96. epic part 2

H.I.S.-toryby Vince Ciotti

Episode #96: Epic, Part 2© 2013 by H.I.S. Professionals, LLC, all rights reserved.

An Epic Tale• The story of Epic starts with its founder, Judy

Faulkner, with whom I have a bit in common: – She too came from Philly, where we both

remember dodging the red SEPTA trolleys!– We both were math majors, with English

minors, she at Dickinson College in Carlisle, PA not too far from her father’s drug store in Erlton, South Jersey, near Haddonfield.

– We both won scholarships in the ‘60s, but that’s where the resemblance ends: I flunked out of Temple & got drafted to ‘nam, coming back to school later to major in English Lit.

– Judy studied Radiation Physics at University of Rochester – sound familiar? Neil Pappalardo of Meditech came from Rochester and as we’ll see, had a surprising impact on Epic...

It Was All in the Program…• When she showed up at U of Rochester, they expected her to

program. She knew nothing about it so they gave her a Fortran book and access to the computer for a week. She was on her own, and fell in love with it, feeling “like a kid playing with clay” – it was combination of language, math, and art: her 3 passions.

• She earned a masters in math at the U. of Wisconsin in the frozen northlands, and won a fully paid-up PhD in computer science. She never finished her dissertation, but years later UW surprised her with an honorary doctorate.

• So here’s another HIS vendor starting in the frozen north, besides:- IBM’s SHAS in Minnesota, Frank Poggio’s HMDS in Madison, Steve Click’s Dairyland in Wisconsin, CliniCom in Boulder, Meditech & Keane in Massachusetts, IDS in Vermont, PHAMIS in Seattle, Lockheed’s MIS pilot at the Mayo Clinic in Minn...

What is it with the frozen north and so many HIS start-ups??

“Bi-Polar” Geographic Theory• Judy had noticed this trend in the

northern origins of HIS vendors too, and we bandied about an interesting theory that has many historical/geographic parallels:– Think of how many countries

around the world are split between an industrial north vs. a more agricultural south:

• US (Yankees vs. Rebels)• Italy (Milan vs Sicily)• Vietnam (Hanoi vs Saigon)• Korea (Pyonyang vs Seoul)

– Are we on to something??

Meditech Connection (“Epitech?”• Back to Epic, Judy took a class in “Computers in Medicine” taught

by UW’s Warner Slack, MD, who went to the Beth Israel Medical Center, an associate of Neal Pappalardo from the MIT project that gave the IT world its most contagious disease: MUMPS.

• Even the acronym denotes its origins as one of the only programming languages designed specifically for Healthcare: Massachusetts General Hospital Utility Multi-Programming System, the only language with its own “built-in” data base.

• As you may remember, Pappalardo created his own version of MUMPS that he used with his new start-up firm “Medical Information Technology,” (pun on his school?), which he called MIIS, short for “MEDITECH’s Interpretive Information System.” And so Judy started her programming in MIIS, just like Ron Apprahamian did at Compucare (episode 69 at hispros.com).

First Work Assignment• After grad school, she worked with John Greist MD, on a project

at the U. of W. to build a system to track clinical data over time. This was a radical idea in the early 70s, since there were no dbms available back then (Ellison didn’t form Oracle until 1977…), only a few small, unknown ones, such as the one from Beth Israel.

• Judy built a system that put the patient at the center, surrounded by reports, displays, etc. An innovation was to place “exits” all through the code so it could be easily customized.- This kept the source code sacrosanct, using exits to modify the

system for individual clients. Most MIIS vendors without exits had to change the source code itself to customize their systems.

• She wrote 3 discrete data sets: (1) constants (eg: patient #), (2) data that occasionally changed (eg: diagnoses), and (3) data that was constantly changing (eg: TPR). In essence, this structure is the underpinning of the “Chronicles” data base Epic uses to this day!

Careful How You Pronounce This…• You can visualize this time-oriented db structure by these charts

presented at the 1978 MUMPS User Group by Judy & colleagues:

• As you might imagine, the acronym “PISAR” did not catch on…

First Applications & Big Raise!• Somehow I had the impression that Judy started writing systems

for her husband, a pediatrician, which explained Epic’s strong physician practice modules. I was surprised to learn Gordon didn’t become an MD until long after he got his biology Ph.D., and Judy was well down the road toward writing applications for a number of ancillary departments at the University Hospital, including:– Inpatient ICU, Psychiatry, Tumor Registry, OB Gyn, Rehab, and

Cardiology • So it was working with end users in these various departments that taught her about health care day-to-day inside operations.

• These apps worked so well, she was given a raise in 1975 from $5 to $10 an hour!

• Even at this “high” rate, she didn’t earn much because she set things up in Chronicles so quickly, eg: Ophthalmology hired her to write a system they thought would take 6 months, she finished it in 45 minutes! So to start making a decent living, she formed a company:

Human Services Computing, Inc. • In March of 1979, with $70K in capital partly raised by selling

some “inside” stock, Judy formed HSC Inc, later changed to Epic.

• There were 3 employees, each working about 1/2 of their time per day, so 1.5 FTEs. Their offices were in the basement of an apartment house pictured on the right.

• Their first computer was a “monstrous” DG Eclipse S/130 with an amazing 194 KB (kilo-bytes) of memory and a 50 Meg disk drive!

• They bought used desks for about $50 each, and started writing systems for a number of early clients in MIIS and Chronicles, such as:- Green Bay Mental Health Center- Denver Children’s Hospital- Healthcare International (a chain)

Early Mentors• Judy was guided in setting up her firm by 2 other HIS-tory heroes:

– Dr. Phil Hicks, of LCI, the large-hospital LIS, who made her get: • (1) UW’s permission, (2) a lawyer and (3) an accountant.

– Neal Pappalardo of Meditech, to whom Judy is indebted for his help in many areas besides MIIS, such as policies, forms, etc.

• Indeed, that explains so many of the similarities between Meditech and Epic that I noted in an earlier episode (#16 on hispros.com):– Everyone resides near the corporate HQ, no “field” offices– No hardware sales, just software, implementation & support– Privately held, no Wall Street pressures for quarterly earnings– Hires a lot of young, bright college graduates, [note – not

exclusive - about 1/3 of our hires are experienced] no outsiders• And to show her gratitude, that is why Epic has focused on larger

AMCs & IDNS, rarely to Meditech’s small to mid-size hospitals!

One More “Super-CIO!”• Next week, we’ll pick up this “epic” tale with their amazing

growth in the large hospital AMC/IDN market, but I must first apologize for forgetting one of the best CIOs I worked with in my intro from last week, who kindly contributed the following:“You didn’t ask me about Judy and we are her second biggest customer after Kaiser! But alas, I would have told you the same: smart, diligent, hard-working, works to do the right thing and really listens to her customers. I think you were one of the influencers that made me reject Epic in the day and I definitely resisted joining the Epic “cult.” But it has been good albeit a wild ride since last we spoke. We signed with Epic at the end of 2010. And here I am 2.5 years later, going up Big Bang with 3 more hospitals on Epic this weekend. We are up in almost all our ambulatory clinics (over 1900 providers) and as of this weekend, LIVE in 17 acute care hospitals with 16 more to go. It is not perfect and we have years of optimization work to make it what we want it to be, but I don’t know of any other system that we could have implemented at the pace we are implementing and getting the results we are getting from a standard build of an integrated system.”

Laureen O’Brien, Vice President and CIO, Providence Health & Services