An Epic Fluff Piece, Debunked

– Hey, what’s up Z pack. It’s Dr. Z. Check it out. This Sunday aired a CBS piece on that one medical records company that nobody knows the name of, but yet runs pretty much the entire show. The 800 pound gorilla in the medical universe, Epic. And someone sent it to me, and I was like, “I got to watch this.” And I did and I was like, “Oh dear. I got to share this with you guys.” Let’s do this, fam.

– While now, we’ve been hearing about how all our medical records are going electronic. So, for the record, how exactly does that work? Rather than ask your doctor, ask our Lee Cowan.

– Yeah, don’t ask your doctor, because your doctor will lose his sh*t on you . “How’s that EHR working out, doc?” “I’m going to kill someone right now.”

– [Lee Cowan] This may not look like the typical setting for a medical software company. Get in a little closer, and that’s even more evident. It’s as much theme park here as anything. Alice in Wonderland kind of stuff, literally. The workspaces here can be in old railway cars or subway cars, treehouses, and gingerbread houses.

– Contrast to where doctors and nurses are actually charting. Crappy little fluorescent lit cubby, where they’re sharing a bunch of computers with a bunch of jerks. I mean, this is amazing. I want in on this scam right here.

– [Lee Cowan] Even its employee cafeteria looks like a train depot to a land that storybooks are written about.

– I walk through and was like, “What is this?”

– [Lee Cowan] What it is, is the self-described intergalactic headquarters of Epic, in the middle of the farm fields of Verona, Wisconsin, just outside Madison. Private medical records of about 60% of the patients in the–

– By the way, look at that. Just such a perfect blood pressure. This is clearly fake. Not admitted. I would hope not. His blood pressure is 120/70. 95% sat though. That’s, that’s tenuous. I mean, I’m thinking early coronavirus here, maybe asymptomatic.

– [Lee Cowan] One of the things that strikes me is that Epic has such a big reach that it really–

– [Dr. Z] Oh my god. It’s Mama Cass if she hadn’t choked on that sandwich.

– [Lee Cowan] Judy Falkner is the 76 year old genius–

– A little pro tip. When you’re 76 and you’re a multi-billionaire, you get to dress like that, okay? I’m 46 and I don’t get to dress like that.

– [Lee Cowan] Computer software engineer and admitted nerd. To celebrate Epic’s 40th anniversary, she dressed like she was back in the 70s again.

– Which is perfect because the software acts like it was written in the 70s.

– [Judy Faulkner] Well, here’s the skinny, man. That’s far out.

– [Lee Cowan] She’s a little far out, too.

– [Dr. Z] You think? This is what happens when engineers build software to be used by doctors. We get this.

– [Lee Cowan] Far out in front. In the process, made herself one of the richest self-made women in the world.

– Now, look. I’m going to be honest. I love capitalism. I’m glad she got rich doing something she found a need. But listen, where do you think that $3.6 billion came from? It came from us. It actually came from patients, it came from health systems that spend billions to implement and execute Epic, which, while very robust and very adaptable, requires a sh*t ton of money to actually get it right, whereas you can pick up an iPhone and pretty much do anything you want, anywhere. So what’s the disconnect here?

– [Judy Faulkner] We have to compete with Facebook, Google, Microsoft, Apple, etc. We get a lot of acceptances.

– People are like, “I really want to work on a 1990s era software platform, you know. I mean, these YouTubes and Googles and Facebooks, they’re all so fancy and new and usable. Take me back. I’m really feeling that nostalgia for where you just has DOS prompt, and just started typing binary.

– [Lee Cowan] As far as big tech companies go, Epic is doing more than just building phones.

– We feel like we have an impact to make. And it’s something that I actually really value about here. I don’t feel like I’m just clocking in and clocking out.

– No, it’s your doctor who feels like that, because of your software. I think these two are actually motivated by the right things, which is they want to change the world. They’re young people and they’re in a cool place, which is Wisconsin. It’s actually kind of cool. Like, I can’t shit on them for that. But I wish they would understand, like the viewers of this are not going to understand from watching this, the amount of suffering that this software has inadvertently created. They didn’t intend to do this. But this is the problem, is that they haven’t made it usable, the client is not a doctor, the client is a health system. They’re forced to do all kinds of things by regulatory decree and billing and CPT codes and all the regulatory stuff that they have to build into it. Administrators have added click-click-click-click-click-click-click, so they can get the data that they think they need, and now physicians and nurses and everybody else on the front lines have been reduced to data entry clerks. We don’t ask our lawyers to be their own court reporters, yet we do that now with physicians because we have the capacity to do it with an electronic health record.

– [Lee Cowan] To move patient records from overstuffed, dog-eared manila folders to digital records accessible with the click of a mouse.

– By the way, this is amazing. Think about this, there were bags and bags of paper, and now we can access it all. And I was there when– I was using EHR since 1999, maybe before that with the VA, and it is a transformative technology. So how the hell did it get so screwed up?

– I used to like, when I was a kid, to play with clay and make things out of clay.

– [Dr. Z] I’m not lying. I love her outfit. Judy, if you’re listening, I want your stylist, okay? I also want at least 2 of your $3.6 billions.

– And I always thought of computer programming as clay of the mind. The first time I did something and there it was on the screen, it was wow. It’s very creative.

– [Dr. Z] I actually agree. I was really into computers as a kid, and it is a very creative platform. So again, let me ask, what the hell happened with Epic?

– [Lee Cowan] System that is now integral to patient care in nearly every major US health system. It’s ubiquity means that you can now go almost anywhere to be treated, and your medical records will likely follow you there.

– Okay. Let’s just parse this. The only way you can share data from an Epic chart, your data, you’re the patient, you own this data, the only way is if you go to another health system that has Epic. So within Epic, it’s highly interoperable, but any other system, forget about it. And that’s why, that’s why we have these walled gardens. Once a hospital system invests in Epic, they can’t change. They’ve already dropped a billion dollars and now their data is now locked in this sort of walled silo. It’s really quite a scam they’ve got going.

– [Lee Cowan] Doctor Steve Peters is a pulmonary critical care physician at the Mayo Clinic in Rochester, Minnesota.

– [Doctor Peters] It’s the old days I don’t want to rush back to.

– [Lee Cowan] He showed us mock ups of what those old detailed paper records used to look like, and how they used to travel. Miles and miles of tubing.

– [Dr. Z] Dude, little tip, reporter. Maybe, maybe this is not the best way to hold the tube. I mean, I’m just saying, I can screenshot that and use it as the thumbnail for this, but I won’t because I’m a good guy. I’m just going to keep pointing at it.

– Yeah, it’s like the arteries–

– [Lee Cowan] It was state-of-the-art in record keeping at the time, so it does make a certain amount of sense that the Mayo Clinic would end up today being the single biggest client of Epic, spending over a billion dollars, over the next several years, to integrate its systems.

– Okay. Now, I understand where we’re coming from. A billion dollars to integrate under Epic. Now, what do you think their doctors are going to publicly say about Epic? That it sucks? How are they going to explain that to their board of directors? Little bias, much?

– [Lee Cowan] With all that data, though, at your doctor’s fingertips, their fingertips can be pretty busy.

– Okay. Here we go. This is where it gets into serious reporting. We’re going to talk about physician burnout, about the fact that doctors have to look at the screen instead of the patient, about information overload, about the new errors that electronic health records introduce, these different types of cognition that we’re having, typing instead of writing. We’re going to talk about all that now. We’re going to talk about having to come home and finish our charting. Sort of pajama time. We’re going to talk about how, I don’t know, some ungodly percentage of physicians cite the electronic health record as a major cause of burnout, about the moral injury that comes from having to treat an electronic health record, figure it out, click all the boxes. A million clicks just to get a simple med out, versus just talking to our patients, holding their hand, comforting a parent or a child. We’re going to talk about that now, right CBS? Because that’s what journalism is, right? We’re going to do that, right? Let’s do that.

– [Lee Cowan] Because of patient privacy, we can’t really show you all the data that doctors have to enter on that Epic system.

– Oh, there it is. Because of patient privacy, we can’t show you the data that doctors have to enter. So this is a notorious thing that Epic does. They won’t allow their screens to be shown. They used to have gag orders, where people could not share screenshots of their screens because then the public would know what we have to deal with, which is a freaking NASA dashboard of scattered information that’s distracting, trying to drill down to find the piece that you want, trying to figure out how to write the order that you want without making errors, new errors, writing on the wrong patient, writing the wrong med, making specific types of errors that are unique to electronic health records. “No, we can’t show that because of HIPAA.” Bullsh*t. You can’t show it because you don’t want to show it. Because if people saw what this was, they would realize that the cognitive burden on physicians is so high, that it’s actually distracting from the ability to care, because your user interface is garbage. And it’s still one of the best electronic health records out there. What does that say? Right? I love people who defend Epic. “Well, it’s still so much better than MEDITECH,” or “Man, have you used Cerner? Cerner is crap.” I’ve used them all. They’re all terrible. You have Stockholm Syndrome. You’ve spent a billion dollars, this is your captor now. You’re going to take their side because what else can you do? Right? Well, what else we could do, is actually demand better. What we could do is change the incentives and the regulations that require electronic health records to be such steaming pieces of crap. We could require that we look our patients in the eye again. We could stand up together as frontline clinicians and take this back from engineers who’ve built this stuff with good intention but no clue of how it’s actually used on the front lines. And then they complain that doctors aren’t participating in the process. B*tch, we don’t have time to tie our shoelaces. We’re too busy clicking the boxes as it is, to become an epic super user or go to classes or spend time in meetings. We’re drowning in our own sh*t already.

– [Lee Cowan] And if you’ve been to your doctor lately, you know it can feel like they spend as much time entering data on a keyboard as they do on you.

– That’s actually not true. They don’t spend as much time entering data on a keyboard as on you. They spend more time. Two hours of administrative tasks, to one hour of patient care, typically.

– [Lee Cowan] Doctor Peters says, “Get used to it.”

– [Doctor Peters] It’s like blaming the word processor for a homework assignment for a student who has to write a term paper. It is where the documentation has to go.

– [Lee Cowan] The technology isn’t the enemy, it’s just the reality.

– [Doctor Peters] That’s correct.

– Did he just say, “Suck it up. It’s not a problem with the chart, it’s a problem with you. Or it’s a problem with what needs to be done.” Okay, that is absolutely the most learned helplessness type of scenario I have ever heard. And I don’t know who this guy is, but I feel like they probably edited him out of context, because no self-respecting doctor would say something like that if other doctors are watching. There’s just no way, all right? Let’s be honest. So I’m inviting him, right now, to come on to my show and let’s talk about Epic, because that would be amazing. And because that is so disturbing, you guys.

– [Lee Cowan] Epic is, however, working on a solution that would free up your doctor altogether.

– Ooh. Wait a minute. Self-destructing Epic, and going back to paper , which, by the way, I’m not advocating. Paper is terrible, all right. It had its advantages, especially the cognitive advantage of writing, but it’s an absolute disaster for getting data. We need electronic health records, we just need them to work for clinicians and patients, and not be glorified cash registers, which is what they are now. And it’s not actually the EHR vendor’s fault. It’s every system of incentives that’s been developed, and how we get paid. That all has to change before we get health 3.0, an electronic health record that’s actually worthy of that.

– [Lee Cowan] Because it might be coming down the road, I understand, is instead of having to key in everything you might sort of have the Alexa of medical records?

– [Judy Faulkner] That is correct.

– [Lee Cowan] And how would that work?

– [Judy Faulkner] The doctor would just say, “Hey, Epic. Show me Lee’s history.” And that would come up. And in the end, the doctor would say, “Hey, Epic. Write my note.” And the whole note would be written.

– Okay, nurses. Let me know this. Epic is listening the whole time to you, okay, just like Siri or Alexa, it’s listening the whole time to you. Are you not worried that your employer, who owns that data, or Epic, that has access to that data, is going to somehow use it against you? So you would really have to trust the vendor, or set up systems that you’re willing to use voice recognition, that’s always on, in the exam room or in the hallway or wherever you’re charting, to be able to do that, because that, to me, is terrifying. Now I’ve had people on my show, like Suki, they make an AI, “Hey, Suki” type digital assistant. I think this is a great idea, but you better fix that issue, because I don’t trust Epic with that. I don’t trust my employer with that. I might trust a third party to keep it somewhere. Even then, it’s tricky. Now again, is it better than entering data by hand? Sure. Should it be the future? Probably. But these are the things you have to think about.

– [Lee Cowan] No shortage of a imagination here at Epic. Medical records don’t really sound all that fanciful. But here, and in Judy Faulkner’s mathematical mind, anything seems possible.

– [Dr. Z] That there, is billions of dollars, of healthcare inflationary dollars, going to build an amazing campus for millennials to prance around in Wisconsin on, and 60% of medical records are controlled by Epic. Why do I always pick on Epic? Because they are the biggest. If Athenahealth or Modernizing Medicine, both of whom I’ve worked with, or Office Practicum, who I’ve worked with, I’ve done talks for, if they were the largest electronic health vendors in the country, I’d be picking on them too. And they would actually probably be cool with it, because those guys, unlike Epic, are willing to admit that electronic health records have huge room for improvement, that they suck in their current iteration, and that they need to get better and we need to get back to clinicians. I have never, and I have spoken with Epic people. That’s not the sense that I get. Because their customers are huge health systems and this is what those health systems are demanding. So who’s fault is it, really? I think there’s plenty of blame to go around. But where I will not accept blame, is having it solely placed on the laps of physicians. “Well, you’re not optimizing it.” “You’re not an Epic super user.” “You’re not participating in the discussion.” I’ve already said why that’s crazy talk, okay? Build us some sh*t like an iPhone, that works, that we can customize, that’s easy to use, all right, that lets us look at our patient in the eye, sure, you can put voice recognition on it, if it’s secure, and we’re good to go. It’s not that hard, you guys. When I first saw this clip, I was so angry, I put out a tweet storm which I’ll retweet. Really, really angry. This is my second draft response to this. And if you notice, I’m not jumping up and down and throwing feces because I’ve had a little time to process this. Everybody’s trying to do the right thing. Judy’s trying to make money, which she has to do, that’s part of her job. This is a private company, by the way, it’s not a public company. So you have no say in what they do, there’s no public reporting. This is a private company that controls 60%, if you believe the piece, which was not a reporting piece, it was a fluff piece. It was basically a glorified infomercial for Epic. If patients actually watch this and go, “God. This is a great company doing great things.” They go to a hospital and they see Epic and they get all excited. That’s a problem. We ought to be, our patients ought to be standing up and demanding better. Demanding better for themselves and for their physicians. They should also demand their data, right? That’s crucial. We’re just the shepherds of our patient’s data. It’s their data. When we were running Turntable Health, we had our own EHR that we built from scratch with our partners Iora, and patients had access to it, it was problem based, you could have a health coach and a doctor writing in it at the same time, there wasn’t a billing component to it, it was pure patient care. And it wasn’t perfect but it just worked. That’s what we need from our electronic health records and we have to demand it. So if you’re on Epic, hey, we can do our part to optimize it but we can’t let these guys off the hook. We’ve got to turn the screws and the pressure on them. We cannot let a fluff piece define the conversation on this. It has to be us, the frontline users of this stuff, defining the conversation, all right? So I’m going to log off now, I’m going to go. I want you to share this video. I want you to become a supporter. I want you to have a voice, leave a comment, tell us your stories, right? And then I’m going to go because after I round at the county hospital, I’m going to spend two hours doing my charting that used to be on paper, it would just take minutes. I would do it as I went, okay? We’ve got to fix this because it is wrecking our calling. And it is fixable. All right, guys? ZDogg out.

– That’s why I’m here. I’m not here for the basketball part.

– [Z Doctor] Oh, snap. It’s live coverage of Kobe’s funeral . Kobe, if you were running Epic, you would have done it right. Just three points.