A maxim that seems to be on the lips of a lot of people to explain the phenomenal success of Epic is that no CIO will get fired for choosing Epic. This is reminiscent of a similar saying about IBM thirty years ago or more when it dominated the mainframe computer industry. A recent blog note raised this same question (see: Who Says Chief Information Officers Can't Lose By Choosing Epic?). Here is an excerpt from that note:
As the saying goes in health IT circles: You can’t lose your job by picking Epic Systems. With its reputation for consistently high marks, and a prestigious roster of clients, hospital chief information officers view it as a safe bet. Not Barry Blumenfeld, it appears. He recently vacated the post of chief information officer at Maine Medical Center, a well-regarded medical center in Portland, and the state’s largest. A story in...Healthcare IT News implies that his departure was related to the hospital’s implementation of Epic’s electronic health record system, estimated at $160 million. In an April letter to employees, Maine Medical Center’s chief executive Richard Petersen partly blamed the launch for an operating loss. The hospital had botched its implementation, disrupting revenue....Maine Medical Center is not the only hospital to run into financial trouble over an Epic implementation. There’s been a trickle of local press reports about others with similar stories. In May, the Winston-Salem Journal reported that the chief information officer of Wake Forest Baptist Health resigned in the middle of a difficult Epic launch, although the hospital says it’s unrelated. Last month, Greensboro, N.C.-based Cone Health announced a wave of layoffs and cuts. Epic is often blamed for hospitals’ financial woes. But, hospitals that can’t afford it should think twice before taking on the burden of a costly implementation.
I think that there are probably three major ways in which a hospital CIO can get in trouble with an Epic install:
- First and foremost, and as emphasized above, one path is not preparing the hospital for the numbing cost of the Epic EHR, exacerbated by the abrupt decline in physician and nurse efficiency and productivity when working with the system (see: The Cost of Deploying an Epic EMR and the "Oreo Cookie" Analogy). In this regard, Epic is probably not much different than its competitors in the EHR market. Unknown at this time is to what extent this drop in efficiency is recoverable as nurses and physicians become more familiar with the system. You may ask why the CIO and not the CFO will take the fall for the cost of the Epic EHR. I suspect that most CFOs will gag initially at the cost of the system and go on record that the hospital can't afford it. This gets them a pass when heads start to roll.
- The second error, closely tied to the first, is for the CIO to oversell the system to hospital nurses and physicians. They need to be told the following at the outset of the Epic journey: Your work efficiency and productivity will take a major hit after our go-live and may never return to what it was previously. We are installing this system because of pressure from the government and because everyone else is doing it. Of course, if the CIO goes on record with such a statement, his or her days will be numbered on this basis alone.
- The last way for a hospital CIO to be fired is not to closely follow the Epic go-live procedures and stumble along the way. Epic has little patience for failures because the success of the company is based, in part, on their high percentage of successful installs. Such missteps on the part of the hospital CIO can be the result of personal shortcomings or aggressive push-back by the CIO regarding the Epic culture or policies. The firing news can come from the hospital executive suite or sometimes be the result of a bad report from Epic after a failed "Judy check" (see: Some Hospitals Can't Get Past the Final Epic Deployment Step: the "Judy Check"). In this latter scenario and If Epic decides that a hospital go-live process is a cause for concern, Epic takes control over the project or walks. In either case, the hospital CIO may end up in the dog house.