17 ms·

The problem with Epic is that they seem to refuse to deal with their technical debt. As far as I know, it's still some janky visualbasic UI with a M/UMPS backe

by caycep 4y ago

The problem with Epic is that they seem to refuse to deal with their technical debt. As far as I know, it's still some janky visualbasic UI with a M/UMPS backend (well w/ a modernization wrapper). And why change because hospital CIOs are willing to approve contracts worth hundreds of millions (and their competitors are even worse) Maybe it all works...however slowly... but pulling data out of what is effectively a bunch of antiquated and super siloed-bins seems overly labor intensive and cost ineffective. The other announcement was that they were doing to do a partnership with Apple, but sounded like the task of actually making a modern native client on MacOS was beyond their technical skill...(their iOS app efforts are...not pretty...)

zitterbewegung 4y ago
Since they have lots of pull in the industry it makes lots of sense for google to partner with them. Possibly they can modernize them but I don’t think that is very likely this looks like more of making a larger moat for both companies.
bena 4y ago
It's all like that. Medical software is a ghetto. I think it's partly because those who have a passion for the industry aren't good developers and good developers don't have a passion for the industry. Not to mention a lot of decisions are driven by medical doctors and if you think software developers believe that being good at one thing makes them good at all things, you are going to love medical doctors.
- philwelch 4y ago
  It's also heavily regulated, which it probably should be, but that has certain tradeoffs and consequences.
  - deleted 4y ago
    [deleted]
  - caycep 4y ago
    regulated...by the HHS panel that conveniently includes Judy Faulkner, CEO of Epic...
- devilbunny 4y ago
  That's certainly an issue, but one thing that MD's (I am one) are very, very good at is knowing whether a system makes their lives easier or harder. Paper charts had their problems - unreadable handwriting, limited accessibility - but they were a very heavily refined system that served the doctors and nurses who used them daily. EMR's are largely written to maximize billing, not end-user convenience. I'm an anesthesiologist, so there's really nothing for me to up-code in order to get paid more for the same work (except that I can declare the patient to be higher-risk, or the surgery to be an emergency, each of which nets my group about $20). It's baked into the system, based on what surgery is being performed. So EMR has been good in that I can find old information more easily, and Epic in particular allows me to get information from other health systems that use Epic, but as a practical matter it's not a big improvement in general from the old system in which paper notes were scanned in after discharge and all dictations (admissions, discharge summaries, any procedure notes) were transcribed into it. But it sure did cost a lot of money.
- caycep 4y ago
  I feel like it's not even medical doctors, it's the CIO/hospital administrators and the insurance companies that drive most of the software decisions, since that is where the money for these large Epic deployment contracts come from and they are the true "customers". Most medical doctors don't even know where to start when asked re software decisions.
srvmshr 4y ago
> As far as I know, it's still some janky visualbasic UI with a M/UMPS backend (well w/ a modernization wrapper). You are correct. They haven't changed in last 20 years. Even in their coding tests, they write pseudo code or ask you to write some code (with basic code grammar & layout provided), which is thinly veiled MUMPS. And there's a proctor who watches you & your screen over remote connection - lest you googled anything related to the problems. It was very creepy
- ssully 4y ago
  I was more surprised about the personality tests that were part of their interview process.
- mardifoufs 4y ago
  That's really bizarre. Do they pay well, at least? I get that there are tons of jobs that aren't super exciting, but even a Java enterprise middleware app sounds better if only because you wouldn't be working on a completely niche platform.
  - srvmshr 4y ago
    2015. $120,000 in Verona, WI. Didn't take the offer when I was told I was going to be only writing M/UMPS. It felt like a career suicide path.
- nightski 4y ago
  Couldn't you just have a separate computer for googling? lol
  - srvmshr 4y ago
    Good question: The proctor made me swivel my laptop webcam around the room to make sure I was alone. Even down & behind to check I wasn't holding anything in my lap. I was allowed one 10min break where cam & microphone were to remain hot & a quick second check before second part of coding test.
RockRobotRock 4y ago
Just an aside, the MyChart web app is very well designed and easy to use compared to other medical sites.
- bkuehl 4y ago
  The company I work for is in the healthcare tech space and we all generally despise Epic. But when I saw the MyChart app, I was really impressed. Also, we were in the ER recently, and my spouse got their test/lab results on their phone before anyone came in for like 30 mins. It was all good news. But probably don't want that to happen if someone ends up having cancer..
- iudqnolq 4y ago
  Only in comparison. I find the regular outages of the message sending bit particularly annoying. (To be fair, could well be Kaiser's fault)
buovjaga 4y ago
The thing is an inflexible abomination and a total nightmare for users. There is ongoing outrage in Finland over the deployment of the system in healthcare and social work: https://en.wikipedia.org/wiki/Epic_Systems#Finnish_experience https://en.wikipedia.org/wiki/Epic_Systems#Finnish_experienc... It is an expensive regression that crashed productivity for everyone.
- kakoni 4y ago
  Samething happening in Denmark and now in Norway. In the meantime, 220 public hospitals in Australia decided to go with Epic [1] [1] https://www.itnews.com.au/news/nsw-health-taps-epic-for-statewide-single-digital-patient-record-588153 https://www.itnews.com.au/news/nsw-health-taps-epic-for-stat...
- caycep 4y ago
  What were they using before? Just out of curiosity?
  - buovjaga 4y ago
    Systems like Effica and Pegasos: https://fi.wikipedia.org/wiki/Potilastietoj%C3%A4rjestelm%C3%A4 https://fi.wikipedia.org/wiki/Potilastietoj%C3%A4rjestelm%C3... https://fi.wikipedia.org/wiki/Pegasos_(potilastietoj%C3%A4rjestelm%C3%A4) https://fi.wikipedia.org/wiki/Pegasos_(potilastietoj%C3%A4rj...
pythko 4y ago
They are finally reaching the point of rolling out their new clients that get off Visual Basic, so that’s something. M, however, ends up being a combined database/business logic platform (and it’s fairly speedy at that, if that’s what you want). Extracting data into a nice tidy relational database does take time and development effort, though, but they have a reasonably robust process for this already. This article seems to be a relatively mundane announcement to me. You could already do this same stuff with Epic on Azure, but I guess more options are nice.
deleted 4y ago
[deleted]
nradov 4y ago
What do you mean by "pulling data out"? The underlying database doesn't really matter for that. Epic supports an extensive set of APIs, including many that implement open industry standards. https://open.epic.com/ https://open.epic.com/
justajot 4y ago
While it's been at least a decade since I've looked at M/UMPS ... I do remember the database having some really interesting stuff going on that suits the storage of healthcare data well. The language itself though ... a complete abomination.
kakoni 4y ago
Well they are moving from visual basic UI towards web-> "Epic is moving the current primary end user application, Hyperspace, to a web-based framework. Hyperdrive, our new client application,"
- caycep 4y ago
  Knowing how they think...this is scary to me. It is not inconceivable they are going to jam their VB ui into some wrapper that somehow runs in an unholy fashion on a web browser...

by caycep 4y ago

zitterbewegung 4y ago

Since they have lots of pull in the industry it makes lots of sense for google to partner with them. Possibly they can modernize them but I don’t think that is very likely this looks like more of making a larger moat for both companies.

bena 4y ago

It's all like that. Medical software is a ghetto. I think it's partly because those who have a passion for the industry aren't good developers and good developers don't have a passion for the industry. Not to mention a lot of decisions are driven by medical doctors and if you think software developers believe that being good at one thing makes them good at all things, you are going to love medical doctors.

philwelch 4y ago
It's also heavily regulated, which it probably should be, but that has certain tradeoffs and consequences.
- deleted 4y ago
  [deleted]
- caycep 4y ago
  regulated...by the HHS panel that conveniently includes Judy Faulkner, CEO of Epic...
devilbunny 4y ago
That's certainly an issue, but one thing that MD's (I am one) are very, very good at is knowing whether a system makes their lives easier or harder. Paper charts had their problems - unreadable handwriting, limited accessibility - but they were a very heavily refined system that served the doctors and nurses who used them daily. EMR's are largely written to maximize billing, not end-user convenience. I'm an anesthesiologist, so there's really nothing for me to up-code in order to get paid more for the same work (except that I can declare the patient to be higher-risk, or the surgery to be an emergency, each of which nets my group about $20). It's baked into the system, based on what surgery is being performed. So EMR has been good in that I can find old information more easily, and Epic in particular allows me to get information from other health systems that use Epic, but as a practical matter it's not a big improvement in general from the old system in which paper notes were scanned in after discharge and all dictations (admissions, discharge summaries, any procedure notes) were transcribed into it. But it sure did cost a lot of money.
caycep 4y ago
I feel like it's not even medical doctors, it's the CIO/hospital administrators and the insurance companies that drive most of the software decisions, since that is where the money for these large Epic deployment contracts come from and they are the true "customers". Most medical doctors don't even know where to start when asked re software decisions.

srvmshr 4y ago

> As far as I know, it's still some janky visualbasic UI with a M/UMPS backend (well w/ a modernization wrapper). You are correct. They haven't changed in last 20 years. Even in their coding tests, they write pseudo code or ask you to write some code (with basic code grammar & layout provided), which is thinly veiled MUMPS. And there's a proctor who watches you & your screen over remote connection - lest you googled anything related to the problems. It was very creepy

ssully 4y ago
I was more surprised about the personality tests that were part of their interview process.
mardifoufs 4y ago
That's really bizarre. Do they pay well, at least? I get that there are tons of jobs that aren't super exciting, but even a Java enterprise middleware app sounds better if only because you wouldn't be working on a completely niche platform.
- srvmshr 4y ago
  2015. $120,000 in Verona, WI. Didn't take the offer when I was told I was going to be only writing M/UMPS. It felt like a career suicide path.
nightski 4y ago
Couldn't you just have a separate computer for googling? lol
- srvmshr 4y ago
  Good question: The proctor made me swivel my laptop webcam around the room to make sure I was alone. Even down & behind to check I wasn't holding anything in my lap. I was allowed one 10min break where cam & microphone were to remain hot & a quick second check before second part of coding test.

RockRobotRock 4y ago

Just an aside, the MyChart web app is very well designed and easy to use compared to other medical sites.

bkuehl 4y ago
The company I work for is in the healthcare tech space and we all generally despise Epic. But when I saw the MyChart app, I was really impressed. Also, we were in the ER recently, and my spouse got their test/lab results on their phone before anyone came in for like 30 mins. It was all good news. But probably don't want that to happen if someone ends up having cancer..
iudqnolq 4y ago
Only in comparison. I find the regular outages of the message sending bit particularly annoying. (To be fair, could well be Kaiser's fault)

buovjaga 4y ago

The thing is an inflexible abomination and a total nightmare for users. There is ongoing outrage in Finland over the deployment of the system in healthcare and social work: https://en.wikipedia.org/wiki/Epic_Systems#Finnish_experience https://en.wikipedia.org/wiki/Epic_Systems#Finnish_experienc... It is an expensive regression that crashed productivity for everyone.

kakoni 4y ago
Samething happening in Denmark and now in Norway. In the meantime, 220 public hospitals in Australia decided to go with Epic [1] [1] https://www.itnews.com.au/news/nsw-health-taps-epic-for-statewide-single-digital-patient-record-588153 https://www.itnews.com.au/news/nsw-health-taps-epic-for-stat...
caycep 4y ago
What were they using before? Just out of curiosity?
- buovjaga 4y ago
  Systems like Effica and Pegasos: https://fi.wikipedia.org/wiki/Potilastietoj%C3%A4rjestelm%C3%A4 https://fi.wikipedia.org/wiki/Potilastietoj%C3%A4rjestelm%C3... https://fi.wikipedia.org/wiki/Pegasos_(potilastietoj%C3%A4rjestelm%C3%A4) https://fi.wikipedia.org/wiki/Pegasos_(potilastietoj%C3%A4rj...

pythko 4y ago

They are finally reaching the point of rolling out their new clients that get off Visual Basic, so that’s something. M, however, ends up being a combined database/business logic platform (and it’s fairly speedy at that, if that’s what you want). Extracting data into a nice tidy relational database does take time and development effort, though, but they have a reasonably robust process for this already. This article seems to be a relatively mundane announcement to me. You could already do this same stuff with Epic on Azure, but I guess more options are nice.

deleted 4y ago

[deleted]

nradov 4y ago

What do you mean by "pulling data out"? The underlying database doesn't really matter for that. Epic supports an extensive set of APIs, including many that implement open industry standards. https://open.epic.com/ https://open.epic.com/

justajot 4y ago

While it's been at least a decade since I've looked at M/UMPS ... I do remember the database having some really interesting stuff going on that suits the storage of healthcare data well. The language itself though ... a complete abomination.

kakoni 4y ago

Well they are moving from visual basic UI towards web-> "Epic is moving the current primary end user application, Hyperspace, to a web-based framework. Hyperdrive, our new client application,"

caycep 4y ago
Knowing how they think...this is scary to me. It is not inconceivable they are going to jam their VB ui into some wrapper that somehow runs in an unholy fashion on a web browser...