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Pointing out how Care Everywhere is supposed to work, and then demanding that "the deriding of Epic's ability to scale should stop" are two separate things.

The one thing Kaiser, Epic, and Justen Deal seem to agree on is that Epic is not available 99.999% of the time. From inside KP, the points made in the Computerworld are obvious: the system is not scaling, and it's having a big impact on workflow and care.

It isn't just databases (Cache, in our case). It isn't just Citrix. It isn't just the network. It isn't just this or that. It's all the things, working together, or not working together in the case of HealthConnect.

As they say, if you can't take the heat, get out of the kitchen. Computerworld has a 722-page report outlining thousands of hours of outages, including dozens of situations in which patient card was dangerously impacted. Simply saying the system can and does scale doesn't cut it anymore. It's not true, and most people see that now.


It seems to me the "presuming" is coming from the people who are actually experiencing the failure of the system. There seems to be a huge gap between the theory of database distribution and the reality of downtime. And all the PR-pushing isn't just a matter of business as usual: quality of patient care is at stake.


re: Epic scalability. I wish folks wouldn't "presume" unless they know more about the underlying technology. Epic utilizes a distributed database structure for their largest customers - such as Kaiser - so that the system acts as one large database, but not all the data resides on one physical server. This architecture is how most computer databases are structured these days, so it shouldn't be seen as a disadvantage. Epic has technology (termed "care everywhere") that allows the distributed databases to sync up - i.e. I'm a Kaiser patient who lives in southern california and I'm on vacation in Colorado. I go to the Kaiser clinic in colorado, they pull my record up in Epic (it is "transferred" from the So. Cal. instance), enter new data on my chart, and then the new data is synched back up with my home instance in So. Cal. So to the patients and providers it's invisible - the data is complete in both instances, and the charges go where they should as well. Tricky stuff, but it's the only wa that a nation-wide EMR can really work effectively.

So, the point is that the deriding of Epic's ability to scale should stop. It's not true - their database goes bigger than most others, and with their other tech innovations it allows the database to be distributed & go even bigger.

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