Medical Futures Lab

Guest posting by Andrew Dumit

In my last blog post, I identified some of the problems with the top three electronic hospital record systems, which basically boiled down to antiquated design and procedure that doesn’t do justice to the modern age. In this blog post, I will be looking at the top three reasons Epic continues to dominate the market in the face of both a poor system and better alternatives.

The first reason Epic maintains its grasp on the market is that Epic has been riding towards the top on the back of taxpayers; specifically, $35 billion dollars in healthcare subsidies that go to hospitals for the purpose of purchasing EHRs. [1] Because Epic was in a dominant position before these subsidies were created, it was in a perfect position to capture even more of the market as hospitals followed the lead of other hospitals and bought into what was already popular.

The second reason Epic continues to dominate the market is that Epic maintains a “closed” system. That is, it’s extremely difficult to providers to transfer records between Epic and other EHR software. This means that inter-hospital transfer of patient records is a struggle if both hospitals aren’t using Epic. What this translates into is that when a hospital without an EHR system is shopping around for one it’s in their best interest to go with Epic because transferring records will be simple. One might think that the government would put standards in place to ensure that hospitals are able to transfer records with ease independent of their EHR vendor, but unfortunately, this isn’t the case. In fact, even Epic’s CEO acknowledges the downside of this system and jokes that “the good thing about standards is that you have so many to choose from.”[2]

The third, and possibly most important reason Epic has such a firm grasp on the industry is due to the conservative culture of medicine.  In a conversation I had with Dr. V (@Dr_V)[3], an insightful doctor who also sees Epic as an antiquated technology, he explained how “the conservative culture of medicine has tended hold back the advancement of technology in hospitals.” Unfortunately, both the tech people at the hospitals and the doctors are often against new technologies for fear they may not work, which could endanger lives. Because of this, hospitals’ progress towards new technology is usually stagnant. This leads to the current situation where even though better solutions may be out there, hospitals aren’t willing to try them.

Due to the tax breaks, Epic’s “closed” system, and the conservative hospital culture, Epic has a tight grip on a huge market. And, in the end, Epic has won the battle for dominance in that market and it’s going to take an incredibly effective new software to remove them from their throne.