Habush Habush and Rottier

Thursday, October 12, 2017

Another Reason to Sue Epic?

A coworker of mine alerted me to this: Mayo Clinic Health Information Offered Through Epic Patient Apps


The article is from (late) April of this year, so it's not exactly breaking news. The article states that Mayo Clinic and Epic are partnering to include health education content published/created by Mayo through Epic's MyChart application.


Because I'm trying not to be a hack, I searched for other articles for confirmation. I found this one on Healthcare IT News: http://www.healthcareitnews.com/news/epic-mayo-clinic-team-integrate-symptom-checker-mychart-patient-portal. This article suggests that Epic will soon jump into the auto-diagnosis RoboDoc market. (I need a jpg of Robocop in a lab coat, now).


Being an Old Fart, I remember Microsoft getting in trouble for bundling MS Office software with its OS. Other health content vendors are available--Staywell, Relay Health, among others. If Mayo content gets provided with the software, how is that any different than the Microsoft antitrust lawsuit? If Corel was pissed then, Staywell should be livid now.

Wednesday, October 11, 2017

Epic at the Supreme Court

If you're interested, here's the oral arguments from the Epic's Supreme Court case.


text (78 page pdf)


downloadable audio file


Habush Habush and Rottier don't expect SCOTUS to make a final decision until winter or spring.

Tuesday, October 3, 2017

The Blacklist


(burying the lede)
Currently, the Supreme Court is deciding on the legality of Epic's clause in their employment contract that all disputes must be handled by individual arbitration--an action that Epic instituted to prevent all the class action lawsuits that they've been getting over the last few years. Here's a link to an article: TL;DR: SCOTUS is undecided, but not every justice has weighed in.




Lede:
I met a person who was actually affected by the heretofore-existed-only-in-threats-and-rumors Epic Blacklist. He was employed as an implementation analyst at a customer site (never an Epic employee) who was involved in various go-lives at that organization. We'll call him Ray.






After working with this customer and finishing a major go-live, Ray decided to leave the organization for some legitimate life reason, probably family related. His employer was cool with this, and it was an amicable separation. Ray wasn't fired, is what I'm saying. The employer liked him, was sorry to see him go, but was supportive of his future endeavors.

Ray got a job with an Epic-preferred consulting agency, and the agency asked Epic about his eligibility. Depending on which consulting firm agent asked which Epic employee, the firm received various answers as to when they could hire Ray--right now, a few months from now, or a calendar year after the hospital's go-live. The consulting firm found a placement for Ray at a new organization, but when it came time to actually get him working, the new org said it would cost them their "Good Install" to hire him. Ray ended up doing non-epic work until a year had elapsed.

It's real, people. And Epic enforces it by reaching into its customers' pocket books. Ray spoke to his consulting firm during all this, and the firm said that Epic set up Good Install/Good Maintenance as a way to have control over who gets to work on Epic products, without hairy legal issues. In effect, an Epic Client can hire whoever they want, but Epic might charge extra for the privilege of hiring certain people.

update:
A reader posted this on another page here:
How does leaving during an active implementation and/or go-live as a consultant/contractor affect your future job prospects? Can you be blacklisted for leaving a client abruptly? Not to pursue another client, but to take a long break.
Based on an N of 1, the blacklist is time-limited. If you leave during an active implementation, odds are good that you WILL get blacklisted. But the blacklist will probably only last a year. If your break is a year, then you shouldn't have any major consequences. If your break is a couple of months, you'll need to find some non-Epic work to do, or an Epic customer who doesn't mind pissing Judy off. Sutter Health comes to mind.

Friday, March 24, 2017

Talking Union



A person can learn a lot from folk songs. Email unionizeepic@gmail.com if you're interested. From the man himself, when I asked if there are any current organization activities going on:

I don't know of anything actively going on. I know a small handful interested in actively pursuing it, but I talk to people about it often and am surprised by the level of passive support. However, we haven't taken any action yet. I'm hoping to get something going in January [2017--I'm not prompt. Don't sue me--Admin].

Please post this email if you write about unionizing at all. I'm hoping to get things going after the new year or so.

If you know anyone still at Epic interested send them my way, please. Especially, if they would be interested in organizing and/or recruiting.

There you have it. Go forth and organize. Every movement starts somewhere, and listening to the soundtrack of the labor movement isn't a bad way to prepare.


Friday, March 10, 2017

A Book Review (of sorts)

I just finished reading Procrastinate on Purpose, by Rory Vaden. In an effort to organize my thoughts and determine how to apply the lessons to healthcare IT, here's this post.


The main points of the book are "work double-time part-time now, in order to have full-time free time later"; and the Focus Funnel (source):


The focus funnel goes hand-in-hand with the Eisenhower Decision Matrix (ugent vs important--"what is urgent is seldom important, and what is important is seldom urgent"). Vaden adds a Z-axis to the decision matrix for Significance. If Urgent asks "how soon does this matter," and Important asks "How much does this matter," then Significance asks "How long will this matter."


The Focus Funnel then asks the user to eliminate those tasks of no significance, automate any repeatable tasks, and delegate tasks that don't require the user's particular set of skills. If the task makes it through to the bottom of the funnel, then a decision needs to be made: Is this task the most significant thing I should be working on right now? If yes, do it. If not, put it back at the top of the funnel.


I grok at a visceral level how effective this is for those in control of their own task list. What I don't understand is how to apply it to my situation, where my workload is partially at my own discretion, but primarily driven by management--and the managers historically don't appreciate automation or delegation, and never eliminate anything. Healthcare IT is also plagued by IT-style busywork, compliance CYA, and patient care criticality. In addition to my actual work, I have to track it for data-driven bean counters, wrap it up in red tape to protect from malpractice suits, and do it all right now because lives are at stake.



I can apply Vaden's method to those tasks where I'm in full control, but I have limited empowerment to delegate. Let's say I'm assigned a task that can be done by anyone on the team, including fresh new hires. By assigning that work to me, it takes away time that I can spend on tasks where I have unique expertise.



Automating is similarly difficult. A task that costs an hour a day, every day, may require 40 hours to automate a permanent fix. The daily maintenance is urgent, as most things in health care IT are, so it still has to be performed alongside the permanent fix.



Eliminating tasks is easy. Managers have even less time than the grunts, so unless the managers are specifically measuring a task, eliminating the pointless stuff will most likely go completely unnoticed. (That only works if the task is truly without benefit.) Managers have limited insight into how one actually prioritizes, so the Concentrate/Procrastinate portion of the funnel is entirely up to me.



The problem then, is with the middle portion of the funnel--that takes a team. And I can't control my team. Without buy-in from the entire team and from management, delegation is unworkable. Without informed prioritization, getting permission to spend time on automation is difficult, but not impossible--I guess this is where the "work double time part time" comes in--if one 80-hour week saves an hour a day forever, that's an extra 250 hours a year that were just freed for more significant things. It also makes me look awesome in the eyes of management.


I encouraged my immediate supervisor to read it, and he might. Maybe change will happen from middle management outward. In the meantime, I work on the things that I can control, and prioritize based on a task's significance to my workload.

Wednesday, January 18, 2017

Supreme Court, Epic, and Arbitration

Over the last few weeks, I've seen a bunch of articles popping up about all the lawsuits that Epic is involved in. Read the links, they say it better than I could, but in summary:


Epic got sued a while back over lack of overtime pay. Epic settled, and then changed its employment agreement to require arbitration rather than lawsuits. Epic got sued again, lost, appealed, and the court of appeals said that forcing employees into arbitration was Not Good. Due to variances in different courts (7th Circuit vs 5th Circuit), people have asked the Supreme Court to give its opinion.


Epic: With the Patient at the Heart*


In other news, I thought this was pretty cool: Flint Doctor uses Epic to Expose Lead Crisis. It's almost a year old, but this is the good stuff that Epic should be doing (and getting credit for) all the time.


*and the Employee in the Lower GI Tract

Tuesday, December 20, 2016

Merry Christmas! (You're welcome)

The ICD-10 and Meaningful Use Illustrated books are still great Christmas gifts. I thought I saw an email that the books were now available at your favorite retail website, but I must have been mistaken.


Here's a list (about a year out of date) of Epic's customers. It's alphabetical--if you want to sort it, copy it into excel. Pipe delimited for convenience.


Name | State | Country
Access Community Health Network | Illinois | US
Admiraal De Ruyter Ziekenhuis |  | Netherlands
AdvantageCare Physicians | New York | US
Adventist Health West | Oregon | US
Akron Children's | Ohio | US
Alberta Health Services |  | Canada
All Children's Hospital | Florida | US
Allegheny Health Network | Pennsylvania | US
Allina Health System | Minnesota | US
Altru Health System | North Dakota | US
AMC - Vumc |  | Netherlands
Amphia Ziekenhuis |  | Netherlands
AnMed Health | South Carolina | US
Ann & Robert H. Lurie Children's Hospital of Chicago | Illinois | US
Anne Arundel Medical Center | Maryland | US
Asante Health System | Oregon | US
Ascension Health | Indiana | US
Ascension Health - Providence Healthcare Network | Texas | US
Aspirus | Wisconsin | US
Atlantic Health | New Jersey | US
Atrius Health | Massachusetts | US
Aurora Health Care | Wisconsin | US
Austin Regional Clinic | Texas | US
Banner – University Medical Center | Arizona | US
Baptist Health | Arkansas | US
Baptist Health System (AL) | Alabama | US
Baptist Healthcare System | Kentucky | US
Baptist Memorial Health Care | Tennessee | US
Bassett Healthcare | New York | US
Bayhealth Medical Center | Delaware | US
Baylor College of Medicine | Texas | US
Baylor Scott & White Health | Texas | US
Beacon Medical Services | Colorado | US
Beaumont Health | Michigan | US
Bend Memorial Clinic | Oregon | US
BJC HealthCare & Washington University | Missouri | US
Bon Secours Health System | Maryland | US
Chesapeake Regional Medical Center | Virginia | US
Boston Children's Hospital | Massachusetts | US
Boston Medical Center | Massachusetts | US
Bronson Healthcare Group | Michigan | US
Brookdale University Hospital and Medical Center | New York | US
Buffalo Medical Group | New York | US
Cambridge Health Alliance | Massachusetts | US
Cambridge University Hospitals NHS |  |
Care New England | Rhode Island | US
Carilion Clinic | Virginia | US
Carle | Illinois | US
Carolinas HealthCare System | North Carolina | US
CaroMont Health | North Carolina | US
Catholic Health Initiatives National | Colorado | US
Alegent Creighton Health | Nebraska | US
Franciscan Health System | Washington | US
St Luke's Health System (TX) | Texas | US
Catholic Health Services of Long Island | New York | US
Cedars-Sinai Health System | California | US
CentraCare | Minnesota | US
Centura Health | Colorado | US
Cheyenne Regional Medical Center | Wyoming | US
Children's Health System of Texas | Texas | US
Children's Healthcare of Atlanta | Georgia | US
Children's Hospital & Medical Center, Omaha | Nebraska | US
Children's Hospital Colorado | Colorado | US
Children's Hospital Eastern Ontario |  | Canada
Children's Hospital of Philadelphia | Pennsylvania | US
Children's Hospital of the King's Daughters | Virginia | US
Children's Hospital of Wisconsin | Wisconsin | US
CIGNA Medical Group of Arizona | Arizona | US
Cincinnati Children's Hospital Medical Center | Ohio | US
Cleveland Clinic | Ohio | US
Cleveland Clinic Abu Dhabi |  |
Community Health Network | Indiana | US
Community Healthcare | Indiana | US
Community Medical Centers | California | US
Cone Health | North Carolina | US
Conemaugh Health System | Pennsylvania | US
Confluence Health | Washington | US
Connecticut Children's Medical Center | Connecticut | US
Contra Costa Health Services | California | US
Cooper University Health Care | New Jersey | US
Cottage Health System | California | US
Covenant HealthCare | Michigan | US
CVS Health | Rhode Island | US
Dartmouth-Hitchcock | New Hampshire | US
Dayton Children's Hospital | Ohio | US
Deaconess Health System | Indiana | US
Denmark Capital Region & Region Zealand |  | Denmark
Denver Health | Colorado | US
Dreyer Medical Clinic | Illinois | US
Driscoll Children's Hospital | Texas | US
Dubai Health Authority |  |
Duke University Health System | North Carolina | US
Dutch Demo System |  | Netherlands
East Boston Neighborhood Health Center | Massachusetts | US
Edward Hospital & Health Services / DuPage Medical Group | Illinois | US
El Camino Hospital | California | US
Elliot Health System | New Hampshire | US
Erlanger Health System | Tennessee | US
Eskenazi Health | Indiana | US
Essentia Health | Minnesota | US
Everett Clinic, The | Washington | US
Fairview Health Services | Minnesota | US
Florida Hospital | Florida | US
Foundation System |  | US
Franciscan Alliance, Inc. | Indiana | US
Franciscan Missionaries of Our Lady Health System, Inc. | Louisiana | US
Froedtert Health, Inc. | Wisconsin | US
Geisinger System Services | Pennsylvania | US
Geisinger Affiliates | Pennsylvania | US
Genesis Healthcare System | Ohio | US
Glens Falls Hospital | New York | US
Grady Health System | Georgia | US
Greater Baltimore Medical Center | Maryland | US
Greater Hudson Valley Health System, Inc. | New York | US
Greenville Health System | South Carolina | US
Self Regional Healthcare | South Carolina | US
Group Health Centre |  | Canada
Group Health Cooperative | Washington | US
Group Health Cooperative - South Central Wisconsin | Wisconsin | US
Gundersen Health System | Wisconsin | US
GW University Medical Faculty Associates | District of Columbia | US
Hackensack University Medical Center | New Jersey | US
Hamilton Health Sciences & St Joseph's Healthcare Hamilton |  | Canada
Harris Health System | Texas | US
Hartford HealthCare | Connecticut | US
Hattiesburg Clinic and Forrest County General Hospital | Mississippi | US
Hawaii Pacific Health | Hawaii | US
HCA National | Tennessee | US
HCA Central and West Texas | Texas | US
HCA Mountain | Utah | US
Health Ventures of Central Iowa | Iowa | US
HealthEast Care System | Minnesota | US
HealthPartners | Minnesota | US
Park Nicollet Health Services | Minnesota | US
Heart of Texas Community Health Center | Texas | US
Hennepin County Medical Center | Minnesota | US
Henry Ford Health System | Michigan | US
HonorHealth | Arizona | US
Hospital for Special Surgery | New York | US
Hospital Sisters Health System (HSHS) Division - Eastern Wisconsin | Wisconsin | US
Houston Methodist | Texas | US
Hurley Medical Center | Michigan | US
Indiana University Health Arnett | Indiana | US
Infirmary Health System | Alabama | US
Inova Health System | Virginia | US
Valley Health | Virginia | US
Institute for Family Health | New York | US
INTEGRIS Health | Oklahoma | US
John Muir Health | California | US
Johns Hopkins Aramco Healthcare |  |
Johns Hopkins Medicine | Maryland | US
JPS Health Network | Texas | US
JurongHealth |  | Singapore
Kadlec Health System | Washington | US
Kaiser Permanente - National | California | US
Kaiser Permanente - Colorado | Colorado | US
Kaiser Permanente - Georgia | Georgia | US
Kaiser Permanente - Hawaii | Hawaii | US
Kaiser Permanente - Mid-Atlantic | Maryland | US
Kaiser Permanente - N Cal | California | US
Kaiser Permanente - Northwest | Oregon | US
Kaiser Permanente - S Cal | California | US
Kelsey-Seybold Clinic | Texas | US
Kettering Health Network | Ohio | US
King's Daughters Medical Center | Kentucky | US
Lahey Health System | Massachusetts | US
Lakeland Healthcare | Michigan | US
Lancaster General Health | Pennsylvania | US
Lee Memorial Health System | Florida | US
Legacy Health | Oregon | US
Lehigh Valley Health Network | Pennsylvania | US
Leon Medical Center | Florida | US
Lexington County Health Services | South Carolina | US
Lifespan | Rhode Island | US
Loma Linda University Medical Center | California | US
Louisiana State University | Louisiana | US
Loyola Medicine | Illinois | US
LSPQ |  | Canada
MaineHealth | Maine | US
Maricopa Integrated Health System | Arizona | US
Martin Health System | Florida | US
Mayo Clinic | Minnesota | US
Medical University Of South Carolina | South Carolina | US
Medisch Centrum Leeuwarden |  | Netherlands
MediSys Health Network | New York | US
Memorial Health Services (MemorialCare) | California | US
Memorial Health, Inc. | Georgia | US
Memorial Healthcare System | Florida | US
Memorial Sloan-Kettering Cancer Center | New York | US
Mercy Health - MO (fka Sisters of Mercy) | Missouri | US
Mercy Health - OH (fka Catholic Health Partners) | Ohio | US
Summa Health System | Ohio | US
Mercy Health Services (MD) | Maryland | US
Mercy Health System - WI | Wisconsin | US
Mercy Medical Center | Iowa | US
Meriter Health Services | Wisconsin | US
Methodist Health System | Texas | US
Methodist Hospitals | Indiana | US
Metro Health - MI | Michigan | US
MetroHealth - OH | Ohio | US
Momentum Health | Oklahoma | US
Monroe Clinic | Wisconsin | US
Montefiore Medical Center | New York | US
Mount Auburn Hospital | Massachusetts | US
Mount Sinai Health System | New York | US
Mt Sinai - FL | Florida | US
MultiCare Health System | Washington | US
Nationwide Children's Hospital | Ohio | US
Nebraska Medicine | Nebraska | US
Nederlands fundamentsysteem |  | Netherlands
Nemours | Florida | US
New Hanover Regional Medical Center | North Carolina | US
New York City Health and Hospitals Corp | New York | US
North Memorial Health Care | Minnesota | US
North Oaks Health System | Louisiana | US
NorthShore University HealthSystem | Illinois | US
Northwest Community Hospital | Illinois | US
Northwestern Memorial Healthcare | Illinois | US
Cadence Health | Illinois | US
Norton Healthcare | Kentucky | US
Novant Health | North Carolina | US
NYU Langone Medical Center | New York | US
Oakwood Healthcare | Michigan | US
OCHIN | Oregon | US
Ochsner Health System | Louisiana | US
St. Tammany Parish Hospital | Louisiana | US
OhioHealth | Ohio | US
Oregon Health & Science University | Oregon | US
OSF HealthCare | Illinois | US
Overlake Hospital Medical Center | Washington | US
Owensboro Health | Kentucky | US
Pacific Medical Center | Washington | US
Palos Community Hospital | Illinois | US
Parkland | Texas | US
Parkview Health | Indiana | US
Partners HealthCare System | Massachusetts | US
PeaceHealth | Washington | US
Peninsula Regional Medical Center | Maryland | US
Piedmont Healthcare | Georgia | US
PinnacleHealth | Pennsylvania | US
Premier Health | Ohio | US
Presbyterian Healthcare Services | New Mexico | US
Presence Health | Illinois | US
Prime Healthcare | California | US
ProHealth | Wisconsin | US
ProMedica Health System | Ohio | US
Providence Health and Services | Washington | US
Providence Alaska | Alaska | US
Providence EMFI | Washington | US
Providence Oregon/California | Washington | US
Providence Washington | Washington | US
Swedish Medical Center | Washington | US
Queen's Health Systems, The | Hawaii | US
Radboudumc |  | Netherlands
Rady Children's | California | US
Reading Health System | Pennsylvania | US
Reliant Medical Group, Inc. | Massachusetts | US
Renown Healthcare | Nevada | US
RiverBend Medical Group | Massachusetts | US
Riverside Health System | Virginia | US
Riverside Medical Center | Illinois | US
Riverside Medical Clinic | California | US
Rochester Regional Health System | New York | US
Rockford Health System | Illinois | US
Royal Children's Hospital |  | Australia
Rush University Medical Center | Illinois | US
Saint Francis Care | Connecticut | US
Saint Francis Health System | Oklahoma | US
Saint Francis Healthcare System | Missouri | US
Saint Luke's Health System (MO) | Missouri | US
Salem Hospital Regional Health System | Oregon | US
Salem Clinic | Oregon | US
Samaritan Health Services | Oregon | US
Sanford Health | South Dakota | US
Sansum Clinic | California | US
Santa Clara Valley Medical Center | California | US
SCL Health | Colorado | US
Scripps Health | California | US
Seattle Children's Hospital | Washington | US
Sechaba Medical Solutions |  | South Africa
CHEIRON-GEN HEALTH |  | South Africa
Select Medical | Pennsylvania | US
Sentara Healthcare | Virginia | US
Singing River Health System | Mississippi | US
Sint Lucas Andreas Ziekenhuis |  | Netherlands
SLUCare / SSM-SLUH | Missouri | US
South Dakota State Lab | South Dakota | US
Southcoast Health System | Massachusetts | US
Spaarne Gasthuis |  | Netherlands
Sparrow Health System | Michigan | US
Spartanburg Regional Healthcare System | South Carolina | US
Spectrum Health | Michigan | US
SSM Health | Missouri | US
SSM Health Care of Wisconsin | Wisconsin | US
St Anthony's Medical Center | Missouri | US
St Elizabeth Healthcare | Kentucky | US
St Jansdal Ziekenhuis |  | Netherlands
St Joseph's Hospital Health Center | New York | US
St Luke's Health System (Idaho) | Idaho | US
St Luke's University Health Network | Pennsylvania | US
Stanford Children's Health | California | US
Stanford Health Care | California | US
Stormont-Vail HealthCare | Kansas | US
SUNY Upstate Medical University | New York | US
Sutter Health | California | US
SwedishAmerican Health System | Illinois | US
Tampa General Hospital | Florida | US
University of South Florida | Florida | US
TempleHealth | Pennsylvania | US
Texas Children's Hospital | Texas | US
Texas Health Resources | Texas | US
Texas Scottish Rite Hospital for Children | Texas | US
The Christ Hospital | Ohio | US
The Guthrie Clinic | Pennsylvania | US
The Ohio State University's Wexner Medical Center | Ohio | US
The Portland Clinic | Oregon | US
The University of Vermont Medical Center | Vermont | US
ThedaCare | Wisconsin | US
Bellin Health | Wisconsin | US
Thomas Jefferson University Health System | Pennsylvania | US
TriHealth | Ohio | US
Trinity Mother Frances | Texas | US
Tucson Medical Center | Arizona | US
UC Health | Ohio | US
UCLA Medical Center | California | US
UCSF Benioff Children's Hospital Oakland | California | US
UCSF Medical Center | California | US
UMass Memorial Health Care | Massachusetts | US
UNC Health Care | North Carolina | US
United States Coast Guard | District of Columbia | US
UnityPoint Health | Iowa | US
University Health (BRF) | Louisiana | US
University Health Care System | Georgia | US
University Hospital | New Jersey | US
University of Arkansas for Medical Sciences | Arkansas | US
University of California Davis | California | US
University of California San Diego | California | US
University of Chicago Hospitals | Illinois | US
University of Colorado Health | Colorado | US
University of Florida | Florida | US
University of Iowa Hospitals and Clinics | Iowa | US
University of Kansas Hospital | Kansas | US
University of Maryland Medical System | Maryland | US
University of Miami | Florida | US
University of Michigan | Michigan | US
University of Mississippi Medical Center | Mississippi | US
University of Pennsylvania Health System | Pennsylvania | US
University of Pittsburgh Medical Center | Pennsylvania | US
University of Rochester Medical Center | New York | US
University of Texas MD Anderson Cancer Center | Texas | US
University of Texas Medical Branch | Texas | US
University of Texas Southwestern Medical Center | Texas | US
University of Utah Hospitals & Clinics | Utah | US
University of Virginia Medical Center | Virginia | US
UT Medicine San Antonio | Texas | US
UW Health | Wisconsin | US
UW Medicine | Washington | US
Valley Medical Center | Washington | US
Vancouver Clinic | Washington | US
Vanderbilt University Medical Center | Tennessee | US
Vidant Health | North Carolina | US
Wake Forest University Baptist Medical Center | North Carolina | US
WakeMed Health and Hospitals | North Carolina | US
Washington Hospital Health System | California | US
Weill Cornell Physician Organization | New York | US
Wellmont Health System | Tennessee | US
WellSpan Health | Pennsylvania | US
WellStar | Georgia | US
West Virginia University Healthcare | West Virginia | US
Wheaton Franciscan | Wisconsin | US
Wisconsin State Lab | Wisconsin | US
Wolcott, Wood & Taylor (UIC) | Illinois | US
Women's College Hospital |  | Canada
Yakima Valley Farm Workers Clinic | Washington | US
Yale New Haven Health System and Yale University | Connecticut | US
Yuma | Arizona | US