Castles, Lucille Ball and Health Records

A brief history of Epic, Second Post in My Series on How Epic Is Screwing America

If you’re unfamiliar with what an EMR is, or why it matters here is my first post in this series: The Monopoly No One Talks About

Judy Faulkner started Epic Electronic Health Record (EHR) in the late 1970s. The idea of the Epic EHR came about when Faulkner was working on a database project for the University of Wisconsin-Madison. She realized that there was a need for better ways to manage and share patient information in healthcare.

Judy Faulkner at Epic’s 2019 User Group Meeting

In 1979, Judy Faulkner and her team developed the first version of the Epic EHR, and wrote it in MUMPS (Massachusetts General Hospital Utility Multi-Programming System). It was designed to help healthcare organizations digitize patient records, streamline workflows, and improve communication between different departments within a hospital.

Epic is still written in MUMPS- the exact same programming language that was available 50 years ago.

Judy again in 2019

Criticisms of MUMPS:

1. Learning Curve: MUMPS has a unique syntax and structure, which can be challenging for developers who are more familiar with mainstream programming languages. It may take some time for programmers to become proficient in MUMPS.

2. Limited Adoption Outside Healthcare: MUMPS is primarily used in the healthcare industry, and its adoption outside this domain is relatively limited. This can make it challenging for developers to transition from MUMPS to other more widely used languages.

3. Maintainability: Some critics argue that MUMPS codebases can become difficult to maintain over time, especially in large and complex systems. The code can become unwieldy and hard to understand, leading to potential difficulties in making updates or modifications.

4. Modernization Challenges: As technology advances, some have raised concerns about the modernity and scalability of MUMPS-based systems. Integrating newer technologies and frameworks into existing MUMPS systems can be complex and may require workarounds.

5. Interoperability: While MUMPS-based systems often excel at handling healthcare data, they have been criticized for their proprietary nature and limited interoperability with other non-MUMPS systems. This can hinder data exchange and collaboration between different healthcare organizations.

6. Lack of Developer Community: Compared to more popular programming languages, the MUMPS developer community is relatively smaller. This can limit the availability of resources, libraries, and tools for developers working with MUMPS.

7. Innovation: All innovation is restrained to the 5-decade-old operating system.

   

   One of the many whimsical buildings on Epic’s campus in Wisconsin

Prior to 2009, hospitals used hundreds of applications to handle their IT needs. Then, Judy Faulkner helped the United States government to craft Meaningful Use language in the HiTech Act, its meaningful use objectives— required healthcare organizations’ compliance to qualify for Medicare and Medicaid incentive payments. Funny enough, the language crafted required complex EHR applications to manage an umbrella of healthcare IT needs within one system. In short, you had to use Judy’s system or one of the few systems that could keep up with the requirements constructed by Judy to be paid.

Yep, that’s Judy again, same meeting

2011, when stage one of Meaningful Use is when Epic went from a big player, to market dominant.

one of the many epic buildings in Wisconsin

There is a craziness and whimsy to Faulkner- I recommend reading this piece about Epic’s Campus in the NYT- Willy Wonka and the Medical Software Factory.

Seriously, you should google images of Epic’s WI campus, it’s insane

Having had many friends work at Epic they praise the pay, the benefits, the education they received, and the career track- but they all say the same thing “Epic owns you. They own all of you.” Coming straight out of college and selling your soul to Epic for a couple of years doesn’t just mean high pay, it also means job stability since today almost 50% of all hospital beds in the United States are controlled by Epic’s EHR.