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I, uh, was fortunate to be invited by an old friend of mine, Megan Dew, who was our, uh, director for our epic implementation to apply for the Emeritus program, and I applied and was accepted into the Emeritus program. It doesn't mean a whole lot other than I'm available through Epic. Uh, should a system have issues and need somebody with my experience to help 'em sort it out or to temporarily cover something and I thought I'd give it a shot.

See what it looked like. Wow. That sounds like a fantastic program. Did, did you, uh, take advantage of, uh, some of the people in the emeritus program when you were doing your implementation? It didn't exist when we were doing our implementation. It's about two years old and still evolving. Um, one of the things we were talking about this time is trying to get awareness developed not only with the BFFs, which are, you know, your first call to Epic, but uh, with some of the folks who are on the front end of the relationships.

So they help, um, organizations actually know, um, that this exists. So maybe we can. Prevent fires instead of trying to put, put out fires. Yeah, no, that makes a lot of sense. So let, let's jump right into U G M. So you, you've gone to a few of these. So you're a veteran, uh, and obviously you did an Epic implementation.

So you're, you're, uh, a fan of Epic 'cause you're implementation went really well. Uh, give us an idea. So, so 40th anniversary for Epic, uh, Judy took us on a, a little path, uh, a down memory lane, if you will give. That, that talk and, and some of the key themes that were going on at the conference. Yeah. So, uh, Judy started at the very beginning.

Um, the theme of this whole thing was of course, uh, the year, summer of 79, and that's when it started. And she paralleled it with her daughter, who also started then and talked about the very early beginnings being asked to even start a company, uh, how they started the, um, bringing in of Carl. This the simple group that they were at first and then how the, uh, organization kept growing.

But that the theme of starting with the patient at the center has been her, uh, driving force the entire career. Now, like you and I would do if we were giving our own biography or, uh, own history, uh, we, you know, we tell our story in a way. That we want our story heard. And so I think, you know, I, she doesn't mess with, um, the facts of the history, but it's Judy telling the story of Epic and it's Epic's her baby.

Um, so you take that into account and enjoy the ride. Yeah, and she is a, uh, I'll give her credit. She's a really good storyteller. Um, and I, I don't mean that like storytelling, like fiction story. I mean, like she is, she is good. She's good at, uh, communicating the story, especially, uh, around Epic, which is something she's so passionate about and it's so near and dear to her heart.

Yeah. And one of the things I've noticed over the, uh, six years that I've been interacting, um, her comic timing continues to improve. So what you're saying is six years ago she would, she would tell a joke and not realize it was a joke until everyone started laughing. And now and a little bit that way.

Yeah. Or try to tell a joke and, um, the audience almost need the cue cards, but now she's, uh, got nice pauses and it's pretty fun. So they do the nor the, the, and we're gonna go back to that talk a little bit. Some things that were pretty interesting, but they do the usual, uh, the usual stuff where they really celebrate the, uh, things that people are doing with Epic.

Um, and give us an idea of, of what are some of the things that, that they celebrated. What are some of the things that, uh, people are doing with, uh, with the Epic platform? So, um, every year of course they celebrate, um, those who achieved, uh, HIMSS level seven. Um, and now of course, in order to encourage people to stay up with their updates and to utilize their epic, uh, resources to the maximum extent, they have the STAR program.

So they celebrate the, uh, nine and single, uh, 10 star, uh, winners. And then, uh, the rest was some of the top tens of accomplishments, you know, uh, uh, MyChart Price estimates in this day of, um, price transparency and requirements to be posting our chargemasters. Um, patients being able to go on their own and get an estimate for what a, uh, procedure would cost at our institution is a unique, um, opportunity.

Uh, one of the. Of course was they celebrated Monahan Atisha, um, and her use of Epic to discover the issue with the, uh, lead in water in Flint, Michigan. Um, and then I think the other one that was, Pretty solid was the, um, work by our colleagues at Henry Ford and the ed, uh, triage protocol that identifies possible human trafficking victims.

Yeah. Um, obviously a huge and tragic issue in, um, the United States still, and, uh, the fact that they have a, uh, protocol that helps to identify is something special. I have no idea. Yeah, that's really, uh, really interesting. In fact, uh, Judy at one point said, uh, innovation is great, but, uh, you know, first try to do imitation.

And so, you know, and when you think about that, there were, so, you know, the, the Henry Ford, Henry Ford, uh, triage around human trafficking, the, um, the, uh, work around Flint, Michigan. Uh, price estimates on MyChart. There, there was just a whole bunch of really neat things, uh, highlighted, and I think sometimes we think about innovation and we have to go out and build a whole bunch of stuff we may not need to do that.

Excuse that theme kind of continued through meeting, I think, you know, the maturation of the. Market, um, meaningful use US two EHRs. And now you have a lot of systems that have been on it long enough that some of the presentations are folks saying, okay, you know, we, we got the tools, we now understand the tools that let's actually use 'em.

And so I think, uh, some of the work that's been done, um, is pretty remarkable. Um, Session I went to was called in Baskett, uh, in Baskett work Queue. Eight physician advisors, four hospitals, one in Baskett and mainline health in Philadelphia is utilizing physician advisors for concurrent chart review and review of recent discharges for, um, making sure that they have the appropriate documentation, appropriate indication for inpatient.

It's not that any of this is rocket science, but it's just the physician leader of this was using the tools in a unique and um, more functional way. And so you can see the maturation occurring. Yeah, so 10,000 people at this conference. Uh, and then I'm gonna get into five, five questions that, you know, my clients and, and, and, um, you know, and guests are, are really at, were asking prior to the meeting, uh, with you, uh, you know, things around quarterly updates, m and a activity and those kind of things.

But, you know, 10,000 people is, is this conference, if you had to stack it up against all the other conferences, is this really the, the one you have to go to if you're an epic shop? I think you have to have some people go to it. Um, I would actually say as a C I O, probably not as much as um, once upon a time.

Um, I think though that your directors, you need them to go and see some of the new stuff that's going on, uh, hear some of the innovative uses. Um, but you know, for myself, there's other things like, um, you know, Scottsdale Institute Chime that I think would be better uses of the limited time that c i O has.

Um, but yeah, I, I put it up against anybody for, um, the director to executive director level. I was, I was looking at the fall schedule with regard to, uh, to conferences and things that are going on. And, uh, it, it, it really is kind of crazy how many, how many, uh, conferences there are this fall. Alright, so let's, let's get into the questions that, that people are, Interesting, uh, you know, have been talking about it within the health IT space.

So the first thing is, uh, the push to foundation and, uh, quarterly updates. I think everyone understands the reason for the push to foundation. Uh, I think the question people are asking is, how are we gonna be able to do this? And how is Epic gonna help us to, uh, to do this? You want us to do it? How are we gonna do it?

So it was interesting because talking to a number of folks, they're doing a, uh, update one approach. So they may be doing quarterly, but they're not taking the one that's the current release. They're taking the one just prior, um, letting somebody else have any of the snafus or the, uh, little glitches. Um, with the quarterly updates course, the glitches are not as numerous simply because the volume of, um, enhancements and changes are not quite as large as when you took those, uh, every 18 month updates.

But I think that's one approach that some are taking. I. Um, have found out that governance was not for just for implementation. They need, um, governance to. And kind of a bend, but not break government structure. We know that, you know, uh, you gotta have some flexibility to adjust, but you really have to stick to your guns.

You can't get off of the foundation too far and maintaining, uh, current, um, currency with. Epic and, uh, doing your upgrades, it's so much more difficult if you customize too much. And, uh, then the other is I think teams are starting to learn to have the flexibility to comply, to combine their application teams to better fit, um, uh, the updates, um, and the enhancements that are coming.

So you're seeing more streamlined workforce by a lot of the systems that have. Recognize that you can't leave somebody in somebody,

folks. Yeah. You know, uh, people are, um, generally from an IT perspective, you sit back and you have a conversation around the complexity of a system. And if it is this complex, it's hard to maintain those systems and the costs just goes up and the um, and the, uh, reliability of the system goes down as you increase the complexity.

So the push to foundation, almost everybody in it understands They're just really struggling with, okay. How am I gonna be able, how am I gonna start taking quarterly updates? Some of these people were taking, you know, annual updates or even every, or even longer than that if they could get by with it. And, and some of them are looking at their distance from where they're at to foundation is pretty significant and represents an awful lot of work around custom customizing the, uh, the product around their workflows and their solutions that

It's, it is gonna be a hard, it's gonna be, it's gonna be a heavy lift for some organizations. Yeah. I think, you know, the, the Geisinger example, um, phenomenal, uh, wonderful system. Um, but they had customized tremendously and they made a decision to go back to foundation. And there was a lot of, uh, disgruntlement to be managed, a lot of, uh, distress.

Um, a lot of folks were having, uh, their cheese moved, they, uh, lost their, uh, personalized order sets, et cetera. Um, but once they got through it, you're starting to see them come out on the other end with some improved results of their pop health, um, which they already were good at, but improved results there and some, uh, improvements in their ability to track quality, um, measures for.

Um, the, uh, outcomes based reimbursement models that they're involved in. So I think, you know, Geisinger for me is a good example of why you have to do it and how you can do it. And yeah, it's gonna hurt like crazy while you do it, but you just do it. Well, it, and if you have the money to do it, I guess, 'cause it, it, it does take, uh, take some, some, uh, some energy to do it.

Let's talk about m and a. So some, some of the organizations I've been talking to are. You know, in the throes of m a, so there's two aspects of that. One is, um, if you are in the acquisition mode, you take a, uh, health system, um, like Jefferson that, uh, you know, just agreed to pick up the Children's Hospital.

Plus they have other acquisitions going on around there. They're, they're an epic shop and you have, uh, similar epic shops that they're, uh, acquiring. But still, it, it maybe not their case, but in a lot of these cases, you're looking at 12 to 18 months. Integrations of these, uh, of these, uh, various health systems, uh, into a single build and, uh, a standard set of workflows, and you start stacking those up, you end up with an awful lot of work back to back, to back around, um, you know, even an epic to epic migration.

So you, I, I know that Epic talked about this actually. Maybe some more work. Yeah. Well, in fact, it's interesting because it's almost a, in some cases it's a, it's a new build. Which is, yeah. Amazing. Well, and you know, one of the things that Providence St. Joseph is pointing out is, um, the expectation of data conversion is so much higher on an epic, epic to epic.

Um, but if you've got two different instances of Epic, that transfer of, um, data is still complex, but you cannot ski on it. Um, and you can't skip the standard install steps just 'cause it's epic. Epic. You still follow the rule books. Um, otherwise you get in a ton of trouble and you have huge disappointment for the group that's being brought onto the motherships or to whatever version of Epic, uh, you're bringing everyone onto.

Um, Epic's recognized this. They're, um, providing some new tools. They've got a pre-work phase, um, uh, playbook, which is really looking at, you know, how do you have to look at the acquisition before you even sign the, uh, papers. Look at the deficits in their IT shop, the opportunities in the IT shop, what's gonna have to be replaced?

How many computers, um, or CPUs are you gonna have to buy, et cetera, and have a realistic view before you get going. And, um, epic didn't provide that type of, um, Awareness they did, certainly if you were doing a brand new installation, but now they're doing it with, uh, these, uh, acquisitions. And the other is an operational playbook for merger acquisitions and consolidations.

And then finally, um, a specific epic to epic conversion toolkit, recognizing that people thought it was gonna be a little easier than this. And the. Two, two systems talked about and one in fact was in trouble 'cause they were in violation of their own policy. But you've gotta make sure that all of your policies are updated to be in coherence with whatever epic build you're going to.

Yeah. Interesting. So they're, they're introducing a lot of things in that area of m and a and they, and they, and we as an industry have been asking for this kind of help. 'cause there's just an awful lot of this work going on. And, and their, their involvement is, is, uh, is gonna be welcome I would think in this space.

Okay. I'm gonna . So, you know, um, you know, one of the things that came up in Judy's, uh, I'm, I'm trying to think. So I have the cost of running Epic. I have. Clinician usability and, and, uh, combating burnout. I have, uh, integrating additional data sources, genomics, uh, social determinants of health claims data, and I have interoperability.

So of those four topics, which one would you like to start with? Um, well, why don't we go to Clinician Usability and Combat Combating Burnout because I think one of the areas that to me is totally remarkable is their partnership's probably too strong a word, but the collaboration with class and the Arch Collaborative, um, the fact that Epic is working with class.

And I know, you know, some people would say, well, Decrease some the class's credibility, but I don't think it does. I think it's just a recognition on their part that's such a large percentage of the, um, health systems and the physician world are on Epic that they ought to pay attention. Um, but that arch collaborative is looking at power physicians using it.

Who's, um, proficient does pro. Really translate to satisfaction and does satisfaction translate to not burned out? And they're finding some, uh, interesting data that I think they're gonna be reporting soon. But it's, it's kind of a conundrum because sometimes the most proficient physicians are the busiest physicians.

And we know the busiest physicians tend to be the burned out physicians, so, right. Um, they, they're finding some. Areas for deeper dives to find out is this really cause and effect? One of our friends from Mayo, uh, appropriately brought up, you know, just because you're seeing something, it's like any other research you can't claim cause and effect until you'd look deeper.

But I think that's a really neat area and a big step forward that ethics recognized they've got to deal with. Um, clinician burnout, not just physicians, but ARN nursing. They've gotta figure out how to help support these folks and collaborating with the class as a start. Yeah, and their general approach is they're a very prescriptive organization, which we've talked about before.

And, uh, so they do have some pool. They will be able to go in there and say, Hey, let's talk about, let's talk about these notes, let's talk about these workflows. And they will, they'll unlike, you know, even unlike A C I O, potentially trying to bring some of this stuff up and, and address it within the health system.

Epic has clout. They're able to, they're able to do things on a scale that, uh, and get things started at a scale that, uh, even, even some CIOs. It's definitely Oh, yeah, yeah. It is overwhelming. And you know, when one of Judy's presentation points that fits in here is, um, that with caboodle and with the, uh, artificial intelligence programs, um, they now have 8 million patient records from the early adopters already in caboodle and, uh, feeding ar ai evaluation.

But that number goes up 230 million. When you get the majority of the epic, um, systems utilizing it, if they really get to that, that's an amazing database. Yeah, it is. And so is, was that the Cosmos, uh, stuff you was talking about? Cosmos and Yep. Cosmos, um, you know, kicking up from caboodle to Cosmos for the ai.

Yep. Yeah. I'm gonna have to have somebody run me through. I, IDO Kdo is the data warehouse. Caboodle is an epic supply product that visualizes and utilizes some of this data, uh, providing some, uh, reporting, and then Cosmos, uh, takes all of this plus, um, other things that you can import, um, in the future. Not all importable at the moment.

Uh, but the idea is that then Cosmos takes all that and can apply ai. Um, To this data and come out with new insights, and again, 230 million records. You start to have some amazing, um, capacity for, uh, developing new insights. Yeah, I, so I, one of the ones I, I do want to hit make sure we hit on this show is, uh, the cost of running Epic.

So, uh, the question becomes, you know, how do we maximize the use of Epic and produce the all overall percentage of the budget that, uh, epic is taking up right now? Uh, I know that some CIOs have given me some significant percentages that they say, look, before I start the month, A, you know, better than half of my IT budget is going to running this one system.

And that's okay. Except they have another 180 to run as well as, you know, new projects and other things that are going on. So, did, did Epic address it at all? Did they, you know, I know they've tried things in the past. I, I think Carl did a, did a reasonable job of, um, addressing it in his, uh, presentation in that he was talking about the fact that.

Epic has continued to grow the number of modules and functionality and uh, the variety of things that it can address. And systems have to be aware that if they're going to be on Epic, they're paying for that and they're paying for that kind of upkeep. Um, but if they have other products that are duplicative or products that they've not used, but they're still paying for standard maintenance, um, they need to start looking at archiving and.

Um, he didn't use the phrase, but one of my, uh, friends, um, sitting at the table used the phrase, gotta clean out the attic. Um, there's a lot of stuff that's just sitting up there and costing money, um, that you may be able to get rid of if you indeed adopt the effect. Can, uh, do it, we're gonna use it, um, mentality and, but you gotta get your portfolio of applications trim.

It's still gonna be expensive for a smaller system, particularly. It represents a big, big chunk of your budget. Yeah, it's interesting. I'm working on an archive, uh, project, uh, consulting project right now for somebody, and as I'm doing the research, what I'm finding is a bunch of health systems instead of investing in an archive solution, which is a fraction of the cost, they keep EMRs running for.

Uh, you know, multiple years. I mean, you can go back and go and it's like, what's this McKesson system? Well, that's our old E H R. Well, how long has that been running? It's like, well, I don't know. It's been running for this. Are you still paying licenses? Yes, we're still paying licenses. I'm like, you know, and, and at, at a fraction of the cost and you just multiply that out.

There's like, there's like 50 of those and you, you drop in an archive solution and, and just do the work and, uh, you can shut those things off. And that's, I guess, one of the things they're saying is, Uh, and, and this is Darren Kin's quote, which he, I think you, you told me he said at this, at the Epic meeting, but he says it to anyone who will hear it, which is, uh, you know, they're an epic shop and, uh, you know, if you're gonna come and knock on his door and try to sell him something, uh, just know that if it, if Epic does it, that's what he's gonna do.

And that's, especially for small health systems, that's probably the right way to go. Absolutely the right way to go. Yeah. Yeah. And you know, and, and I heard the argument and I agree with the argument that some things that Epic is doing, they're not doing optimally or as well as some of the third party softwares out there.

But the one thing you can trust is the Epic community will get them doing it better. And Epic iterates as fast as any of the EHRs. Um, can they just have this amazing large group of talented people. Yeah. And that's, that sort of gets to, uh, you know, the, the, uh, epic view of the world is Epic can do, uh, epic can do it all for the health system.

I mean, they, they wouldn't say it all. Yeah. But they would say the things they do, they do well and you should rely on us to do those things. Yeah. Uh, um, And, but, and four years ago I heard Judy say, um, you know, if we can't do it, well we don't do it. And there are some things she said at that time. She said, there are some things I simply don't do.

Um, they're doing more and more, but yeah, their, their goal is to do 'em excellently and, um, you know, they, we can. Take any one of the current EHRs and particularly my physician colleagues, uh, we can just, you know, tear 'em up to pieces, um, because they're not where we want 'em to be, but no one's getting there any faster than Epic.

And there's, you know, other good systems. I think Meditech concern are, um, making some progress, but, you know, epic's definitely gotta be contended with, so the overall cost of this stuff is just gonna drive. Drive a, a stake in, uh, best of breed, best of breed is gonna become one of those things that you just can't afford to do.

Uh, and, uh, I, I don it's, yeah, it's gonna be harder and harder, harder and harder. So I think, you know, there's a core point and things like that, uh, where they have their niche and, um, they provide that interoperability component. I think those are the, uh, products that are going to thrive. But anyone who goes, you know, directly at a module in Epic is gonna have a hard time.

So one of the, um, one of the hot topics on Twitter, uh, around the, um, conference was Judy's comments on information blocking and, um, and, and the, uh, you know, the, the, and APIs and, uh, the, the stuff that you're, you're getting out of O N C and um, And, and you know, it, it's really falling into two camps. It's falling into one camp, which is to say, Hey, you know, we're gonna have a, we're gonna have a privacy thing here, so we've gotta protect the, the patients.

We're gonna have a privacy thing. And then you have really, I, I'd say what it feels to me is like the innovation community is saying, uh, you know, that's a really convenient place to be, to say, Hey, you know, uh, Trust Epic. We're gonna control the flow of information and you have to pay us to get the information and whatnot.

And so it's, it's, I I, again, I didn't go to the conference so I didn't hear the quotes directly, but uh, if you look at it on Twitter, you're seeing some pretty interesting responses to it. No one doubts, um, You know, 'cause Epic has, has done a, a phenomenal job with their, uh, sharing platform and, and, uh, amassing those records, making 'em available for, uh, research and, and other things.

Um, but you have this innovation community over here that's saying, Hey, let, let me, let me take a crack at some of this stuff. Just make this stuff available via APIs. Can you give us an idea of, of what are some of the things she said? And put, put it in context so you know, people, uh, you know, will understand where she was coming from.

So I think, um, we have to start with the fact that we know, um, Judy's always had a vision and it's a remarkable vision. Um, and look at where it's brought her since 79. Um, that being said, that vision is patient at center, but epic. Surrounding the patient more and more and more and more layers, um, until Epic is the galaxy of care for the patient.

Um, and Epic is everywhere. Um, that's her vision, uh, that's going to mean that she's gonna protect it very much and not appreciate, uh, external intrusion. So when you hear the narrative and you take the quotes and context, you recognize that it really is just duty. Um, being, um, herself, um, just making sure that she helps us to understand that she's got a vision for Epic, helping everybody.

Alright. Yeah, she's, she's, she's protecting the patient. She's protecting the patient, then that's, that's her heart for it. But it comes across, um, as she's blocking other people or, or fending off other people. And more concerning is maybe the fact that she's, um, putting herself in opposition to the government and, you know, the, uh, that's a difficult position to put yourself in.

And maybe there's a better way than being quite as, um, Oppositional and maybe it's getting in the room and helping to develop, uh, the path forward for everybody, uh, participating in that. And, you know, I don't know if that's gonna be a possibility, but I think, you know, in, in the world I live in and you know that I live in the a m a and other organized medicine, we've gotta be in the room.

I, I mean, I, I hope, and I think she does understand that she's putting her clients in an interesting position because yes, they're, they're epic clients and they appreciate everything that Epic does for their communities and for them. But o o C is their largest payer. I mean, I, I can't think of a health system where the O N C isn't their largest payer.

So you, you, you have to be careful not to put people in a, uh, between a rock and a hard place. And the other thing is, I would say Epic has such a great opportunity to lead here. I. It's, it, it is just outstanding that they could, they could go into the room and if they could see eye to eye with, uh, uh, with, uh, secretary Azar and, and Sima Verma and, and the rest, um, you know, I, those conversations would be really interesting.

I think we could, uh, I know that, you know, in Judy's world, they are moving healthcare forward and they are moving healthcare forward, but I, I think there's still so much more opportunity and the reality is, The more people you involve, the more people you can, uh, the more smart people that you allow to try to solve a problem, you're just gonna, you're gonna end up with more solutions, more opportunities for solutions.

That's, I don't, that's more commentary than anything. Yeah. But I, I think the other thing is, um, people on the other side of the issue have, there's a risk in distracting them from the amazing things that are going on. You know, the, the MyChart bedside on the phone. 'cause again, back to the consumer centricity.

Getting that amount of information and the, just the elegance of the information that can now be presented to the patient at the bedside. Um, family can track who's been at the bedside, um, the, uh, MyChart Care companion, um, coming out. It's gonna, you know, help patients with reminders for the medications.

People will get distracted if they see the opposition and they stop looking. And I think that's something that I would advise anyone who's a supporter of, uh, the Epic product to say, Hey, we, we wanna make sure that people know this is going on. This is good for patients, this is good for communication with other clinicians.

Um, let's not lose that by. Again, uh, taking on the irresistible force. Right? And, uh, and, and I, I hope we did that on this show. I hope we highlighted, um, you know, enough of came out the conference. Uh, you know, fixated on this one thing people like to get fixated on, on, uh, on, on the, on the one thing. But there's, there's a lot of, uh, exciting and positive things coming outta the conference to, to me, the key takeaway of the, um, conference, if anyone's gonna hear one thing is that there's a maturation in the systems on Epic to where they are now starting to move forward with real case patient care initiatives and real clinician care initiatives.

That we just didn't have a chance to get our head up and do when we were busy putting in the EHRs and meeting the, um, arcane, arcane, uh, measures of meaningful use. There is now real movement that I think is going to help us move to a value-based and quality outcomes, um, oriented system. And that's what people ought to take away.

I think this was that tipping point in the user group meeting to where you're starting to see some real progress in areas that, at least me as a physician and me as a patient matter. I wanna thank David for taking the time, uh, before he gets on the plane and heads back from Madison to spend a few minutes with us to fill us in on the U G M conference this year.

Uh, it's always great to have him on the show and I really appreciate him taking the time. Uh, please come back every Friday for more great interviews with influencers. And don't forget, every Tuesday we take a look at the news, which is impacting health. It. This show is a production of this week in Health It.

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