs with a history of success are "installable" and most can probably be described as "good enough."
Let's assume that you agree with this last statement and you also agree with Mr. HIStalk's list of mistakes made by hospitals. It then becomes apparent that the vendor which is most able and willing to prevent hospital-generated mistakes when installing its software will have the best record of success. In fact, Epic's reputation seems to hinge on two major factors: (1) carefully picking its hospital clients; and (2) carefully managing the deployment process including the critical user training.
Here's a quote from a Forbes article about Judith Faulkner's predilection for picking the right hospital clients (see: Forbes Provides Some New Details about the Kaiser/Epic Deal):
At the beginning of each year, Faulkner commands her tiny salesforce to select customers based on whether they are fit to work with Epic—making it a privilege.
Here's an excerpt from a blog note by Vince Ciotti that was intended to illustrate the dark side of Epic, which is to say the problematic side (see: The Other Side of Epic):
The “Epic Way.” Time and again I have heard from CIOs who have gone through an epic install (lower case intended) that the only way to make an Epic implementation successful is to not change the system, but rather adopt your workflow to EpicCare. This is silly in light of the mega-bucks Epic charges. Vendors like Cerner and Siemens pride themselves in adopting their system to their clients’ workflow through screen painting and workflow engines. How can Epic dare charge so much, yet be so inflexible?
It seems to me that Epic's EMR deployments succeed because of its inflexibility, which allows the company to dictate terms to its hospital clients. In so doing, it prevents the hospitals from making most of the errors listed by Mr. HIStalk above. In short, the company is able to charge a premium price because it's inflexible in its client relations.