In a recent note, I discussed a newly announced deal between Epic and CVS's MinuteClinic for the deployment of EHRs in their walk-in clinics (see: Epic EHRs Added to In-Store MinuteClinics; the Pursuit of Connectivity). The Medial Quack reminded me that MinuteClinic had announced a previous EHR arrangement with Allscripts in February of 2012 (see: CVS Flip Flops With Medical Records Choice For Minute Clinics, Selecting Epic; CVS Caremark's MinuteClinic to Deploy Allscripts EHR Nationally). She also commented that the prior electronic medical record used by MinuteClinic was their home-brew version that based on e-ClinicalWorks.
I am not surprised that CVS/MinuteClinic has been trying to move away from home-brew software in favor of a commercial EHR. Hospitals, clinics, and physician offices learned this lesson decades ago. You need to have a company that can support your software rather than your internal IT department for both economic and regulatory reasons. Internal IT personnel often favor home brew software development, preferably poorly documented, because it provides a long-term employment contract for them.
I don't know why the previous contract between MinuteClinic and Allscripts was canceled but this does not stop me from speculating about the cause. It's possible that the Epic arrangement may also blow up, perhaps for the same reason that the Allscripts deal went away. Here's some reasons why Epic and CVS/MinuteClinic may not have a harmonious relationship; some of these same reasons may apply retrospectively to Allscripts:
- Epic has mastered client control in order to enhance their software deployment success record. They have learned that if their hospital clients modify their software, they often break it or stress it. A large national business-savvy corporate client like CVS may be harder to dominate in this way. My guess is that MinuteClinic will be much more satisfied, in the long run, with a smaller EHR vendor with a system designed for simple healthcare delivery and based in the cloud.
- The ambulatory care records of a MinuteClinic will be rudimentary compared to most physician office practices and hospital ambulatory care settings. CVS may ultimately balk at the inherent work-flow inefficiencies and complexity of the Epic ambulatory care software.
- Epic executives prefer to use consulting firms approved by them as key interfaces between them and their clients, allowing the company to grow faster and optimize new software releases and products. I don't know who or what will function as the "interface" between CVS/MinuteClinic and Epic. My guess is that the CVS/MinuteClinic internal IT department is managing the Epic software deployment. If so, this may place additional strain on the relationship.
An old adage is that culture always trumps strategy. I view CVS/MinuteClinic and Epic as having different cultures with the former representing a go-go, growth-oriented company and the latter an insulated, inward-looking healthcare IT company. There is a wide gulf between the two. Based in part on the apparent failure of the previous Allscripts venture, I would guess the chance for success with Epic will be slim. If it doesn't work out, it will probably take at least two years for the announcement.