5 ms·

I also worked at Epic for a while; CEO was definitely a control freak at that time. I consider it very likely that she has not changed in that respect. I was

I also worked at Epic for a while; CEO was definitely a control freak at that time. I consider it very likely that she has not changed in that respect. I was promised employee stock at hiring. The company shortly thereafter reneged and substituted a "shadow stock" plan. The rationale I was given explicitly mentioned that having too many private stockholders would trigger mandatory financial reporting, and that the company would rather give me the finger than its balance sheet. It was just one of the many reasons why I left. The company was fueled entirely by the inherent brokenness of the US health care complex. It seemed to be metaphorically powered by shoveling fat stacks of $100 bills directly into the fireboxes of pre-Watt Newcomen steam engines. They didn't even bother with the seemingly simple expedient of converting the $100 bills into $1 bills to increase the available fuel supply. The end product that was visible to the customer was good, but it almost certainly cost several orders of magnitude more to produce it than was strictly necessary.

stephencanon 10y ago
> The end product that was visible to the customer was good This would be news to my wife (a surgeon), or any one of her coworkers. The software is universally viewed as terrible by everyone I've talked to. It actively results in worse records because (at least as configured) it's so cumbersome to use that many notes are frequently kept out of the system. A management plan that takes seconds to explain verbally requires minutes of data entry.
- bduerst 10y ago
  The thing about Epic Hyperspace is that it's polarizing for those who work in the medical profession. You either love it or you hate it, and the physicians who hate it typically hate it because of what you said - they're suddenly having to type their own notes into a computer rather than dictate it to someone else. Personally I'm of the opinion that doctors doing their own data entry is better for liability and malpractice reasons, but I empathize with your wife and people who hate doing it.
  - stephencanon 10y ago
    The data entry just gets dumped on residents, adding to their already absurd workload (and realistically gets done at the very end of their shift after being on call for 24-30 hours). There is no plausible way that this results in better accuracy. The idea is great, but it just runs into an absolute brick wall of realities of the health care system and human behavior.
    - bduerst 10y ago
      Has your wife ever come up with solutions? I've thought about trying to solve this data-entry problem in healthcare before, but it seems to be almost an admin/process issue.
      - eonw 10y ago
        i think you can dump audio files into dragon(nuance) and get the transcript back for data entry.
        bduerst 10y ago
        Yeah, I almost mentioned dragon but I didn't because I wanted to avoid anchoring the question. They seem to be (or were) a market favorite.
        nradov 10y ago
        Yes but doing that takes some time, and then correcting the numerous errors takes more time. So it's not necessarily more cost effective than using template data entry forms. Some doctors now dictate, and then rely on transcription services which use speech recognition to generate a rough draft followed by human transcriptionists to fix most of the errors.
  - whafro 10y ago
    I don't think it's quite so cut-and-dried. A lot of the anti-EPIC sentiment I hear (digital health founder here, wife is a physician at a major medical center) is kept pretty separate from the anti-notes sentiment (which is equally loud). Instead, the EPIC complaints are about the UI and workflow, which was modeled after the typical paper H&P (history & physical) forms clinicians would traditionally fill out. It comes down to the same UX lessons we've learned about most offline-to-online form transitions: directly porting a form is rarely the answer. The anti-note sentiment has to do with the fact that they're copying-and-pasting from previous notes (often the vast majority of a note's content is pasted in), they're using MS Word to draft the notes because of a buggy editor UI, and then when they're in a situation they actually have to read the note, they're sifting through a pile of duplicated, pasted content. There's a ton of opportunity for change here. There's an equal amount of risk involved, and selling these types of products into healthcare is about as fun as removing your fingernails. That's the piece EPIC does well, and why they're still a behemoth, even if their product is a five out of ten.
- logfromblammo 10y ago
  Ha! I said "customer", not "end user". The customer is the hospital and/or HMO administrator! And I used "good" to damn with faint praise. It generally meets customer requirements, and probably doesn't cause as much iatrogenic harm as whatever systems it replaces. For what it costs, I would personally expect quite a lot more out of it than it delivers. But there's only so much you can do with a perpetual parade of recent college graduates that generally turn over after about 2 years.
- quantumhobbit 10y ago
  My wife, also a surgeon, had a slightly different report. Of the 3 EMRs she has used, she said Epic's sucked the least. A low bar to clear, but they must be doing something right, or at least less wrong than the competition.
bduerst 10y ago
Yeah, the stock "options" were a joke, but it's decent experience and pay for entry level, which they hire in droves. I only recommend working there to people if they're right out of college and not in an engineer role, since their MUMPs/Cache stack is pretty dated.
- eonw 10y ago
  every engineer i ever met from EPIC was fresh out of school, one of them told me thats almost entirely what they hire.
  - logfromblammo 10y ago
    And that's by design of the CEO, who explained (paraphrasing) that such people are far more eager to drink her personal flavor of the corporate Kool-Aid if they haven't already been tainted by tasting someone else's.
    - fluxquanta 10y ago
      I'm glad you're reaffirming the thoughts I had back in 2010 when, after the phone screening, I was invited for an on-campus interview to which I said no after reading some scathing reviews online. I very distinctly remember it seeming a bit like a cult with the overbearing CEO that answers to no one creating a sprawling campus out in rural Wisconson that's so comfortable and with so many amenities you'd never want to leave! Sounds like I made the right choice to decline, even though I'm currently working for a private company with the same type of CEO, only with revenues at half of one percent of Epic. But hey, I read a couple of weeks ago that they were hiring a sushi chef, and I do love sushi!
      - logfromblammo 10y ago
        It's not exactly rural Wisconsin. It's effectively in a suburb on the the southwest side of Madison. Rural Wisconsin is at least a 15 minute walk from the parking lot. The Epic campus is very close to the epicenter of the best place for a typical HN reader in Wisconsin. Since the UW-Madison campus is on the west side of town, the geometry of the lakes almost assures that people who work in high tech businesses or academia commute in from the southwest quadrant, if they don't live in the city proper: Cross Plains, Middleton, Verona, Fitchburg, Oregon. I loved living in/near Madison for the 6 months of the year that it wasn't either winter or unsubtly hinting that Mr. Winter had only just stepped out for a moment, and would likely be back any minute now to finish hitting my other kneecap with a lead-free pipe and then drag me around on a chain behind his Prius for a bit. The immediate environs are great. But I had to leave for financial reasons. If you have the opportunity to take a job in Madison, Wisconsin, that is not with Epic, do consider it.
eonw 10y ago
they are also heavily propped up by the fact the gov will cover a large portion of the costs of install and migration. if these costs wasn't covered or subsidized, i believe the picture would look very different.

stephencanon 10y ago

> The end product that was visible to the customer was good This would be news to my wife (a surgeon), or any one of her coworkers. The software is universally viewed as terrible by everyone I've talked to. It actively results in worse records because (at least as configured) it's so cumbersome to use that many notes are frequently kept out of the system. A management plan that takes seconds to explain verbally requires minutes of data entry.

bduerst 10y ago
The thing about Epic Hyperspace is that it's polarizing for those who work in the medical profession. You either love it or you hate it, and the physicians who hate it typically hate it because of what you said - they're suddenly having to type their own notes into a computer rather than dictate it to someone else. Personally I'm of the opinion that doctors doing their own data entry is better for liability and malpractice reasons, but I empathize with your wife and people who hate doing it.
- stephencanon 10y ago
  The data entry just gets dumped on residents, adding to their already absurd workload (and realistically gets done at the very end of their shift after being on call for 24-30 hours). There is no plausible way that this results in better accuracy. The idea is great, but it just runs into an absolute brick wall of realities of the health care system and human behavior.
  - bduerst 10y ago
    Has your wife ever come up with solutions? I've thought about trying to solve this data-entry problem in healthcare before, but it seems to be almost an admin/process issue.
    - eonw 10y ago
      i think you can dump audio files into dragon(nuance) and get the transcript back for data entry.
      - bduerst 10y ago
        Yeah, I almost mentioned dragon but I didn't because I wanted to avoid anchoring the question. They seem to be (or were) a market favorite.
      - nradov 10y ago
        Yes but doing that takes some time, and then correcting the numerous errors takes more time. So it's not necessarily more cost effective than using template data entry forms. Some doctors now dictate, and then rely on transcription services which use speech recognition to generate a rough draft followed by human transcriptionists to fix most of the errors.
- whafro 10y ago
  I don't think it's quite so cut-and-dried. A lot of the anti-EPIC sentiment I hear (digital health founder here, wife is a physician at a major medical center) is kept pretty separate from the anti-notes sentiment (which is equally loud). Instead, the EPIC complaints are about the UI and workflow, which was modeled after the typical paper H&P (history & physical) forms clinicians would traditionally fill out. It comes down to the same UX lessons we've learned about most offline-to-online form transitions: directly porting a form is rarely the answer. The anti-note sentiment has to do with the fact that they're copying-and-pasting from previous notes (often the vast majority of a note's content is pasted in), they're using MS Word to draft the notes because of a buggy editor UI, and then when they're in a situation they actually have to read the note, they're sifting through a pile of duplicated, pasted content. There's a ton of opportunity for change here. There's an equal amount of risk involved, and selling these types of products into healthcare is about as fun as removing your fingernails. That's the piece EPIC does well, and why they're still a behemoth, even if their product is a five out of ten.
logfromblammo 10y ago
Ha! I said "customer", not "end user". The customer is the hospital and/or HMO administrator! And I used "good" to damn with faint praise. It generally meets customer requirements, and probably doesn't cause as much iatrogenic harm as whatever systems it replaces. For what it costs, I would personally expect quite a lot more out of it than it delivers. But there's only so much you can do with a perpetual parade of recent college graduates that generally turn over after about 2 years.
quantumhobbit 10y ago
My wife, also a surgeon, had a slightly different report. Of the 3 EMRs she has used, she said Epic's sucked the least. A low bar to clear, but they must be doing something right, or at least less wrong than the competition.

bduerst 10y ago

Yeah, the stock "options" were a joke, but it's decent experience and pay for entry level, which they hire in droves. I only recommend working there to people if they're right out of college and not in an engineer role, since their MUMPs/Cache stack is pretty dated.

eonw 10y ago
every engineer i ever met from EPIC was fresh out of school, one of them told me thats almost entirely what they hire.
- logfromblammo 10y ago
  And that's by design of the CEO, who explained (paraphrasing) that such people are far more eager to drink her personal flavor of the corporate Kool-Aid if they haven't already been tainted by tasting someone else's.
  - fluxquanta 10y ago
    I'm glad you're reaffirming the thoughts I had back in 2010 when, after the phone screening, I was invited for an on-campus interview to which I said no after reading some scathing reviews online. I very distinctly remember it seeming a bit like a cult with the overbearing CEO that answers to no one creating a sprawling campus out in rural Wisconson that's so comfortable and with so many amenities you'd never want to leave! Sounds like I made the right choice to decline, even though I'm currently working for a private company with the same type of CEO, only with revenues at half of one percent of Epic. But hey, I read a couple of weeks ago that they were hiring a sushi chef, and I do love sushi!
    - logfromblammo 10y ago
      It's not exactly rural Wisconsin. It's effectively in a suburb on the the southwest side of Madison. Rural Wisconsin is at least a 15 minute walk from the parking lot. The Epic campus is very close to the epicenter of the best place for a typical HN reader in Wisconsin. Since the UW-Madison campus is on the west side of town, the geometry of the lakes almost assures that people who work in high tech businesses or academia commute in from the southwest quadrant, if they don't live in the city proper: Cross Plains, Middleton, Verona, Fitchburg, Oregon. I loved living in/near Madison for the 6 months of the year that it wasn't either winter or unsubtly hinting that Mr. Winter had only just stepped out for a moment, and would likely be back any minute now to finish hitting my other kneecap with a lead-free pipe and then drag me around on a chain behind his Prius for a bit. The immediate environs are great. But I had to leave for financial reasons. If you have the opportunity to take a job in Madison, Wisconsin, that is not with Epic, do consider it.

eonw 10y ago

they are also heavily propped up by the fact the gov will cover a large portion of the costs of install and migration. if these costs wasn't covered or subsidized, i believe the picture would look very different.