Epic: Medical records innovator

In 1979, Epic was just a handful of employees working out of a basement office in Madison. It has come a long way.

Today, Epic is one of the biggest names in electronic medical records. Hospitals and clinics across the globe rely on Epic’s software to manage patient records, and approximately 66 percent of the U.S. population has a record in Epic, according to the company.

Epic is also an economic force in Wisconsin. The company employs about 9,400 people at its sprawling headquarters in Verona, just outside of Madison. Staying on the cutting edge of the industry for nearly 40 years requires an ongoing commitment to innovation, according to Epic president Carl Dvorak.

According to Dvorak, Epic was one of the first companies to address how clinicians interact with medical records, looking beyond recordkeeping for billing and accounting; Epic claims to be the first system of its kind built as a database rather than hard-coded; and Epic was a pioneer in providing patients with access to their own medical records starting in the 1990s.

“We were a platform long before being a platform was cool,” Dvorak said.

As Epic has grown, so, too, has its team. Fifteen years ago the company employed around 500 people, compared to nearly 10,000 today, making it an incubator for talent in the state.

“One of the things that people master here at Epic is the ability to work hard,” Dvorak said. “We’re a very bright, very creative group of people, but at the end of the day we do have a high standard of excellence and of performance.”

Former Epic employees have gone on to work in leadership roles at health care tech startups including HealthMyne Inc., healthfinch Inc. and HealthDecision Inc., all based in Madison, as well as statewide organizations such as the University of Wisconsin System and Aurora Health Care Inc.

“We’d obviously prefer they stay here, but that’s not always in the cards for everyone,” Dvorak said. “I can tell you with all honestly that when I hear about an Epic person who’s gone on to do something wonderful in the world, I get that little internal beam of pride.”

For current employees, Epic’s roughly 1,000-acre campus is an extension of the company’s personality – “a little bit whimsical and a little bit interesting,” Dvorak said.

Meetings take place in an oversized treehouse. Employees can grab lunch at Lou’s Soda Fountain, a ’50s-style diner with a checkered tile floor and jukebox. An entire wing of the campus  –  aptly named the Wizards Academy – is modeled after Hogwarts.

Since Epic moved its headquarters from Madison to Verona in 2005, the campus has undergone five expansions, with a sixth still in the planning stages. Epic’s headquarters has become an attraction in its own right, and the company invites the public to drop in for self-guided tours.

While Epic has often been celebrated for its eccentricity and its culture has helped recruit and retain employees, the company has also faced criticism from within the health technology community. 

A widely publicized 2014 report from the Rand Corp. described Epic as a “closed platform,” denouncing the software’s limited interoperability with providers across different electronic medical record systems.

Critics say Epic has sometimes stifled innovation, particularly when it comes to sharing patient records and the integration of third party applications.

Dvorak says he hears those concerns, but he’s never heard “a concrete, sustainable suggestion for what to do differently.”

“At the end of the day, we’re a software company. The only thing we have is intellectual property,” he said. “If we gave away everything we built for free, we wouldn’t be a company at all; we’d have disappeared long ago.”

In 2017, Epic launched the App Orchard – a marketplace for Epic-approved external apps – and some viewed it as an opening up of Epic’s once-guarded system. The App Orchard gives startups and small tech companies direct support and access to Epic’s APIs, along with the ability to launch apps that integrate with Epic software. Epic’s customers can use apps from the App Orchard with confidence that they have been vetted by the Epic team, Dvorak said.

He added that the App Orchard was not a response to criticism about being “closed.” The company maintains that it has been “open” all along by supporting outside partners through Open.epic, a portal that provides resources to third-party application developers.

“The App Orchard is not a symbol of being more open,” he said. “It’s more about how to construct a marketplace that builds confidence and creates opportunity.”

Since the creation of the App Orchard, 250 organizations have joined the platform and launched 50 new apps that are now available to Epic’s customers. HealthDecision is one of those organizations.

HealthDecision facilitates shared decision-making between patients and clinicians. The app integrates directly with Epic’s software, allowing doctors to pull up relevant data that helps patients make important decisions and understand the risks associated with a particular medication or procedure.

“I think (the App Orchard) is functionally making (Epic) more open, whether or not it was a specific response to that criticism,” said Jon Keevil, founder and chief executive officer of HealthDecision. “We were really impressed when we started working with them through this process.”

John Runions, director of North American systems engineering and business development at Springfield, Illinois-based information technology firm Levi, Ray & Shoup Inc., says the App Orchard has been a boon to LRS’s app, which integrates with Epic’s software to streamline printing processes for large hospitals.

“They’re certainly a very careful organization when it comes to doing things with third parties, but they seem fair about it,” Runions said.

Beyond the App Orchard, Epic is looking to the rest of the world as it continues to grow. The company is expanding its customer base overseas, with offices in the Netherlands, Australia, Denmark, United Arab Emirates, the United Kingdom, Saudi Arabia and Finland.

Epic is also putting its data to use to help U.S. communities handle the fallout of the opioid epidemic. The company has created dashboards to help its customers monitor the prescribing patterns of clinicians and identify hot spots where opioids are prescribed in high quantities.

Looking forward, Dvorak says Epic will continue to adapt and innovate as e-visits, telemedicine, genomics and changes to the U.S. health care system impact the way Epic’s clients rely on electronic medical records.

“We’ve got an amazing set of ingredients to rethink how health care is delivered in total,” Dvorak said. ϖ