Epic's Principles, Part 2

See Part 1 here

Epic's next two principles also go together really well, so they'll share a blog post.

3. Expectations = reality.
4. Keep commitments.

If I remember correctly, Judy explained number 3 as "What the customer expects to happen is what they judge us [Epic] by." She went on to give an example, paraphrased here: If they expect flying monkeys to jump out of the screen and hand deliver an AVS to the patient, they'll be disappointed when that doesn't happen and that will reflect poorly on Epic when KLAS scores are being given. Therefore, Epic employees should manage their customers' expectations.

The fourth principle is like it: If you say you're going to do something, do it. I.E., if customers expect you to do something, make sure that you do that thing so that reality matches the customers' expectations.

Epic has a hit-or-miss track record with this, and it all depends on how much Epic overworks its customer-facing employees. When I was hired, one of Epic's differentiators was that they had umpteen employees per customer, instead of having each employee oversee several customers at once. As we all know, the ratio has changed somewhat--there are still more employees than customers, but pretty much everyone in a customer-facing role oversees several customers at once. During my tenure, this worked well for the lower-maintenance applications, like Cadence or Identity. It emphatically did not work for Epiccare Ambulatory or Inpatient, especially since the purchasers of those applications expected undivided attention from their TS.

The major clinical applications just have too many issues, too many customizations for one person to handle multiple customers. Deadlines will inevitably slip, one very verbal customer will get more attention the the customer with the extra-savvy analysts, and all customers will get upset because they're not getting the attention that they expect to get. Expectations did not match reality, and commitments could not be kept.

The work you promised to do to your one customer doesn't get done because your other customer had an unplanned downtime in addition to being affected by a new patient safety escalation.

Epic is not set up such that commitments can be kept or expectations can be met. They need to hire TS at the same rate as they take on new customers, and they need to retain the employees they have. A lot of burnout could be prevented by Epic having realistic expectations for its employees, and the voluntary turnover could be ameliorated somewhat. The involuntary turnover would be less of a problem as well, due to less burnout-induced mistakes.

Epic's 2 for 4 on their principles. They are NOT following these at all, and are, in fact, setting themselves up for failure on these fronts. It would be so easy for them to hire/retain/retrain the employees to meet the demands of the job; it just seems like Epic isn't interested in that.

Epic's Principles, Part 1

The first of a series, as alluded to in this post. In this mini-series, I'll explain where I think Epic is following its own principles, and where Epic is falling short. Since I haven't worked for Epic for several years now, my recollections may not reflect current reality. If this is the case, I humbly ask any current or recently-freed Epic employees to set me straight.

In this first part, we'll consider Epic's first two principles:

1. Do not go public.
2. Do not be acquired.

So far, success on both counts.  Hooray!

Ever since I first saw these principles plastered all over campus, I thought these were odd principles to put in front of the rank and file. Cerner can't write a check to me to buy the company. They'd have to go through Epic's army of lawyers, and Judy Faulkner and Carl Dvorak specifically. Neither of these principles are things that I will ever be in a position to break.

So why include them for all employees? Why not just leave them on a plaque in Judy's office, or as explicit instructions to the decision-making board in the event of Judy's retirement or inability to continue running the company?

Almost all the explanations I can come up with are cynical (surprise!). Those two principles could be included as a roundabout way of implanting the idea that even you, the lowly rank-and-file grunt, might be running the company one day and you WILL be in a situation where you'll have to think on these and make a decision.

It could be a roundabout way of discouraging other companies from even asking about potential buyouts or public stock sales. Epic goes through a lot of employees, and eventually those ex-employees leave Dane County and go to medical or tech organizations throughout the country. Judy knows we're all very intelligent (she's said so on numerous occasions), and she knows we will likely rise in authority in whatever company we find ourselves in. Since we've been implanted with these two principles, we know that when we become the CEO of X, we won't just be able to buy Epic outright. If I owned Epic, after all, there are a few DLGs that my users have been whining about that I'd fast-track for the next major version. 

I understand why Judy doesn't want the company to be acquired or to go public, and her reasons are sound. If it were a public company, then decisions would be accountable to a larger, possibly much less informed board. In practice, stockholders care more about dollars than about the company's mission, and I get the impression that Judy truly believes in Epic's mission (the part about providing better healthcare, not the part about galactic domination). Epic wouldn't have as much freedom to take risks or to adapt quickly to industry changes were it beholden to a board of stockholders.

"This company was founded on the principles of not going public and not being acquired," said no business owner, ever. They're good guidelines for the decision-making cadre, but I don't think they're worthy of being principles that the proles have to follow.

Epic in the News

I saw this article pop up in one of the various epic-related LinkedIn groups: Epic opportunity: The software giant is positioning Dane County for an economic breakthrough. Lots of interesting facts--Epic plans to add 800 positions a year for the next several years, and about 1200 employees leave each year. It also included Epic's 12 principles, which I'd forgotten about. There's enough in those 12 principles to fuel at least a couple of posts.

(Updated after a current Epic employee posted the comment below.)
Epic's 12 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, no matter how good the deal. 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.

Class Action Suit Filed Against Epic. Seriously.

A reader of this blog brought this to my attention: Epic hit with class-action lawsuit on overtime wages. It appears as though ex-Epic QAer, Evan Nordgren, was not properly paid time-and-a-half for overtime work during his tenure as an Epic Systems Corporation employee. Habush, Habush, and Rottier are representing the case, and they have a form on their website if you were a QAer in the last 3 years and would like to join the list of plaintiffs.

Wisconsin state law stipulates that all employees are eligible to earn time-and-a-half for overtime, unless they fall under certain exemptions. I remember looking at those exemptions years ago and deciding that Epic TS were sadly exempt from time-and-a-half. Nordgren's lawyer, William Parsons, believes otherwise about QAers.

Epic had this to say in response, according to the numerous (albeit repetitive) articles I found on the subject:

We believe the lawsuit is without merit. We provide good, professional jobs to very talented people, and we value their contribution to improving health care. State and federal law make it clear that employees in computer-related jobs who primarily test software are appropriately classified as salaried professionals. That is precisely the role our quality assurance team performs.

After doing a quick calculation based on Wisconsin law DWD 274.04(15), if you work at Epic and make less than $53,460 yearly, you may be eligible for overtime pay (calculated by $23.67 hourly pay times 2000 hour work-year). As we all know, the 40-hour work week doesn't exist at 1979 Milky Way, so the real hourly wages for QAers are probably much less.

I'm very excited to see how this turns out. I'll post updates here as I learn more.

Update 4/7/14:
A commenter posted this on a separate page, but I thought it belonged here:

Epic recently responded to this internally. All new and current employees have to sign away their rights to litigation over wage and hour questions as a term of new/continued employment. An excerpt:

"I understand and agree that arbitration is the only litigation forum for resolving covered claims, and that both Epic and I are waiving the right to a trial before a judge or jury in federal or state court in favor of arbitration."

Caveat Emptor

 I did a brief search on the benefits of arbitration vs a trial. (Source: http://www.jdsupra.com/legalnews/arbitration-vs-bench-trial-55694/) Arbitration is more expensive than a trial, offers little ability to appeal, but offers more privacy. It's that last quality that I think Epic is more interested in. Everything they do internally is shrouded in secrecy, especially anything negative (like a lawsuit alleging they don't pay their employees fairly). Caveat emptor, indeed.

Update 12/4/14
I'm behind on posting this, but Epic settled the dispute.  Epic unsurprisingly admitted no guilt or wrongdoing, but did set aside $5.4 million for the settlement. With a class of around 1000 members, that boils down to at most $5400 per person. That's a bit over a single month's pay for your average QAer at Epic.

Go-Live Gone Wrong, Continued

I saw a co-worker reading this: Epic Installation Proves More Expensive, and I read the article over his shoulder. It's a follow up to the Go-Live Gone Wrong article that I wrote about a while back. In a testament to the state of modern journalism, the only new fact is that Maine Health is spending $55 million dollars more, solely because of Epic. Most of the money is for training and retraining users, with the remainder being used for the previously planned rollout of Epic throughout the organization.

 The comments on the article are interesting--especially the one about Stockholm Syndrome amongst Epic's customers. While technically Epic doesn't have a monopoly on the industry, free-market principles don't apply to EMRs. It is just too expensive (in dollars and hours) to take one's business elsewhere if an EMR vendor doesn't deliver.

Lisa Frank and Epic

I saw this article show up on my facebook feed and was intrigued, because my wife still talks about Lisa Frank artwork on occassion: Inside the Rainbow Gulag: The Technicolor Rise and Fall of Lisa Frank. Read it now. I'll wait.

The first thing that jumped out is the similarities between Lisa Frank and Judy Faulkner.  From starting the company in 1979 to million-dollar sales shortly thereafter, to this quote: "Thirty-five years and one mega-brand later, there are only two photos of [the company's founder] floating around the Internet." I counted only 4 distinct photos of Judy on the first page of a Bing search. Last, the description "a very passionate lady, although a little manic and not always all there" could apply equally to Faulkner as it does to Frank. Anyone who was around when she was comparing Epic to Facebook and suggesting that we come up with a Farmville-esque game related to healthy children can attest to that.

As I read through the first few paragraphs describing the workers' attitudes about their place of employment, it felt like I was reading Glassdoor reviews of Epic. Lisa Frank's artists, like Epic's staff, were overworked, under-appreciated, and prone to early burnout.

Deeper in the article, however, LFI and Epic's differences begin to emerge. Lisa Frank, Inc took a more top-down, aggressively insulting approach to management, with equal rage directed at employees and middle management. Epic, in contrast, is apathetic at the top and useless in the middle. Faulkner appears to be too caught up in schmoozing hospital CEOs and directing EMR legislation as an Obama appointee to effectively manage her company. (I define management as "encouraging and providing resources for the growth and development of a company's assets, whether those assets are material or personnel.) Her lack of focus combined with Epic's much-vaunted "flat hierarchy" lead to a frustrating organizational structure for the bottom-rung employee. Instead of one unified company led by an actively participating CEO,  Epic instead has hundreds of tiny fiefdoms run by managerially-inexperienced Team Leads. These Team Leads, who are thrust into the position armed with nothing more than their previous experience as One Who Takes Orders and a couple of books, learn to lead with either the unforgiving iron fist of Power Gone To The Head; or fearing conflict, they lead with Friendliness, Understanding, and Avoidance Of Any Criticism Constructive Or Otherwise. One leads to burnt out employees who quit in disgust, while the other leads to employees who don't know if they're meeting expectations or not until they get fired.

Either way, it's a problem. Lest Epic go the way of Lisa Frank Incorporated, I suggest they invest in their employees by drastically changing their management structure. Big companies need Middle Management. Epic hasn't been a small startup in over a decade. It's time for Judy to accept that, and make adjustments to her company. 

ICD-10

If you ignore the ridiculous amount of effort needed to implement ICD-10, and the consistently-delayed deadlines, ICD-10 can be hilarious.

With diagnoses like V95.40XA, Unspecified Spacecraft Injuring Occupant, Initial Encounter and W55.3, Contact with non-horse, non-cow hoof stock; it's hard not to chuckle once in a while.

Enter Struck By Orca, ICD-10 Illustrated. Featuring full-color artwork from more than 30 artists, it shows some creative interpretations of the more interesting causes of morbidity that will be available to clinicians this time next year (or the year after that, depending on CMS's procrastination).

At only $20, I think this should be in every waiting room in every clinic across the country. Order now and get it in time for Christmas.

According to the site's admin, the project has a few ex-Epic folks involved. I'm assuming some of them are sitting out their non-compete year. That non-compete year is a great opportunity to get in touch with your inner creativity, as well as put project management skills to use by taking an abstract idea and turning it into a solo art exhibition. There is absolutely nothing preventing you from creating GANTT charts in gouache.