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Maximizing EHR Potential, MyChart, and Interoperability with Epic VP of Patient Experience
Episode 3852nd April 2021 • This Week Health: Conference • This Week Health
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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Thanks for joining us on this week in Health IT Influence. My name is Bill Russell, former Healthcare CIO for 16 hospital system and creator of this week in Health. IT a channel dedicated to keeping health IT staff current and engaged. Today we have a great show for you. We have Sean Bina, who is the Vice President of Access and Patient Experience for Epic, and we talk all things MyChart.

We talk telehealth, we talk all the things that Epic is sort of looking at right now around the patient experience. Great show. I hope you'll enjoy it. Special thanks to our influence show sponsors serious healthcare and health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders.

If you wanna be a part of our mission, you can become a show sponsor as well. The first step. Is to send an email to partner at this week in health it.com. Just a quick note before we get to our show. We launched a new podcast today in Health it. We look at one story every weekday morning and we break it down from an health IT perspective.

You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there. You could also go to today in health it.com, and now onto today's show. All right. Today we are joined by Sean Bina, the VP of Access and Patient Experience at Epic. Good morning, Sean, and welcome to the show.

Hi, bill. Thanks for having me. I laugh because I, I hit your LinkedIn page and it said, Epic's spokes model is, is that a official title or, or a self? So, uh, selected Title I, let's just say Judy didn't give me that title. , does she know you're using that title? I doubt it. Well, if, if she is, I, I I think it's, I think it's fun.

I think it speaks to your culture at, at Epic. So I think it's phenomenal. I, I look to this conversation.

Just the change in behaviors, telehealth, growth,

I mean so many areas, but let's start with tell us role at. Sure. So I started off 24 years ago at Epic. So I've worked half my life at Epic and it's been a great experience. It's been a wonderful ride. As, um, we've grown as a company, and particularly I've been focused throughout most of that time on the patient experience and how we can expand the use of MyChart and provide patient with patients with more digital tools that they can take advantage of.

So now I spend my time working with customers. I work . Both with prospective customers and our current customers on how they can deploy MyChart effectively. Well, uh, yeah, so, and that's, that's, um, we might as well just start right there. So, you know, patients have really relied on virtual virtual tools to connect with their providers throughout the pandemic.

And I'm sorry for my listeners, I just changed my microphone to my actual microphone, so it might sound a little different. I was on the road last week and I was using my, my MacBook microphone, so now I'm back, back in the studio. So patient, have patients have relied on virtual tools to connect with providers through the pandemic.

ng to see. Of video visits in:

Back in February of last year, I tore my Achilles and so I had to go through full surgery, all kinds of physical therapy. In the middle of, in the middle of Covid. And then my DO daughter also had some pretty significant healthcare issues. And what I found as a patient was that certain things were great from a virtual care perspective and certain things aren't so great.

So some examples of things that were great are things like follow-up visits with a clinician where you already have a relationship and you're really just having a discussion. The amount of time that, you know, I've saved in terms of my daughter and I both being able to be connected in virtually into a visit instead of having to drive in and park and, and, uh, you know, get into the hospital, find the right room and wait when, instead just being able to get on a virtual call with my daughter's position has been phenomenal.

But for something like physical therapy. I did both in-person and virtual physical therapy and the in-person. Physical therapy was certainly a better experience in terms of being able to take real measurements, hands-on my physical therapist, being able to see how I was recovering from from my surgery.

And so I think there's really room for both of these things going forward. And what we're seeing is that while virtual visits have dipped from their peak, we're still continuing to see. Potentially, I think in the future we'll see about a third of all visits being done virtually. Yeah. Uh, no. Definitely a, a third, a third's a little higher than what I'm hearing.

I'm hearing it's about 25%, but a third would be phenomenal. 25 to 30% or a 33% would be, uh, exceptional. I think we will just have to follow the funding and see how that, how that sort of transpires. Let, let's talk, let's focus in on MyChart a little bit. So, you know, I, I know, I know. People who I've interviewed and, and clients who use MyChart, like straight outta the box, here's, here's your MyChart, and use it.

And I know people who've taken the components, broken it down and built it into their, their own experience. Talk about how you're working on the MyChart experience, the, the, the usage of it and the sign up and, and just to, to, to simplify that process for users and, and how has that been impacted by the, the pandemic?

Yeah, so a. Yeah, we have, we definitely have customers the.

Now when I talk about that, they still do, uh, branding. They, you know, use their own colors. They use their own setup. Many of them have their own app that you can download from the app store, and it's really a small minority of our customers at this point, that kind of self-develop their MyChart and then just consume components of MyChart through data tiles and the mobile library.

But with that said, in terms of our focus on signup, is we've seen, you know, a huge spike in terms of the number of patients that are actively using MyChart on a, on an ongoing basis. While MyChart isn't required to having a video visit, it certainly makes that experience better because you can do all of the pre-visit work.

So when you traditionally went into the office, you'd have to, you know, pay your copay, review your insurance information, sign off on forms, and then potentially, you know, fill in, you know, in the old days you fill in a paper sheet with all of the information about your upcoming visit. Now that can all be done in MyChart so that when the physician and the patient connect.

All of that kind of pre-visit work has been done in a MyChart experience. Now, in terms of the other part of your question, in terms of signup, we've continued to make that much easier than ever before. So for a patient that goes to a healthcare organization, really it's just a matter of either before or after their visit they get an email or a text.

And from that . They can just enter their date of birth and then create a pass, username and password and get signed up for MyChart. So the hurdles for becoming a MyChart user are are much fewer and easier to get over than ever before. Was that driven by the, the vaccine scheduling challenge of, I mean, these people weren't necessarily patients, but you still needed to get them in line.

Is that one of the things that drove that? Yeah. Well, we've been working on this, this whole process of getting patients signed up easier over the last few years. So all of the groundwork had been laid for this. But then you're right, like we had healthcare organizations that would have 30,000 vaccines that they needed to give in a week.

And, and then the, the patients that were going to be eligible for that, some of them were already active MyChart patients, but some of them might have been, they might have received a file from a school system that we wanna get all these teachers vaccinated, or we wanna get all these patients, uh, vaccinated that are in nursing home.

So we had to have a, a new ability to kind of upload those patients into the system and then send them what we call a scheduling ticket so that they could go in and schedule for the first time and then create a MyChart account. Wow. So, so talk about that, that process a little bit. Are, are a lot of systems using the, the vaccine scheduling through Epic and, and through MyChart?

And, and then will that become sort of their proof of, of vaccination that they, they can use MyChart for that. Yeah, yeah. Good, good question. So the, the fun thing here is like that, that example I, I mentioned where they had 30,000 slots that they needed to fill. They did the vast majority of that online, so they were actually able to fill all 30,000 slots in 24 hours.

Patients are obviously anxious to get in and get their vaccine, and 75% of those were filled through MyChart. So there's, when we look at the kind of how vaccines are being administered, there's kind of like this multistep process. First, you obviously identify which patients eligible. You can't just open the floodgates and say anybody that wants to come in can go in and schedule online and book an appointment because there's a limited supply at this point in time.

So first it was identifying eligibility. Then the second thing was sharing these, what we call scheduling tickets out to patients, which then gave them the ability to schedule their first vaccine, and then once they had that to schedule their second vaccine. Timelines from there. And then the third thing that you mentioned is that we need to be able to track and maintain.

We have been building out essentially a. Where I can see all of a patient's latest covid information, or as a patient, I can see all my latest covid information, my last negative test, any self-assessments that I've been doing when my next appointment is going to be whether I've had vaccines administered.

And then obviously the goal of that is to get to the point where once a patient's had two vaccines. Uh, administered that they can then kind of hold this up as a passport to groups to say, you know, I'm fully vaccinated at this point. What, what's the key metrics that you track for MyChart usage? Is it, is it logins?

Is it, uh, what, what, what is it? Is it logins? Well, so we track, first of all, we track just overall activation. So there's over 200 million patients that have been active on MyChart. Then more specifically, we track how patients are using it. So are they active in a given year? And so like we have 120 million patients that are active users of MyChart right now in the, in the last year.

And then, and then we break that down from there. So the thing that we're actually really interested in tracking is for patients that are getting regular healthcare. Are they active MyChart users? So we, we look at a metric that says, for patients that have been in to their healthcare organization three or more times in the year, are they active MyChart users?

So we'll oftentimes see that even though a group may only have 50% total adoption across their total, all of their patients, they'll that be at like 75 or 80% adoption for patients that have been seen three or more times in a year. Interesting. So it, it's interesting to me 'cause we've moved beyond logins.

We're, we're looking at really engaging the community in their health. And so there's a lot of different ways to do that. And one of the ways is to just get more touchpoints and one of those is remote patient monitoring. And I know that, you know, you've done some work with Cleveland Clinic in connecting up, you know, apple Health, Google Fit, and those kinds of devices.

Does that drive more activity in MyChart? I think, you know, interestingly, the things that really drive activity in my chart if we look at organizations is are they opening up scheduling? Are they providing things like patient estimates and the ability for patients to pay their bills online or set up payment plans or request financial assistance?

Those, it's still those kind of core operational things that drive adoption. Now there are of course, huge benefits as we start to remote monitoring. At Oxner, they, they're kind of famous for their oar, where what they've done is they've, they allow physicians ascribe various remote monitoring devices, and then they send patients out to their oar where patients get signed up connected to the devices.

They help them kind of walk through the steps of either connecting to.

For, for example, they did a study around their hypertensive patients and a 40% increase in terms of the number of hypertensive patients that were meeting their goals that were doing this sort of remote monitoring. So huge reduction in readmissions. You know that, that's so fascinating. It just takes me back when we were developing our portal back in 20.

Gosh, 12 or 13 people were like, we had to get the patient record just right to be viewed just right. And so we finally, you know, after almost six months of work, we went out . We finally went out to the patients and said, what do you want most in your portal? And they said, scheduling and bill pay. Yeah. And I'm like.

Why did we spend so much time getting the record just right when all we had to do is ask the patients, what do you, what will you use it for? And so I, if you were to stack rank it, I mean, you sit there and you go, scheduling makes perfect sense, right? I want, I want scheduling to be easier interacting with the health system.

And this is one of those tools that does that. And then you have . I know you have bill pay. Are there other things that sort of rank up there high that get, get, get usage of, of a, uh, portal like MyChart? Yeah, I, we oftentimes talk about this as Maslow's hierarchy of, of patient needs and you know, kind of just like Maslow said that you need food, warmth, and shelter before you can write, write poetry.

I was actually in Finland, they told me that you need food, warmth, shelter, and wireless. In order to write computer code. And so I thought that was kind of funny. But as a patient, you need the basics in place. The scheduling, the billing, the ability to communicate with your physicians is really important.

So we see, you know, messaging back and forth is a real key. And then obviously, obviously access to clinical information. I'm very excited as a patient that test results and notes are going to be automatically released to, released to me in the coming, coming months as, uh, 20th Century Cures goes through, so that I'll have even more access to my record than ever before.

And then I think as a patient, I also am starting to expect that not only will I see my test results, but I can also do things like access my images, so I directly access the images. All of that becomes really important as a patient when I need to share my record or interoperate with somewhere else. And so we built a set of tools in into MyChart.

Kind of multifactorial way to do this. You can download record, you can pick up your record and share it with somebody else. You can, we obviously support underlying interoperability so I can, uh, do a direct message and send ACCD to another provider. I. So, and then one thing that's really cool is MyChart also provides this concept that we call Happy together.

And what it'll do is it'll pull information from multiple organizations, very much so through Epic to Epic today. But then we've also started linking up non Epic. Of vendors like Cerner to be able to pull in information so that as a patient, I can go to one MyChart and see all my test results, all my visits, my allergies, meds, and current health issues across all the sites of care that I go to.

Yeah. So that I, and that, that's really powerful. Yeah. I, and this, my, my personal example was when I tore my Achilles, I did not tear it here in Madison, Wisconsin. I was actually running a race in Arizona. I went to Mayo Scottsdale to get my care there. Initially came back. I usually get my care through Group Health, but I needed surgery at the University of Wisconsin, so I had to coordinate care at across three organizations, and I can go into my MyChart and see all of that information in one place.

Right. Well, you're talking Mayo, which is an Epic client. You're talking Wisconsin, which is a Epic client and uh, I'm not, what was the other one you referred to? Group Health is also an Epic client. Yep. Yeah, so I mean, so that's the, that's the, I mean, that's been your claim to fame, it's sharing across Epic clients is, is extremely effective and, and, and works really well.

How, how does it. How does it work with, with, with a Cerner client? So we're using the fire standard as, and as the fire standard continues to develop and grow, it's becoming even easier to be able to make these connections to third parties or to to other vendors. And so that's definitely the, the kind of the core pathway that we've gone for, that.

All right. Well, we're I, I, I'm probably gonna come back to interoperability and really round to innovation a little bit, uh, later, but I, I, I want to get back to something you were talking about earlier, which is the, the, the care journeys and how they've changed as a result of telehealth. So how are you delivering telehealth today through the, through, through the Epic platform?

Are there multiple ways or is there a, a preferred way that, that people are experiencing Telehealth through MyChart? So Epic has our own telehealth or video app that you, that organizations can use. I think we're at about a hundred organizations that are already using that today. And then we work with, you know, kind of everyone else under the sun, so Doximity and, and Teams and Zoom, et cetera.

So you can use whatever video platform of. That really creates an integrated experi experience for the patient. Most of those vendors have done the, the kind of deeper level integration that we need. So you don't have to do sign-ins to multiple platforms, but rather, once you're in MyChart, it just takes you directly into that video client.

Right. And, and as I mentioned earlier, we also have support for physicians both within the, the Epic video clients and then some of the other vendors also offer this. To be able to email a patient and then have them link into the video client without, um, going through my chart. Yeah, I, so that's the direction I was gonna go.

So how close have you gotten to, you know, single click talking to a doctor? I mean, 'cause that's like the, the holy grail, I guess. Yeah, it, that, that exists today. So a physician can just email a patient a link and uh, they can connect into the video client. And now we, so actually I think it's next week, we will be supporting in Epic.

Other vendors already support this, a multi-party video visit as well, which is really key for like, when we talk about . Situations where an interpreter needs to be involved, or multiple family members need to be connected in, or you need to have multiple physicians connecting with an individual patient to be able to have that kind of collaboration.

Wow. And so this is really gonna change. It, it, it has the potential to really change how healthcare is delivered, bringing family members in from afar, bringing as, as you say, interpretive services in as well. Bringing consults into, I mean, you could have a, a pretty robust platform. How are health systems rethinking those, those care pathways and those care journeys with telehealth integrated?

'cause it's not just gonna be when we think, when we think telehealth today, we think follow-up visits and we think. You know, that, that initial visit of, Hey, I'm, I'm not feeling well, but this, this has the potential to be really integrated across the board. Are, are we seeing a lot of that work? Yeah. So, you know, you're exactly right.

Groups started with kind of the kind of initial, uh, onboarding visit and then doing follow ups through this particularly, you know, it's a great use for post-surgery. You know, I can, I can very quickly have, uh, a nurse or a physician look at how I'm recovering, look at my wounds, go through my follow-up instructions and education without me going into the office.

And so those were initially the primary use cases. But now, you know, there's, there's certain specialties where this is gonna be the predominant way that people are seeing patients, particularly like in areas like behavioral health. Where, you know, doing, doing a video chat is very, very natural way to get that type of care.

And we'll continue to see that. That's kind of a fo focal point. Yeah. The, it's, uh, it, it is interesting to me as I, as I think through this, I mean, there, there could be an awful lot of, of different areas where this, this gets integrated. Talk about, so one of the things I heard . Was that the percentage of failed connections for whatever reason, you know, people don't recognize that you need a cell connection or a, a wifi connection to do a good video call or whatever.

Mm-Hmm. , are you guys tracking like the, the failed. Visits and, and helping organizations to identify the challenges around that. Yes, absolutely. So that's kind of one of the things that we've mach machined into the software is A, the ability for patients to test out their video prior to the visit. B, we see a lot of groups using a virtual rooming process now where a nurse is connecting with the patient first.

Making sure that they're all set up and connected so a physician doesn't come into an empty room and, and then wait. And then c we, we do reporting and analytics. That kind of whether the patient was able to connect, how many failed connections there were and we're, we're excited because with the Epic video client, in part because it's so deeply integrated in with the experience, we've seen a big reduction in the number of failed connections.

Yeah. So much of the. I think what I, I'd, I'd like to do is start talking about some of the interoperability initiatives and, and things you guys have going on. 'cause you connect up to so many different aspects of healthcare. One of the things you guys recently did was participating in the, uh, vaccine credential initiative.

Can you describe that work a little bit and, and what you guys are doing? Yeah, so.

Patients being able to share proof of their vaccination. And the, the focus of the initiative is really kind of giving patients control, which I'm a big advocate of, and then also making sure that we're maintaining the patient's privacy and so. VCI, as they're called, they're finalizing the specifications and we'll be delivering them to the EHR vendors so that we can basically create the smart health card, which will have a QR code, which would be readable by other systems, so that you could instantly, as a patient, communicate your vaccination status.

So I think it's a really admirable initiative. It's, it's fun to see all the different vendors coming together and participating in it. And, you know, I think we will start to see results from that in the coming weeks. Yeah. And so that, that's one initiative. Talk. Talk a little bit about 21st Century Cures and where you see, uh.

I see that those efforts sort of taking, I know there's some initial pushback, mostly from a patient privacy perspective is why Epic was pushing back and saying, Hey, the controls aren't really in this yet. Uh, are you guys participating in helping to establish some of those, those privacy standards and, and helping to make sure that.

You know that the, the goal of 21st Century Cures is really achieved. Yeah. Yeah. So we participated in that process, you know, for the last couple years in terms of helping them refine and think through the implications of some of the things that were happening. The main thing that we were concerned about was that patient's data would be used and sold without patients knowing about it.

Again, we wanna give patients control over their data and we want them understand what is happening when apps are accessing data.

Other systems would kind of demand from Epic, how are you using this, using patient data as you're requesting it. So that was really our, our focus was just simply, simply on making it so that it's transparent to the patient, what's happening with their data. We all, we of course, are big advocates of sharing as much information with the patients as possible.

But then also building in the right tools so that in certain physician patient interactions there, there may be, there may be certain circumstances where the time is not right for a physician to share a particular piece of data because it could lead to a, something that would be life's threatening for the patient.

So we had to build controls into the system to really to, to support that. So the fun thing here is the default behaviors that we're sharing with patients. But then we have built in a series of controls to, uh, to, for physicians that, to be able to step in and say, not for this. Yeah. And it's, it's, it's interesting.

I mean, we, we all understand 21st century cures. I mean, just the, the name says it. All right. We want to, I. Advance cures and we would advance, uh, the health of the community. And, but part of that is by enabling all these, uh, innovators to be able to access portions of the record on my behalf. Yes. And hopefully with my permission, I mean, this is part of what you were saying.

I mean, it's, it's, I, I want to grant permission to my record to be used by this third party to help me with my health. And that could be something like MyFitnessPal or something to that effect that I, what I'm just. I'm just conjecturing. I don't know if MyFitness valves heading in this direction, but I'm just saying, you know, something to that effect where I get more engaged in my health on a day-to-Day basis.

They pick up one or two things from the health record that helps them to help me to stay engaged with my health. But along with that came, and we talked to a lot of different guests about this, came some challenges. Like, okay, how do I know that the vendor on the other side is a, you know, is is an honorable actor.

On my behalf, right? And not just collecting information and am I gonna know if they're using the information in other ways other than the stuff that I've told them that I can, that I can utilize it? And, and, and some of those things weren't really defined out of the ch with, with the 21st Century Cures.

And that's the work that we are still trying to get right today to make sure that I know what, how my record's going to be used on my behalf. Yeah, that's. That's really the focus for us is just making it so that patients understand what what's happening. And then also the, the secondary thing is, you know, we're really excited about the ability to connect more apps into the patient experience.

So we really see MyChart as a platform on top of which groups connect. Wide variety of the apps. So some good examples is we've had groups build in way finding applications or, or for inpatients, the ability to do dietary or ordering. So being able to order from a menu-based system and then, and, and get, get connected in, or the ability to add a provider finder.

So we see. Lots of, we've seen, this has gone on for many years. The ability for us to connect in other apps into MyChart to create a better experience is, is, is that primarily through App Orchard and does that change a little bit under 21st Century Cures? It is. Historically we just did direct connections, uh, with apps, but then we have really transitioned that into App Orchard so that everyone is kind of.

The same set of rules and guidelines and so that our customers can easily go in and see what apps are already out there and available as they're trying to make these decisions. You know, it's, it's, I'm gonna go back to this, this idea of we have some, really, some organizations that have really forward thinking,

They work with you directly, but they also, they have some initiatives and they, they step back and they go, all right, I'm gonna break Epic into our MyChart into its components. Yep. I'm gonna use those components, but then I'm gonna augment it with a handful of other things. You talked like wayfinding. Hey, well that's already, you can do that within MyChart.

You don't need to do that outside, but there's, there's some things that they might, sorry, bill, we don't, you know.

Where you should park your car and whether there's a spill that you need to get around. You know, there's third parties that do that, so we would connect into them. That's certainly not something that kind of falls within our domain. And then you're exactly right. Some of the, especially some of the larger organizations that were, that have a, a history of doing a lot of self development and.

Tens of thousands of hours of creating their app and creating their own presence. They wanna continue down that path. And, and we love that and continue to work with them on that because, you know, like we may not at least right now, develop the kind of payer functionality, for example, that's, uh, a Kaiser would want to offer to some of their patients.

Oh, that's interesting. Yeah. And that's, that's a great example that, you know, the, the, the payer functionality and whatnot, and they can use. And the good, the good thing about that is they're not starting from scratch. They have this, this base that they can work from and then they can really focus in on the things that differentiate their organization.

Exactly. I think that is the real key, is that you're not in a situation where you're rewriting a lab results control, where we've spent, you know, thousands of hours working with organizations, interviewing patients. Create a great view for patients regarding their lab results. But then if you, if you do need to create something, you have the opportunity to kind of build, uh, on top of MyChart or, or, or request services from MyChart.

The other example, by the way that we see very commonly is. Some of the self-development shops need to support multiple EHRs. So they live in a world where they have Cerner, Athena, epic, Allscripts, and they need to create a single patient portal at least for a period of time while they're making, making transitions.

And that's a great example of where people do. Information from multiple portals all together into a self-developed one. Interesting. You know, I, I joke sometimes that this show is the education of Bill Russell. What, what am I not asking that I should? What's, what's an area that I should be delving into?

Well, one thing, two things that you brought up that I wanted to go back to. So one, you talked about remote monitoring and telehealth and where that's going. And I talked about kind of some of the basics, but we really see, we really see a lot going into a remote monitoring or home-based hospital in the home style workflows.

So moving from doing basic things like setting up this video visit to not only being able to pull in, uh, data from home-based devices, but then also allowing patients to do everything from infusions at home. I. Being able to able communicate with a nurse who's managing a kind of a virtual patient floor, being able to allow patients to order supplies from the home.

So we think that we think that the hospital in the home will be a huge use of that. Yeah. And that's, I, and that's gonna be a significant push post covid, I think. Well, it's a significant push, uh, during Covid, and I'm not sure we're gonna see that change. So it's gonna be that, that will be an interesting, an interesting play to see how all that information flows back into the medical record.

Now, the problem we've always had is doctors are like, you know, no MAs. I mean, I can't take any more data. So what are we doing around, around that? Yeah. Which is totally fair. We oftentimes say the great thing about the EHR is that all of the data is there, but that's also the hard thing of the EHR, and that's been, that's actually increased as we have more and more interoperability.

So now you have a med list from the patient, you have med list from two or three organizations they've been into in the past, and then how does a physician really reconcile and manage all of those meds in a clean and fast way? So that's. That's kind of like, that's one of our focal points is, is how do we reduce the noise for physicians, bubble up the most relevant stuff at any given point in time, and then make it so that lots of things can be dealt with directly with the patient.

I. So a good example is, let's say that I have a home glucometer that's connected up to Epic and I'm using a care plan through MyChart. Well, if I have low blood sugar and hypoglycemic, we could actually automatically trigger alerts to the patient that say. Here's education, what to do when you're hypoglycemic.

Here are the, the tasks that we want you to do over the next coming days, and then we wanna do a video visit with you in a week regarding this to make sure that you're on track. So, pushing many of these things right back to the patient versus having the physician have to take a look at that data before providing that next care.

You know, it's, it's, as you're talking about these things, I wonder if there's a. An opportunity for an Airbnb of healthcare hospitals, right? So Epic is managing a thousand beds in this community. And oh, by the way, only 500 of 'em are in hospitals, but 500 of 'em are in people's homes. I have not thought of that, but that, that is a cool concept and I could definitely see that type of thing happening.

Yeah, that, that would be interesting. You, you said two things. What else? What else did I miss? The other thing that you kind of alluded to that I think is super essential to what we're doing is the whole issue with the digital divide. And so, you know there, there's kind of two different elements to the digital divide.

There's getting people access. So how do we provide internet to rural communities? How do we make sure that people in the inner city have access to being able to, you know, you know, just simply get online and get connected. And then the second thing is really where our work is, which is creating a super usable platform.

And there there's a lot that goes into this. So we have to make sure that our software's accessible. So that if I have issues with my eyesight hearing, et cetera, that I can get connected in and that I can use, for example, an appropriate screen reader to use the software. We have to make sure our software's responsive across platforms, so it has to work whether I'm an Android iOS user, whether I'm using a mobile browser, whether I'm using it on my computer.

s that go all the way back to:

So we still have thousands of patients that are using Android five as their core oss, and we don't, we don't wanna cut them off of MyChart just because they can't afford a. The last thing I'll say there is we've really been focused as, as a company overall on social determinants, and that means that helping patients.

A identify patients that are having issues with depression by doing things like PHQ nines and promise Catt B, being able to help patients get into their appointments. So working with like Lyft and Uber to be able to overcome some of those barriers. You know, it's, you, you're giving me chills as, as you talk about development.

I, and I think people think this is pretty easy, but, you know, just try to develop a simple ADA compliant website. You'll realize how hard this is. 'cause now you're not only talking about an ada, a compliant website, you're talking about apps on phones and you're talking about multiple sizes of the phones.

Now, the Apple ecosystem, the only thing you have to deal with is apple's . Constantly tweaks to make it better. And so you're, you're constantly just catching up to them as they tweak their system. Yes. But Android as, as you, I, I, I remember the amount of libraries we had to maintain for Android apps was ridiculous.

And, and it doesn't function the same way across all those different. You know, all those different platforms, it, it is very challenging to maintain essentially multiple builds. Yes. Across all those, all those platforms. Well, and then of course there's the multiple builds across those, all those things. But then we also have multiple versions.

So, you know, we come out with a new version every single quarter, winter, spring, summer, and fall, which has new updates. And so as you know, as the government add requirements. We need to make sure that all of the prior versions that customers are using, or at least the vast majority of them, that the customers are going to be upgrading to support that new requirement.

So that's the kind of dark side of the development process. Yeah. And, and our listeners would be familiar with, with the , with the dark side of the process. Social determinants is interesting. Is, is Epic gonna be a platform for social determinants data? Is that, is that a direction? Yeah. Yeah. So we, we already, both clinically and then from the patient side track and manage social determinants information and then increasingly we're trying to make the resources to help patients directly available from, from Epic.

So being able to allow a physician to actually, we, like we have physicians now that write prescriptions to . Community food pantries for patients at Hurley Medical Center. They actually have their clinic kind of over the top of a farmer's market, and they will give the patient a food prescription to go downstairs and, uh, get healthy, healthy food.

The thing that's interesting to me is just the, the amount of information that's going into the medical record is so vast and and necessary right to, to provide the best care for me. Well, what I will say about that, that that topic is we, we, we really do see the intersection of healthcare and social care coming together.

And in fact, internationally, some of our customers are using epic not only for healthcare, but also for social care tracking. And what means is. They, you know, all of their kind of core services that they're providing for, for, for people in general are getting linked in and connected to their healthcare.

And so when we look at a patient, we have to look at. Who is in their network. So not only the patient needs the care for themselves, but do they get support through, uh, the church? Do they get support from family members? Do they get support from other members of the community? And then how do we create this kind of community connectivity for our patient?

Yeah. And yeah, we, we, we looked at it back in 20 12, 20 13. We were looking at care, I guess they call 'em care circles or those kind of things. It's the. The people that provide care. 'cause when we talk to our c uh, to the community, one of the things they said is, Hey, I'm caring for my parent in Wisconsin.

And I I, and we were sort of sitting back going, okay, what can we do for those people who are caring for somebody halfway across the country? I. And that's a very real need, very real challenge for a lot of people today. Yeah, it's been particularly hard with Covid, right? So if my mom lives in Seattle and she ends up in the hospital, not I, you know, I can't go in, I can't fly to Seattle and see her in person in the hospital.

So I need a way manage. MyChart isn't just, uh, ambulatory application. It really extends through a toolkit that we call MyChart bedside into the hospital, where now proxies can do everything from being able to see what education and who's on the care team and what the schedule looks like, uh, for, for their family members on a day, to being able to, of course see things like test results or uh, or place orders or requests for their loved ones directly from home.

Proxies. Yes. Um, , I'm sorry. You're bringing back, bringing back a lot of memories. Alright, la last question here. So LA you know, epic started the Epic Health Research Network. Can you just describe what that is and, and we'll end on this. Yeah, so the Epic Health Research Network is really, it's an electronic journal that was launched to help customers and data scientists to share insights derived from.

EHR data. So the goal was to make it really fast and easy for, for our data scientists internally and also for our customers to be able to publish new information with a particular focus originally around c Ovid 19. So just simply being able to look at the data, being able to track and report on things that, patterns that we're being able to see in the data, like ventilator use, for example.

and then be able to publish that onto our website for review by anybody out there in the public. Wow. Well, I promise that would be the last question. So I'm gonna have to have somebody from Epic in the, the data science area and whatnot, dive a little deeper. 'cause that sounds, that sounds, again, just extremely powerful and, and something that a lot of health systems could really benefit from.

Yeah. The, the other kind of element there is. You know, you've probably heard about Cosmos, which is we've been aggregating data from across our customers. We have over a hundred customers participating, and we have about a hundred million patient records, unique patient records that have been identified that are in there, that now people can, uh, go in and do research on that data at scale.

Yeah. Yeah. That's amazing, Sean. You did not disappoint as epic's spokes model . I love, I love that. So you guys are back in the office, it looks like, uh, you're, you're back in the office in, in Wisconsin. How's that going? Well, we, I love it because A, the food is great. You probably heard about that. Heard epic.

B you know, the, the offices, our offices are really safe. So we have great hvac and then we, we all are working from private offices, the people that are coming into Epic. And so you're really in like this safe, secure spot and. I just love being able to get outta my house and come in and focus a hundred percent on work.

Yep. And we've had a lot of conversations on what does life look like after Covid, and it's gonna be a hybrid of, of sorts is is what we're sort of picking up. And people are like, well, people aren't gonna wanna come back. I'm like, nah, I don't think that's the case. I think there's a mix. I think there's, you know, people who are, are looking forward to getting back in that collegial kind of, you know, back and forth and, and that kinda stuff.

Even if they have to wear a mask, even if they have to, you know, whatever the, the protocols and and precautions are. I think they're just looking forward to going to lunch with some friends. Yeah. We have about 4,000 people that come into our campus every day. Throughout the Covid crisis. Yeah, so lot of people definitely feel that way already.

Fantastic. Sean, again, thanks. Thanks for your time. I really appreciate it. Yeah, no problem. Nice talking. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show.

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