9 ms·

What is your opinion of Epic?

phren0logy 6y ago
It's among the least bad, but nobody would ever mistake it for software sold to general consumers in this century. I know it's complex and specialized, but so are IDEs, and those are (in my limited use and understanding of them) worlds better in their engineering. That said, I'm not crazy about how actively Epic appears have tried to keep medical records created in Epic locked in to Epic. The spirit, if not the letter, of the legislation requiring a move to electronic records was due to record portability. From where I stand, they have actively prevented that (or at a very minimum sandbagged) to expand their market share.
- phobosanomaly 6y ago
  Another unintended consequence of this is that it makes it extremely difficult for doctors and nurses to pull data to do basic research or look at patient outcomes. For example, if you wanted to see what the outcomes of giving a specific drug at a specific dose to a specific group of patients at your hospital was, you're in for a real fun time manually copy-and-pasting thousands of entries from the EMR to a spreadsheet. Now more than ever it is important to look at data relating to patient outcomes with various COVID treatments that haven't been thoroughly vetted yet. But, guess why your local hospital isn't doing anything like that? Because what should be a simple 3-hour exploratory data analysis that can be breezed through IRB now has to involve a budget component of hiring a professional copy-paste person. Can't even use med students to do it anymore because they aren't allowed to hang around the hospital due to COVID, and you can't access those records remote due to HIPAA.
  - josephpmay 6y ago
    That’s just completely untrue. First of all, Epic has a built in tool called Slicer Dicer for clinicians to perform pretty complex population data analysis without having to do any database queries. Second, every healthcare organization extracts much of their patient data to a data warehouse where you can perform direct SQL calls on it.
    - phobosanomaly 6y ago
      Thank you very much for sharing that. I'll look into it more. The clinicians (head of trauma Evidence-Based Medicine as well as the head of the trauma department overall) I have talked to at my non-academic Level II trauma center do not have any clue this exists. They are currently exporting thousands of records by hand. Edit: Do you know offhand of a good guide to SlicerDicer I can share with them? I will google around, but if you had something you personally liked?
      - josephpmay 6y ago
        I work at Epic, so the resources I have are all internal training/document. That being said, the best way to learn it is probably to have someone who’s an expert in it, ideally another doctor, walk them through it. If you want, I can see if I can find some specific customer-facing documents/training to link them to.
        owowow 6y ago
        Lack of public documentation has to be my #1 pain point with proprietary software over the years. Especially in the EMR space, putting up barriers to access basic documentation is quite unreasonable. Public documentation is not going to suddenly allow your competition to gain an advantage, while your own firm benefits from users being able to easily google and get authoritative answers from your own official documentation.
        deleted 6y ago
        [deleted]
      - thesishelp 6y ago
        There's still likely some good reason to do that work manually. The quality of data entry into EMRs is often poor, especially when it comes to event or time data that's not just numeric bloodwork. Imagine that at a random physicals date your patient was suddenly was 155kg and 65cm tall. Or for another example, having someone be inaccurately be diagnosed as having new onset diabetes after transplant, despite them having DM for several years prior. People switch up entry fields, inaccurately assess or diagnose patients all the time--generally because of the sheer variety of ways in which data can be screwed up, only a person can notice those oddities (or write a little script to fix them). At population levels I could concede that these errors may well be inconsequential though.
  - willcipriano 6y ago
    > and you can't access those records remote due to HIPAA. The person who told you that is misinformed. I have personally worked on products that allow physicians and staff to access patient records remotely in a safe and fully HIPAA compliant manner. It's incredibly common.
    - phobosanomaly 6y ago
      Sorry, I worded that poorly. I meant the med students doing the grunt work.
  - nradov 6y ago
    Most EHRs now have standard HL7 FHIR APIs which would allow remotely querying that data.
    - phobosanomaly 6y ago
      Thanks for the heads-up! Do you know of a good way to leverage this API in a way that can be directly used by clinicians to pull and work with data?
      - nradov 6y ago
        You'll have to start by finding the FHIR web service endpoint URL for your EHR instance, as well as appropriate authentication credentials. Client applications can be written using the HAPI FHIR library. https://hapifhir.io/ https://hapifhir.io/ Then use the search operation to find the resources you need. http://www.hl7.org/fhir/search.html http://www.hl7.org/fhir/search.html
- nimish 6y ago
  Thankfully, TEFCA was implemented anyway, and is still on schedule. We'll see what it works out to in practice. But data sharing is definitely still possible, today, even with Epic (they are quite good actually). You are limited to certain reasons but they are pretty broad. Full disclosure: I work on this full time. It is a strange world, that works on its own standards and practices for good and bad reasons.
- nradov 6y ago
  The latest version of Epic has fairly complete record portability. Is it missing anything specific? https://open.epic.com/ https://open.epic.com/ I think EHR vendors sometimes get unfairly blamed. The fault often lies with provider organizations who simply haven't turned on the available functionality.
  - odyssey7 6y ago
    Why do I feel stressed out visiting this link on desktop? Perhaps someone who's good at UX could share a few thoughts?
    - hanklazard 6y ago
      Ha, exactly. UI/UX is precisely the area where Epic fails the most. I am not an expert in this area, but in my every day use, I can only describe the Epic style of UX as "vomit all information onto the screen at once."
      - nradov 6y ago
        Given a choice, clinicians would usually rather have maximum information density to avoid clicking around for what they need.
        Shared404 6y ago
        Some better organization to the information would be nice though. Edit: Not a doctor/in health care. Just basing this on the link above.
        nradov 6y ago
        Better how?
        Shared404 6y ago
        Looking at the website right now, I see three different horizontal arrangements of links. Of these links, there are four duplicate pairs, at least. Two of these sets of pairs lead to indistinctly named pages (/Home/InteroperabilityGuide and /Home/Interoperate) I would start by having all of these links be at the top, and adding some descriptive text to each of the fields in the main body, as opposed to meaningless graphics/marketing numbers. Addendum: Also, I wouldn't want to do the split in thirds thing that occupies the majority of the page. Each of those can get a description of at least a paragraph, and go one after the other. If there's not enough info to fill a paragraph, then they probably need to be merged. Edit: ambiguously -> indistinctly
VectorLock 6y ago
I know a whole bunch of nurses who won't shut up about how much they hate Epic. I watched my doctor try to use it once when I was in for a visit and he didn't seem to be enjoying the experience much either based on his grumbling. It seemed like there was a LOT of UI cluttering going on so I can understand how it might not be very easy to use.
- mv 6y ago
  At my hospital the nursing UI of Epic is absolutely horrid. It's cluttered and confusing with multiple places to document everything. Epic is completely customizable, but the people who make the decisions in nursing management aren't always the same people using the software. That and funding to make the changes. If you want to see really bad software take a look at Meditech it defaults 800x600 (!), and doesn't resize well at all.
  - throwaway4220 6y ago
    Ah yes, I am still forced to use Meditech's telnet interface today. I asked our IT guy if we can please change the font to a smoothed, non-raster font. I think it took all his willpower to not burst out laughing lol
- somehnguy 6y ago
  Just a little personal anecdote but - A while back I had a week long stay in the hospital, after some small talk with one of my nurses she learned I write software. She told me a bunch of things they hated about Epic and gave me a quick tour of the interface they have to use. The main complaint seemed to be that things they need to do hundreds of times a day require way too many input actions. And it did indeed look incredibly cluttered. I love getting little tours of software I'll likely never use even though I'm not in a position to fix any of the problems. It's just interesting.
  - bena 6y ago
    You know why? Because every doctor, nurse, tech, etc has a goddamn opinion on what's important. They're of the opinion that everything needs to be "as few clicks" as possible. As if "number of clicks" was the only worthwhile message. Nobody would read a book where the keyboard was pressed as few times as possible. Sometimes, complex actions require complex input. We should be shooting for discoverability, not "number of clicks".
euthymiclabs 6y ago
All EHRs are bad, some are just worse than others. With the right build, Epic is one of the least bad. But the wrong build can really be soul-destroying.
hanklazard 6y ago
MD here. Epic is terrible, as are all other EMRs that I have used (with the exception of VA's older software). I use Epic every day and I am ready to jump ship from medicine altogether to help build an EMR that could actually work well for both health care providers and patients. There is no excuse for such poorly executed software, especially the UI/UX.
- rscho 6y ago
  My bet is you won't succeed. UI is bad because of corporate and legal constraints, not because developers don't know better. Regardless, best of luck!
caycep 6y ago
Virtual basic running in some weird instance of something that you can only get through via citrix? "least bad" is not saying much, they're all pretty bad.

It's among the least bad, but nobody would ever mistake it for software sold to general consumers in this century. I know it's complex and specialized, but so are IDEs, and those are (in my limited use and understanding of them) worlds better in their engineering. That said, I'm not crazy about how actively Epic appears have tried to keep medical records created in Epic locked in to Epic. The spirit, if not the letter, of the legislation requiring a move to electronic records was due to record portability. From where I stand, they have actively prevented that (or at a very minimum sandbagged) to expand their market share.

phobosanomaly 6y ago
Another unintended consequence of this is that it makes it extremely difficult for doctors and nurses to pull data to do basic research or look at patient outcomes. For example, if you wanted to see what the outcomes of giving a specific drug at a specific dose to a specific group of patients at your hospital was, you're in for a real fun time manually copy-and-pasting thousands of entries from the EMR to a spreadsheet. Now more than ever it is important to look at data relating to patient outcomes with various COVID treatments that haven't been thoroughly vetted yet. But, guess why your local hospital isn't doing anything like that? Because what should be a simple 3-hour exploratory data analysis that can be breezed through IRB now has to involve a budget component of hiring a professional copy-paste person. Can't even use med students to do it anymore because they aren't allowed to hang around the hospital due to COVID, and you can't access those records remote due to HIPAA.
- josephpmay 6y ago
  That’s just completely untrue. First of all, Epic has a built in tool called Slicer Dicer for clinicians to perform pretty complex population data analysis without having to do any database queries. Second, every healthcare organization extracts much of their patient data to a data warehouse where you can perform direct SQL calls on it.
  - phobosanomaly 6y ago
    Thank you very much for sharing that. I'll look into it more. The clinicians (head of trauma Evidence-Based Medicine as well as the head of the trauma department overall) I have talked to at my non-academic Level II trauma center do not have any clue this exists. They are currently exporting thousands of records by hand. Edit: Do you know offhand of a good guide to SlicerDicer I can share with them? I will google around, but if you had something you personally liked?
    - josephpmay 6y ago
      I work at Epic, so the resources I have are all internal training/document. That being said, the best way to learn it is probably to have someone who’s an expert in it, ideally another doctor, walk them through it. If you want, I can see if I can find some specific customer-facing documents/training to link them to.
      - owowow 6y ago
        Lack of public documentation has to be my #1 pain point with proprietary software over the years. Especially in the EMR space, putting up barriers to access basic documentation is quite unreasonable. Public documentation is not going to suddenly allow your competition to gain an advantage, while your own firm benefits from users being able to easily google and get authoritative answers from your own official documentation.
      - deleted 6y ago
        [deleted]
    - thesishelp 6y ago
      There's still likely some good reason to do that work manually. The quality of data entry into EMRs is often poor, especially when it comes to event or time data that's not just numeric bloodwork. Imagine that at a random physicals date your patient was suddenly was 155kg and 65cm tall. Or for another example, having someone be inaccurately be diagnosed as having new onset diabetes after transplant, despite them having DM for several years prior. People switch up entry fields, inaccurately assess or diagnose patients all the time--generally because of the sheer variety of ways in which data can be screwed up, only a person can notice those oddities (or write a little script to fix them). At population levels I could concede that these errors may well be inconsequential though.
- willcipriano 6y ago
  > and you can't access those records remote due to HIPAA. The person who told you that is misinformed. I have personally worked on products that allow physicians and staff to access patient records remotely in a safe and fully HIPAA compliant manner. It's incredibly common.
  - phobosanomaly 6y ago
    Sorry, I worded that poorly. I meant the med students doing the grunt work.
- nradov 6y ago
  Most EHRs now have standard HL7 FHIR APIs which would allow remotely querying that data.
  - phobosanomaly 6y ago
    Thanks for the heads-up! Do you know of a good way to leverage this API in a way that can be directly used by clinicians to pull and work with data?
    - nradov 6y ago
      You'll have to start by finding the FHIR web service endpoint URL for your EHR instance, as well as appropriate authentication credentials. Client applications can be written using the HAPI FHIR library. https://hapifhir.io/ https://hapifhir.io/ Then use the search operation to find the resources you need. http://www.hl7.org/fhir/search.html http://www.hl7.org/fhir/search.html
nimish 6y ago
Thankfully, TEFCA was implemented anyway, and is still on schedule. We'll see what it works out to in practice. But data sharing is definitely still possible, today, even with Epic (they are quite good actually). You are limited to certain reasons but they are pretty broad. Full disclosure: I work on this full time. It is a strange world, that works on its own standards and practices for good and bad reasons.
nradov 6y ago
The latest version of Epic has fairly complete record portability. Is it missing anything specific? https://open.epic.com/ https://open.epic.com/ I think EHR vendors sometimes get unfairly blamed. The fault often lies with provider organizations who simply haven't turned on the available functionality.
- odyssey7 6y ago
  Why do I feel stressed out visiting this link on desktop? Perhaps someone who's good at UX could share a few thoughts?
  - hanklazard 6y ago
    Ha, exactly. UI/UX is precisely the area where Epic fails the most. I am not an expert in this area, but in my every day use, I can only describe the Epic style of UX as "vomit all information onto the screen at once."
    - nradov 6y ago
      Given a choice, clinicians would usually rather have maximum information density to avoid clicking around for what they need.
      - Shared404 6y ago
        Some better organization to the information would be nice though. Edit: Not a doctor/in health care. Just basing this on the link above.
        nradov 6y ago
        Better how?
        Shared404 6y ago
        Looking at the website right now, I see three different horizontal arrangements of links. Of these links, there are four duplicate pairs, at least. Two of these sets of pairs lead to indistinctly named pages (/Home/InteroperabilityGuide and /Home/Interoperate) I would start by having all of these links be at the top, and adding some descriptive text to each of the fields in the main body, as opposed to meaningless graphics/marketing numbers. Addendum: Also, I wouldn't want to do the split in thirds thing that occupies the majority of the page. Each of those can get a description of at least a paragraph, and go one after the other. If there's not enough info to fill a paragraph, then they probably need to be merged. Edit: ambiguously -> indistinctly

VectorLock 6y ago

I know a whole bunch of nurses who won't shut up about how much they hate Epic. I watched my doctor try to use it once when I was in for a visit and he didn't seem to be enjoying the experience much either based on his grumbling. It seemed like there was a LOT of UI cluttering going on so I can understand how it might not be very easy to use.

mv 6y ago
At my hospital the nursing UI of Epic is absolutely horrid. It's cluttered and confusing with multiple places to document everything. Epic is completely customizable, but the people who make the decisions in nursing management aren't always the same people using the software. That and funding to make the changes. If you want to see really bad software take a look at Meditech it defaults 800x600 (!), and doesn't resize well at all.
- throwaway4220 6y ago
  Ah yes, I am still forced to use Meditech's telnet interface today. I asked our IT guy if we can please change the font to a smoothed, non-raster font. I think it took all his willpower to not burst out laughing lol
somehnguy 6y ago
Just a little personal anecdote but - A while back I had a week long stay in the hospital, after some small talk with one of my nurses she learned I write software. She told me a bunch of things they hated about Epic and gave me a quick tour of the interface they have to use. The main complaint seemed to be that things they need to do hundreds of times a day require way too many input actions. And it did indeed look incredibly cluttered. I love getting little tours of software I'll likely never use even though I'm not in a position to fix any of the problems. It's just interesting.
- bena 6y ago
  You know why? Because every doctor, nurse, tech, etc has a goddamn opinion on what's important. They're of the opinion that everything needs to be "as few clicks" as possible. As if "number of clicks" was the only worthwhile message. Nobody would read a book where the keyboard was pressed as few times as possible. Sometimes, complex actions require complex input. We should be shooting for discoverability, not "number of clicks".

euthymiclabs 6y ago

All EHRs are bad, some are just worse than others. With the right build, Epic is one of the least bad. But the wrong build can really be soul-destroying.

hanklazard 6y ago

MD here. Epic is terrible, as are all other EMRs that I have used (with the exception of VA's older software). I use Epic every day and I am ready to jump ship from medicine altogether to help build an EMR that could actually work well for both health care providers and patients. There is no excuse for such poorly executed software, especially the UI/UX.

rscho 6y ago
My bet is you won't succeed. UI is bad because of corporate and legal constraints, not because developers don't know better. Regardless, best of luck!

caycep 6y ago

Virtual basic running in some weird instance of something that you can only get through via citrix? "least bad" is not saying much, they're all pretty bad.