Epic Systems

Care Everywhere is Epic's health information exchange software, which comes with its electronic health record (EHR, or EMR) system.[21] A 2014 article in The New York Times interviews two doctors who said that their Epic systems wouldn't allow them to share data with users of competitors' software in a way that will satisfy the Meaningful Use requirements of the HITECH Act. At first, Epic charged a fee to send data to some non-Epic systems.[22] Epic said the yearly cost for an average-sized hospital was around $5,000 a year.[21] However, after Congressional hearings, Epic and other major software vendors announced that they would suspend per-transaction sharing fees.[23] Epic customers must still pay for one-time costs of linking Epic to each individual non-Epic system with which they wish to exchange data; in contrast, Epic's competitors have formed the CommonWell Health Alliance which set a common Interoperability Software standard for electronic health records.[23] A 2014 report by the RAND Corporation noted the software was difficult and costly to use in conjunction with other billing systems.[24] The report also cited other research showing that Epic's implementation in the Kaiser Permanente system led to efficiency losses.

In September 2017, Epic announced Share Everywhere, which allows patients to authorize any provider who has internet access to view their record in Epic and to send progress notes back.[25] Share Everywhere was named Healthcare Dive's "Health IT Development of the Year" in 2017.[26]

An Epic electronic health record system costing £200 million was installed at Cambridge University Hospitals NHS Foundation Trust in October 2014, the first installation of an Epic system in the UK.[27][28]

After 2.1 million records were transferred to Epic systems, it developed serious problems and the system became unstable.[29] Ambulances were diverted to other hospitals for five hours and hospital consultants noted issues with blood transfusion and pathology services.[30] Other problems included delays to emergency care and appointments, and problems with discharge letters, clinical letters and pathology test results.[28] Chief information officer, Afzal Chaudhry, said "well over 90% of implementation proceeded successfully".[27]

In July 2015, the BBC reported that the hospital's finances were being investigated.[31] In September 2015, both the CEO and CFO of the hospital resigned.[32] Problems with the clinical-records system, which were said to have compromised the "ability to report, highlight and take action on data" and to prescribe medication properly, were held to be contributory factors in the organization's sudden failure.[33] In February 2016, digitalhealth.net reported that Clare Marx, president of the Royal College of Surgeons of England and member of the NHS National Information Board, found that at the time of implementation, "staff, patients and management rapidly and catastrophically lost confidence in the system. That took months and a huge amount of effort to rebuild."[34]

In 2016, Danish health authorities spent 2.8 billion DKK on the implementation of Epic in 18 hospitals in a region with 2.8 million residents.[35][36] On May 20, Epic went live in the first hospital. Doctors and nurses reported chaos in the hospital and complained of a lack of preparation and training.[36]

Since some elements of the Epic system were not properly translated from English to Danish, physicians resorted to Google Translate. As one example, when inputting information about a patient's condition, physicians were given the option to report between the left and the "correct" leg, not the left and right legs. As of 2019, Epic had still not been fully integrated with Denmark's national medical record system. Danish anesthesiologist and computer architect Gert Galster worked to adapt the system. According to Galster, these Epic systems were designed specifically to fit the U.S. health care system, and could not be disentangled for use in Denmark.[36]

An audit of the implementation that voiced concerns was published in June 2018.[37] At the end of 2018, 62% of physicians expressed they were not satisfied with the system and 71 physicians signed a petition calling for its removal.[36][38]

In 2012, the Hospital District of Helsinki and Uusimaa (HUS) decided to replace several smaller health record systems with one district-wide system created by Epic. It was called Apotti and would be used by healthcare and social services for the 2.2 million residents in the HUS area. The Apotti system was selected as the provider in 2015 and implementation started in 2018. By November 2022, the Apotti system had cost 625 million euros.[39]

After the implementation, complaints from healthcare workers, especially from doctors, started accumulating. The system was accused of being too complicated and that its convoluted UI was endangering patient safety. For example, one patient was administered the wrong chemotherapeutic drug due to an unclear selection menu in the system.[40]

In July 2022, a formal complaint demanding that the issues in the system be fixed or the system be removed entirely was sent to the Finnish health care supervising body Valvira. The complaint was signed by 619 doctors that use Apotti.[41]

Central Norway started introducing Epic (branded “Helseplattformen”) in the winter 2023. After approximately two months, the public broadcaster NRK reported that around 25% of the doctors at the region's main hospital considered quitting their job, and that 40% were experiencing stress related health issues due to the new IT system.[42] Previously, health personnel actively demonstrated against the software by marching though the city of Trondheim.[43] Due to the chaos ensuing the introduction, including 16.000 letters not being sent to patients, the Norwegian CEO of the Helseplattformen IT project, Torbjørg Vanvik, had her employment ended by the board.[44] Unexpected cost increases forced the authorities to decrease efforts in other areas, such as a planned initiative on mental health.[45] Employee representatives state that the public will receive ”significantly worse services“.[46]

In 2020, the novel coronavirus pandemic spread in the United States. Epic Systems faced considerable criticism for their initial plan to have their 10,000 employees return to work on-campus.[47] Employees expressed concern about returning to the office, with the first group being required to return as early as August 10 while the pandemic continued to spread.[48] This plan was abandoned, and as of December 2020, employees were still able to work from home.[49] The plan had come about despite a Dane County public health order requiring remote work "to the greatest extent possible."[50] Criticism revolved in particular around the fact that employees were being ordered back to preserve the company "culture," despite CEO Judy Faulkner's admission that work was getting done remotely.[51] According to The Capital Times, who interviewed 26 Epic employees about the plan, "13 [employees] said they have knowledge of managers being demoted for expressing concern about the company’s plans to bring its nearly 10,000 workers back" to on-campus work, and all requested anonymity for fear of employer retribution.[52]

In a survey of over 400 Epic employees, 89% of respondents expressed dissatisfaction with how Epic was handling the pandemic.[53]