Epic Tells Customers It Will Stop Google Cloud Integrations

Do you mean that Epic's EHR and business practices are equally awful to each other, or to Google's EHR and business practices (is Google's EHR in the state that its awfulness can be proclaimed?)

I talked to a doctor at Stanford and he mentioned to me one reason why the main Stanford Health and Stanford Children's Health have separate patient portals (not unified) that you have to create separate logins for is because of the huge amount Epic wanted to charge to merge them. (They both run separate Epic instances as far as I can tell)

Epic is ruthless and takes competition out by any means necessary. They are a dinosaur that avoided competition for decades, and Google is a massive thread. This is good news because they are scared, and Google has an infinite runaway to take them out. Epic should have worked tirelessly to innovate and improve US healthcare, but instead chose to stay still and to profit. They won’t be for long.

I work in the public sector where we often pick Azure, but your reasoning for why we do it is wrong.

People are professionals, and these decisions are important and expensive enough that they are very rarely made by lower level management. Sure your CTO will advice the executives to go with Azure, but it’s not because he or she fears Linux, Azure runs a lot of Linux after all. It’s because of several business related reasons.

When you’re and enterprise sized organisation your IT staff probably knows Microsoft products. They are certified in them, and have worked on them for maybe decades. You probably also already run an Office365 platform, which means you probably already run things like Azure AD, which again means, that training and re-training costs will be millions lower if you stick with Microsoft rather than going with AWS, and Google is typically not even on the table because their support isn’t competitive with Microsoft or Amazon. Not only are there the training cost, but you will probably lose your best IT staff members if you don’t pick the technologies they like, and that’s really expensive in a world where some of the hardest IT people to hire are people who know how to manage an enterprise sized cloud setup.

Then there is the business relationship. We’ve worked with Microsoft for what? Three decades? And while the average Joe was making M$ jokes, they were the only company, aside from IBM, to take enterprise organisations with a lot of different business related needs serious. It’s hard to compete with that sort of history. Amazon actually does a great job with AWS now that they’ve realised just how much money is available in public sector cloud, but they’re still up against a business relationship where we know that we can call directly to Seattle when something breaks and that they will be on the phone with us all the way until it’s fixed. Not having the same relationship with Amazon is a huge risk factor in your strategic analysis, and that is something most enterprise organisations but especially the public sector is very careful with.

I don’t think I’ve ever heard a single argument to run Windows because it was safer than Linux, or any of the million other Internet armchair options on why the public sector wastes its money on Microsoft. The truth is a lot simpler, there is no alternative, and Microsoft is actually very good at selling software solutions as well as support to enterprise organisations. There is no actual alternative to office365, and 90% of the 300-500 applications/IT-systems you operate only run on Windows and have no alternatives available. Like we run a medical journal that keeps track of first graders vaccination history, it’s client only works on Windows and it’s backend is on a mainframe. We’d like to replace it, because only a few companies know how to operate mainframes, which means they can squeeze us on price, but no one has made a competing system, and that’s just one of a million such stories.

If the price difference isn’t significant, you’re going to have a very hard time competing with Microsoft if the enterprise organisation you’re selling to in anyway has to operate part of its backend in a lot of organisations.

Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far as I can tell, Google is approaching the problem foremost from the perspective of "how can we make people healthier by making software more effective." Epic and Cerner are simply not doing that. Somewhere in the comments here someone mentioned that most EMR software is a billing system with record keeping attached. Although implementations vary between hospitals, the software is always purchased by administrators, typically with little input from doctors.

In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients.

Google has made a lot of mistakes. If they build something doctors truly want to use and that helps properly organize information, however, and if Google doesn't misuse the data/people aren't unreasonably paranoid about data misuse, it will be a godsend for the industry and it will save lives.

We haven't even begun to talk about the potential for machine learning and statistics to understand what treatments are most effective if data are structured properly. This is unquestionably an interesting and unique case where collecting massive amounts of data and handing in to a trusted, competent, creative, research-oriented authority could have incredible benefit for mankind. I don't trust Cerner or Epic with this mission for a second.