An Epic conflict of interest

Pejman Yousefzadeh Co-Host, Coffee and Markets
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Meet Judy Faulkner. She is the founder and CEO of Epic Systems Corporation in Wisconsin. She is also a member of the GAO Health Information Technology Policy Committee and an advisory board member of the Journal of Healthcare Information Management. She is also politically active. In 2008, Faulkner gave at least $110,000 to political organizations and candidates, including $57,000 to the Democratic National Committee and $2,300 to then-Senator Barack Obama, according to the Center for Responsive Politics. After Obama’s election, Faulkner continued giving to the Democrats, giving at least $85,000 through the 2010 midterm election. In 2010, Faulkner gave $60,000 to the Greater Wisconsin Committee, which was responsible for targeting conservative Wisconsin state Supreme Court Justice David Prosser for defeat. In 2011, Faulkner has given over $51,000 to Democrats.

The $787 billion stimulus bill signed into law by President Obama in February 2009 included $19 billion for healthcare information technology (HIT), and created the Health IT Policy Committee, whose job it was to advise the federal government on spending the $19 billion allocation. The committee was to have one member responsible for representing information technology vendors. Judy Faulkner was designated as that member.

A key aspect of HIT is “semantic interoperability,” which refers to a situation in which multiple systems are able to send and receive information, and are able to reconcile different terms. For example, if different names or terms come up for a particular disease, and the terms are reconciled, we will have semantic interoperability. Achieving interoperability means achieving efficiency in information transfers, which will bring about better patient service. And yet, Judy Faulkner, as the lone HIT representative sitting on the Policy Committee, has done everything in her power to stymie interoperability.

Consider the following observation from Glen Tullman, the CEO of AllScripts, which is a HIT company:

Epic is the least-connected system of any out there. … The only people in the market who are fighting connectivity are Epic, and their strategy is to say, “Sure, you’re connected as long as everybody’s on one system and it’s the same version.” … Epic is not only against connectivity, but they’re anti-innovation. From that standpoint, they’re kind of exactly the opposite of the connectivity model that the rest of the industry is working toward.

Politicians are giving Faulkner cover. A number of members of Congress wrote to both the Department of Veterans Affairs and the Department of Defense, demanding the implementation of an HIT system. The letter cites Kaiser Permanente, the Cleveland Clinic, and Cedars Sinai — all Epic clients — as having model systems and includes endorsements from both Republicans and Democrats. Of course, Faulkner did not procure Republican support for Epic’s work by having contributed money and energy to Democratic causes. But we don’t know whether her Democratic support was merit-based, or whether it came as a result of her fealty to the Democratic Party’s agenda.

Referring to the work done by another Epic client, President Obama stated, “We have to ask why places like the Geisinger Health system in rural Pennsylvania … can offer high-quality care at costs well below average, but other places in America can’t.” CNN commented that “[t]he Obama administration points to Geisinger as proof that the nation’s health care system can be made more effective and efficient.” Regarding Kaiser Permanente in North Carolina — also an Epic client — the president said, “They’ve got health information technologies so that when you take a test, it actually gets forwarded to the next doctor and the next doctor and to the nurse and the pharmacist, so that there aren’t any errors.” And talking of the Cleveland Clinic — yet another Epic client — the president said that the clinic “has one of the best health information technology systems in the country.”

But Geisinger’s adoption of Epic’s technology led to mistakes, including the prescription of incorrect drug dosages to patients, as reported by Neil Versel. Responding to the problems, Faulkner said, “It doesn’t work when you mix and match vendors. … It has to be one system, or it can be dangerous for patients.” To which Versel makes the obvious reply:

 … Judy Faulkner believes that the inability to integrate systems is a risk to patient safety? Really?

This shouldn’t have to be a warning to customers that they should only buy from one vendor. This should be a wake-up call to vendors that they had better start cooperating with each other.

As an American taxpayer, I don’t want my money spent on systems that can’t interface and can’t interoperate. That’s not “meaningful use.” It sounds more like blackmail by a vendor.

Indeed. But Geisinger was forced to pay $35 million to Epic for the installation of HIT, and Epic then charged another $2 million to fix the resulting problems.

Similar problems cropped up for other Epic clients. Swedish Hospitals Systems in Seattle suffered a shutdown of its medical records system for four hours in January of this year. An audit early this year found severe billing discrepancies at the University of Iowa Hospitals and Clinics. And five years ago, information technology problems at Kaiser Health Systems became severe enough to force the resignation of Kaiser’s chief information officer — but not before Kaiser committed $4 billion to the conversion to Epic software by 2013.

So much, then, for the promise of “hope and change” when it comes to the field of HIT. Partisan politics, favoritism, and cronyism are preventing patients from receiving the best care possible. The whole story is a scandal. And it should be treated like one.

Pejman Yousefzadeh is an attorney in the Chicago area. He is a contributor to The New Ledger, co-host of the Coffee and Markets podcast, and editor of A Chequer-Board of Nights and Days.