Epic's Principles, Part 8

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

Principle 10 is interesting--it used to be "Don't take on debt, no matter how good the deal," but apparently Judy had to buy some buildings on credit. It's nice that day-to-day fiscal responsibility is a priority, but unfortunately, I'm in no position to know how well Epic is doing on that. The company is privately owned specifically to keep this kind of information out of the public.

Epic gets a bye on this one, due to my lack of insider information.

Because of that, you get a twofer this week. "Focus on competency. Do not tolerate mediocrity." As with most things, Epic takes an inconsistent approach to this.

Judy most assuredly does not tolerate perceived mediocrity in its employees, but she sure is happy to have the least mediocre EHR out there. There's a difference between Best and Least Bad. Epic is adequate, but the volume of user complaints and bug reports preclude any claims of excellence. Epic does try, though; they're just hampered by how they enforce their ban on mediocrity.

I'm talking about how Epic churns and burns through its employees. New employees are trained to a level of adequacy, then left to sink or swim on their own. If they start to sink, rather than fish them out of the pool and enroll them in swim lessons, Epic lets them drown.

Most business knowledge that I've come across (google: retraining vs replacing employees) advocates that retraining is the more sound business decision. In terms of lost productivity and monetary expense, replacing costs more. Consider Epic: When I was there, communal wisdom stated that it took about 9 months for a TS to become self-sufficient after being hired. Retraining the under-performing employee should take about a month or two of concentrated effort. Replacing that employee starts the 9 month counter over. If most people are leaving sometime between 1.5 and 2.5 years, then the customer is getting minimal competency from their TS.

If training were better, and could be compressed into a shorter time frame, that would help Epic live up to its principle. Get the employee competent faster. If Epic retrained the underperformers--time management skills, prioritization, troubleshooting shortcuts, etc--then they wouldn't have to give up 9 months of non-productive time. Epic wouldn't have to pay that new employee for 9 months on the promise of only a couple months of productivity after that.


While Epic tolerates mediocrity in their product, they are quick to fire mediocre employees, which is a no-tolerance response. Epic has historically struggled with getting its employees the right training, and Epic never retrains. Competency is assumed, never questioned, and never corrected if necessary. There's little proof of a focus on competency. Epic fails on this principle.

Epic's Principles, Part 7

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

"Follow processes. Find root causes. Fix processes."

This one has always bothered me from a semantics angle. What is the Epic Employee to do with the knowledge of the Root Cause? Why was the employee told to find it? What if the process wasn't the root cause of the problem? I would have rephrased it to "Follow processes. Find root causes of problems. Fix root causes."

Epic has a lot of processes that need fixing, and since several of these processes have been flawed for the better part of a decade (at least), it's clear that Epic has no interest in fixing them. The most obvious example of this is their HR practice. Epic follows the practice of hiring the best and the brightest of the inexperienced. Shortly after the employee becomes competent with solo work, the load gets bigger until the employee either buckles under the strain or decides that the strain isn't worth it. At that point, the employee starts looking for work outside of Epic, taking all that experience with him.

The root cause of that problem is firing the employee instead of investing in their growth. Since Judy has gone on record at a staff meeting to lament their employee retention numbers, she could kill two problems by fixing one root cause.

Then there's the problem of Epic's development. Everyone who's gotten a peek behind the curtains knows that Epic's code base is held together with chewing gum and baling wire. A bona fide Patient Safety Escalation comes out every other week, and there are about a dozen Care Concerns each week.

Development processes were followed; Epic has numerous checklists for that. Problems were introduced into the product. Root causes were discovered by the Patient Safety committee. The problems were fixed after the fact (mostly), but the processes that allowed those issues into the software weren't modified.

The root cause of a given PSE is relatively easy to discover, and the code change required to prevent that specific problem from occurring in the future is manageable. However, the root cause of Patient Safety issues in general hasn't been looked at. How can Epic prevent buggy software from going out? I've heard suggestions (and posited some of my own), but nothing has changed.

While Epic talks a big game about fixing processes, they don't really deliver on that.

Epic's Principles, Part 6

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

Epic has a slide, so I guess that's got to count for something.

Seriously though, there's a fine line between having fun and frivolously wasting money. UGM walks that line nicely. There are loads of customer-centric events that (to me, at least) never appeared to be gross misuses of money. For customers visiting Verona's campus, Epic follows this principle pretty well.

However, for Epic employees visiting customer sites, fun with customers usually isn't a priority. While visiting Epic staff could suggest going out for a meal during lunch or after work, many Epic customers prefer that visitors' time be devoted more to resolving issues than extra-curricular socializing. Given various legal and ethical issues around vendors paying for clients' meals and vice-versa, the Epic employees that I've dealt with are doing the right thing, even if it's not necessarily following Epic's 8th principle.

Out of 8 principles so far, Epic's actually following 3 ½ of them (and two of those are gimmes).

Epic's Principles, Part 5

 Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

"Create innovative and helpful products." Having recently spoken to some brand new Epic users, I could have some fun with the "helpful" part of this, but since I did drink the kool-aid pretty heavily for my tenure at 1979 Milky Way, I'll abstain from most of the snarkiness.

When used well, I do think Epic is really helpful. As a MyChart user, it's great to be able to see my lab results whenever I feel like it. It's convenient to schedule appointments without having to wait on hold on the phone. As someone who's watched clinicians ooh and aah when they were able to see other providers' notes on their patients, it's obvious that Epic can be helpful.

However...
A couple of things have to align for Epic to be helpful: The customer has to have implemented the software correctly, and Epic's code has to work. It's not a principle, but it's shown at every staff meeting: "Rule #1: Software must work. Period." Judy used to enjoy mentioning how the Cerner CEO thought that was a personal dig directed at him, but I've seen enough Patient Safety Escalations and Care Concerns coming from hastily coded Epic software to say that Epic is guilty of breaking Rule #1, too.

Software that doesn't work isn't helpful. When Epic works, it's beautiful, but when it doesn't work it's downright dangerous. Epic needs to work on the safety of its products. That, in turn, will increase the helpfulness factor.

I'll give Epic half credit on the helpfulness bit of Principle 7. As for innovation, there's a good mix of innovation and stagnation happening in Verona.

On the one hand, they haven't done much that's truly groundbreaking since taking over the entire industry. Their new products are primarily focused on providing an Epic option for specialty software that used to be sold by best-of-breed vendors. On the other hand, MyChart is really cool, as is Haiku and Canto.

Meriam-Webster defines innovation as merely an improvement over something existing. By that definition, Epic is constantly innovating, as their software is consistently getting better over time. However, my own exacting standards demand more. I feel that innovation needs to be more earth-shattering, like what the iPhone did to the cell phone industry. Giving patients easy access to their own health records was that kind of game changer. There's a Chronicles quote that says "Talent hits a target that no one else can hit. Genius hits a target that no one else can see." MyChart was genius. Beaker, Phoenix, Beacon, Thumper or iHeartHearts or whatever they're calling Cardiant now--those  all stem from talent. Innovation requires genius, in my book.

tl;dr: Epic does a pretty good job with innovation and helpfulness, by the dictionary definitions. I wish they would do more and try harder to be more helpful and innovative.

Happy Returns

I've been maintaining this blog for over three years now, and I've had Google Adsense running on it from the get-go. This month is the month where I've finally crossed the minimum payment threshold. That couldn't have happened without you, my loyal readers.

Adsense's ToS prevents me from outright asking for people to click on the ads, but I do offer my heartfelt thanks for those who've done so voluntarily.

With my new-found wealth, I think I'll probably purchase the Struck By Orca book, and possibly even buy myself a nice meal from the dollar menu at my local fine dining establishment.

Edit:
Also, I'm starting to get spambot comments. That's a solid marker of success. If I didn't publish your comment and you're not a spambot, it's because you put some hyperlink in your comment. If you want your comment to be published, either don't include any links, or make the link relevant. I'm not going to publish your comment if it includes a link to your blog about cat-shaped coffee mugs, if the rest of the comment is just praise for how awesome this blog is. If you want to praise me, great! Just don't include random links. If you have something meaningful to say about Epic, the trials and tribulations of Epic consulting, or if you have inside information (like you've been to a recent Epic all-staff meeting), I might be more inclined to post your comment, cat blog link or not.

Epic's Principles, Part 4

It's been a while since I first posted the full list. Ergo:

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

 This week brings us to Principle 6: Have standards. Don't do deals.

Whenever I heard Judy explain it at staff meetings, she related it to the price of the software. I.e., Kaiser pays the same price per license as Maine Health. Epic isn't going to give one customer a huge discount just to get its business. Like the first two principles, I never saw how it related to me, personally, as someone not in a position to make deals. As I'm thinking about it now though, with my embittered snarkiness in full bloom, Judy and the sales team are the only folks at the company who are even in a position where they could follow this principle, in Sales or otherwise.

If Epic employees had standards, they wouldn't allow themselves to work 60-80 hour weeks. If Epic employees had standards, they'd give their bosses realistic expectations of the work that they can realistically handle in a given week. If Epic employees had standards, they would politely but firmly inform their TLs that their customers are used to certain standards of support, standards that will no longer be achievable if the employee's customer load increases.

I've often said that one of the reasons Judy primarily hires recent college grads is because they don't yet know what is standard for work expectations. If they don't know any better, they're easier to exploit.

Realistically though, the Epic rank-and-file just aren't in a position where they can obey Principle 6. If they tried, they'd be out of a job faster than you can say "Fix processes." In fact, Epic actively encourages its employees to lower its standards. I remember a conversation I had with my TL, after he listened in on a weekly issues call with my customer.

TL: You said "I don't know" a lot.
Me:  That's because I didn't know the answer off the top of my head. I want to research it before giving them potentially incorrect information.
TL: Just tell them something, and then correct it later.
Me: ...Ok... (raised eyebrow)

After the next issues call the TL listened to:
TL: You told them some things that aren't right.
Me: But you said--!

You get the picture, and you've probably lived through it. It is possible in certain areas of life to have standards that are too high. However, in a situation with as much potential for harm as clinical software, there shouldn't be any compromises when it comes to accuracy. You shouldn't have to make a deal between response time and response accuracy.

The "don't do deals" aspect is also interesting, in that it's definitely one sided. Epic won't cut a deal for anyone, but boy-oh-boy will it wring every last advantage out of anything that comes its way. I'm thinking primarily of how it burns through its employees, but I'm sure Judy is reaping lots of rewards from her seat on Barack's EHR panel.

In any rate, the upper echelons at Epic are in a position to obey the principle as it relates to customer expectations. But internally, standards are always movable.

Epic's Principles, Part 3

See the previous posts here:
Part 1
Part 2

Epic's next principle is 5: Be frugal.


Good advice, but I don't think Epic actually follows it.

Dictionary.com defines frugal as:

economical in use or expenditure; prudently saving or sparing; not wasteful

Epic is not that. Epic wastes money (not in large sums, at least not that I've been privy to) on lots of little things that add up. Epic wastes its employees' time, and it wastes its employees in general. 

I remember when I was working there, every office received its own Dymo label maker. Previously, you could only find a label maker in the supply rooms. I'm not sure what the demand was that necessitated a label maker for every 1.5 employees--I don't think I ever had to wait to use it, even when there was only one per floor. The label makers in question have a current list price of $29.99 (available on Amazon). I doubt Judy paid full retail price for them, as I'm certain Epic has enough sense to get bulk discounts where available. Even so, my back-of-the-napkin calculation has the price of enough label makers for every office at Epic being close to one employee's yearly salary.

I would rather Epic had spent that money on hiring an additional TS, in keeping with Principle 3: Expectations = Reality. I expect my TS will be fully committed to my customer and no one else, and that is not reflected in reality.


Epic is not frugal with its employees' time. It takes 6-9 months for a new TS to become self-sufficient. Epic's customers are paying that TS for the time spent on the steep learning curve (which doesn't make the customers happy--no one likes paying master prices for apprentice work), which will then go to waste as the average employee will leave Epic (one way or another) after another 12 or 18 months. Epic is throwing a quarter of its salary expenditures down the drain--they're not reaping any rewards from retaining skilled workers--they train the employees and then fire them (or burn through them) just as they get the knowledge sufficient to do their job effectively. At that point, Epic adds multiple customers to a single employee's roster, which turns a functional, bright, excited little worker bee into a stressed, overworked, non-functional drone. Epic wastes (definitions 4 or 5) its employees.

And some of the uses that Epic puts its employees to just don't make good business sense. The "starting salary" of a TS, when put in hourly form, was about $28 when I started at Epic. Some employee duties included making popcorn for the Staff Meetings, and directing traffic at UGM. I don't know of any popcorn makers who earn $28 an hour, and that's not counting the lost productivity cost in taking that employee away from customer-facing work. The frugal thing to do would be to leave that employee in his office so he can work on billable tasks. Pay a local store to make all the popcorn--the increased productivity from Epic's employees will pay dividends, even if outsourcing the popcorn costs a little bit more per box. The same goes for all the UGM work, which is addressed in greater detail here.

Epic is frugal with employee salaries, so that's something. Compared to other software companies of similar size, and even the salaries of analysts at Epic's customer sites, the Epic employee is receiving less pay than people doing similar (sometimes identical) work at other organizations. Epic is very generous with its raises though, and those who are permitted to stick around make money hand over fist. But the average employee isn't going to last long enough to get that kind of salary. The low starting salary coupled with the huge raises for long-timers leads to a good-looking average salary, but chances are you're not going to hit that average during the typical short tenure of an Epic employee's employment. 

Further breaking the illusion of frugality, there's Epic's artwork, which can best be described by borrowing from Hooters: tacky and unrefined. Judy is on record saying that the art work is a miniscule amount of the yearly budget. But as perceptions also equal reality, it gives the appearance of wasting a lot of money. Customers do not feel as though installing a tube slide or putting a paper-mache giraffe in a forest of fake bamboo is a good use of the copious amounts of money they've paid into Epic's coffers.

There's also the campus, which grows like a tumor. All that construction isn't cheap, and I understand that Judy had to modify the 10th principle because of it. "Don't take on debt, period" is a completely different from "Don't take on debt except in these specific circumstances."

The key to frugality is the wise use of resources. I'm not sure what the return on investment was for those label printers, or if there was one to begin with. If Epic spent more on outsourcing those tasks that don't require extensive, specialized software knowledge (like making popcorn and directing traffic), and less on cool gadgets (like popcorn machines), the appearance of frugality would show more. As it stands now though, there is nothing frugal about Epic.