Here's an interesting item courtesy of Mr. HIStalk that relates to the final step in the deployment of an Epic EHR in a hospital -- the "Judy check" (see: News 12/5/12).
From Diminutive Avian: Re: Epic. Most people don’t know that Epic has one final implementation check. Judy has to personally give the go-ahead. If she doesn’t like what she sees, she tells the customer she’s pulling out and gives them their money back. That’s another reason why the company has only successful implementations.
Mr. HIStalk response: Unlike publicly traded vendors, Epic is more than willing to walk away if the client is botching the install and ignoring Epic’s recommendations.” I’ve been told that at least two big academic medical centers are in precisely this predicament as we speak. From what I’ve heard, Judy gives the client two choices: (a) agree to let Epic send in a SWAT team to take over the project, or (b) find themselves another vendor.
I was prompted to ask myself to ask the following question upon reading this item: why do some hospital executives need to give the keys to the place to Epic, an IT vendor? I don't think that this happens in other industries. Are we dealing with massive in-house IT incompetence in hospitals or some other factor? I suspect that there may be two forces at work here.
The first is that there is a poor record of complex, large system installs across the world, particularly in large organizations. Too many moving pieces and too many affected users resulting in political chaos and technical complexity. I discussed this idea in a previous note (see: Modeling the Costs of IT System Failures Globally). Here is a quote from it:
Researchers often attempt to quantify the number of failed IT projects, usually reporting statistics that discuss failures as a percentage of the overall number of IT projects. These failure stats are primarily useful to the extent they illustrate that IT failure is a common and serious problem. In a recent white paper, Roger Sessions defined a model (Cost of IT Failure) that quantifies the dollar cost of IT failure worldwide. Roger concludes that global IT failure costs the world economy a staggering $6.2 trillion per year, or $500 billion each month.
The second force at work is that hospital executives have been conned into thinking that their only solution to support clinical computing is the deployment of a single, large EHR. The fallacy of this thinking was pointed out by Dr. Paul Chang in a lecture at Pathology Informatics 2012 (see: The Internet as the New Industrial Revolution: Implications for Healthcare). Here is an excerpt from that note:
[W]e have hospitals today spending hundreds of millions of dollars installing EHRs running on local servers that are the rough equivalent of "mainframe computers" in a former era. Dr. Paul Chang commented in his lecture at PI-2012 that healthcare is the only industry in the U.S. that "solves" its computer problems by using a single, monolithic, inflexible EHR system rather than a set of specialized servers connected on a network (see: Digital Revolution in Radiology). With this more advanced computer architecture, the user submits a query to the network and the response is assembled using information from the most appropriate, specialized systems.
The irony of Epic and its EHR is that the company provides both the most widely accepted EHR solution for hospital executives and then evolves into the hospital's worst nightmare. It sells a monolithic product that only the company can install in some settings. The reasons that only its SWAT team can finish the install are: (1) the members of the SWAT team understand the product in-depth; and (2) the SWAT team can ride roughshod over hospitals employees who don't favor the system and may be sabotaging its deployment. It would be interesting to find out how short a leash Epic puts these errant clients after the install.