This question centers on their API and the charges to use the API for me. If API access for other software vendors and clients were free, then I would support the NOT a monopoly argument. But when you charge to for a 3rd party selected by your client to access their own data, it muddies the water.
So its seems that the comments can be put into two buckets, those who don't view Epic as an monopoly and those that do, the ones that don't have certainly provided more details as to what went into their decision, verses the common thread among those that do believe Epic is a monopoly sound like sour losers, either they have competed against Epic and lost, or they feel as though Epics stance on integration with their systems are to confining and don't provide them with enough ways to integrate, which is simply another way of competing with Epic, and finally a conspiracy theory as to their is a relationship between the Affordable Care Act and Judy being on a committee, which by the way multiple other leaders of EHR companies were sat on.
Paul - 8 months ago
Not sure if it will technically qualify as a monopoly but it's the safest purchase for any CIO. It equates to job security, membership to an exclusive club and extensive networking opportunities. Can't blame the CIO to pick EPIC over any other EHR's amongst ever shrinking competitor list.
Am curious though on how they justify the cost of EPIC to their board when almost all healthcare organizations are financially struggling and cutting cost/jobs etc. It's like you don't have enough money to pay your rent but still end up buying a Roll Royce.
AT - 8 months ago
It sure is an interesting market position for Epic, unlike any other I can think of. I don't think "monopoly" is the right designation, but it's certainly unlike anything any other industry has seen that I can think of. Judy had the foresight to understand that when the time would come for providers to go electronic that the focus would need to be ambulatory and was also inspired by Neil Pappalardo to self-develop all of her own fully integrated modules as they expanded into acute, etc. Not to mention also by using MUMPS and only hiring smart college grads and training them the "Epic" way. Then comes along HITECH/MU to by and large mandate EHR adoption with the stick more than the carrot, and Epic really was the only one out there for large IDNs to implement at the time that had true ambulatory/acute integration combined with the ambulatory usability the providers (i.e. decision makers) needed. That wasn't her fault. She also knew that the right strategy was to win over the largest IDNs and AMCs. Now Epic is gaining more market share with M&A than health systems independently "selecting" Epic, but how is that a monopolistic practice? System A running Epic acquires system B and while system B and their providers may want to stay with their longtime EHR partner, there is no decision to be made. Maybe health systems being able to "resell" Epic as a path for small hospitals and clinics to get Epic is questionable. I guess what it boils down to for me is that there are many monopolistic activities/behaviors in healthcare, Epic has reaped the benefits and achieved its dominance as a by product of these to a large extent, but Epic is not and never has been the real problem.
Samantha Brown - 8 months ago
By the legal definition in a court of law, probably not. However, they are effectively thwarting innovation with some of their business practices that make using third parties, particularly in the Patient engagement space, so onerous.
Cosmos - 8 months ago
Epic is unquestionably a monopoly in the Academic Medical Center segment. Proof: 18 out of the top 25 largest AMCs use only epic or are switching to Epic: https://www.beckershospitalreview.com/ehrs/top-25-health-systems-by-ehr-vendor.html
That far exceeds the 50% standard in the traditional definition of a monopoly. And those AMCs are growing by acquiring local competitors.
Brian Too - 8 months ago
I am extremely reluctant to criticize Epic, who have been fully engaged for decades and have the results to prove it.
What I find a bit disheartening is that the competitors are fairly weak, and those competitors seem to be getting weaker. Everything is moving in the wrong direction for a potential customer, to have multiple strong products to choose from. The market is so much better and stronger when picking a winner is actually hard.
These days? Picking a winner on an RFP isn't very hard.
Remember when Eclipsys was a viable contender? Remember when McKesson/HBOC was strong in this space?
Smartfood99 - 8 months ago
It is a fact that midsized and smaller hospitals are choosing Epic primarily because of the monopoly on interoperability and meaningful sharing of patient records. This is 100% an anti-competitive practice and it simply isn't a "characteristic of a monopoly," it 100% is a monopolistic practice. Ask any CIO at any hospital or system under 500 beds that chose Epic over MEDITECH or Cerner in the past 5 years why they moved and they will confirm this was the primary driver despite the added costs and additional resources needed to run Epic.
Ed - 8 months ago
Hhmmm, kinda helps when the CEO greases the wheel of Washington. Then Obamacare is passed.
"Faulkner received a plum appointment to a federal health IT policy panel in 2011. Brandon Glenn of Medical Economics noted that “it’s not a coincidence” that Epic’s sales “have been skyrocketing in recent years, up to $1.2 billion in 2011, double what they were four years prior.”
Just because something is the dominant, favored, or more functional solution doesn't make it a monopoly. Epic has some characteristics of a monopoly but it simply isn't. The DoD did a bake-off a few years ago and didn't select Epic.
Natural monopolies are sometimes a good thing. Consider utilities like electric and water, the national military, or the local fire department. These are areas where it's most efficient and effective for the customer to have a single provider., I think there is an argument to be made on whether a national EHR should be a natural monopoly. However, I imagine the regulation that comes with that would be stifling to innovation.
Now, if you want to run Epic without using Microsoft in your environment that is a much bigger challenge..
Ross Koppel - 8 months ago
yes, an effective monopoly--with both good and bad elements.
Bob - 8 months ago
there is no competition.
all the ones who say yes are not on Epic
resistance is futile, you will be assimilated
- Epic
This question centers on their API and the charges to use the API for me. If API access for other software vendors and clients were free, then I would support the NOT a monopoly argument. But when you charge to for a 3rd party selected by your client to access their own data, it muddies the water.
So its seems that the comments can be put into two buckets, those who don't view Epic as an monopoly and those that do, the ones that don't have certainly provided more details as to what went into their decision, verses the common thread among those that do believe Epic is a monopoly sound like sour losers, either they have competed against Epic and lost, or they feel as though Epics stance on integration with their systems are to confining and don't provide them with enough ways to integrate, which is simply another way of competing with Epic, and finally a conspiracy theory as to their is a relationship between the Affordable Care Act and Judy being on a committee, which by the way multiple other leaders of EHR companies were sat on.
Not sure if it will technically qualify as a monopoly but it's the safest purchase for any CIO. It equates to job security, membership to an exclusive club and extensive networking opportunities. Can't blame the CIO to pick EPIC over any other EHR's amongst ever shrinking competitor list.
Am curious though on how they justify the cost of EPIC to their board when almost all healthcare organizations are financially struggling and cutting cost/jobs etc. It's like you don't have enough money to pay your rent but still end up buying a Roll Royce.
It sure is an interesting market position for Epic, unlike any other I can think of. I don't think "monopoly" is the right designation, but it's certainly unlike anything any other industry has seen that I can think of. Judy had the foresight to understand that when the time would come for providers to go electronic that the focus would need to be ambulatory and was also inspired by Neil Pappalardo to self-develop all of her own fully integrated modules as they expanded into acute, etc. Not to mention also by using MUMPS and only hiring smart college grads and training them the "Epic" way. Then comes along HITECH/MU to by and large mandate EHR adoption with the stick more than the carrot, and Epic really was the only one out there for large IDNs to implement at the time that had true ambulatory/acute integration combined with the ambulatory usability the providers (i.e. decision makers) needed. That wasn't her fault. She also knew that the right strategy was to win over the largest IDNs and AMCs. Now Epic is gaining more market share with M&A than health systems independently "selecting" Epic, but how is that a monopolistic practice? System A running Epic acquires system B and while system B and their providers may want to stay with their longtime EHR partner, there is no decision to be made. Maybe health systems being able to "resell" Epic as a path for small hospitals and clinics to get Epic is questionable. I guess what it boils down to for me is that there are many monopolistic activities/behaviors in healthcare, Epic has reaped the benefits and achieved its dominance as a by product of these to a large extent, but Epic is not and never has been the real problem.
By the legal definition in a court of law, probably not. However, they are effectively thwarting innovation with some of their business practices that make using third parties, particularly in the Patient engagement space, so onerous.
Epic is unquestionably a monopoly in the Academic Medical Center segment. Proof: 18 out of the top 25 largest AMCs use only epic or are switching to Epic: https://www.beckershospitalreview.com/ehrs/top-25-health-systems-by-ehr-vendor.html
That far exceeds the 50% standard in the traditional definition of a monopoly. And those AMCs are growing by acquiring local competitors.
I am extremely reluctant to criticize Epic, who have been fully engaged for decades and have the results to prove it.
What I find a bit disheartening is that the competitors are fairly weak, and those competitors seem to be getting weaker. Everything is moving in the wrong direction for a potential customer, to have multiple strong products to choose from. The market is so much better and stronger when picking a winner is actually hard.
These days? Picking a winner on an RFP isn't very hard.
Remember when Eclipsys was a viable contender? Remember when McKesson/HBOC was strong in this space?
It is a fact that midsized and smaller hospitals are choosing Epic primarily because of the monopoly on interoperability and meaningful sharing of patient records. This is 100% an anti-competitive practice and it simply isn't a "characteristic of a monopoly," it 100% is a monopolistic practice. Ask any CIO at any hospital or system under 500 beds that chose Epic over MEDITECH or Cerner in the past 5 years why they moved and they will confirm this was the primary driver despite the added costs and additional resources needed to run Epic.
Hhmmm, kinda helps when the CEO greases the wheel of Washington. Then Obamacare is passed.
"Faulkner received a plum appointment to a federal health IT policy panel in 2011. Brandon Glenn of Medical Economics noted that “it’s not a coincidence” that Epic’s sales “have been skyrocketing in recent years, up to $1.2 billion in 2011, double what they were four years prior.”
https://www.news-press.com/story/opinion/columnists/2015/07/29/michelle-malkin-obama-administration-favoritism-puts-personal-data-jeopardy/30836589/
Just because something is the dominant, favored, or more functional solution doesn't make it a monopoly. Epic has some characteristics of a monopoly but it simply isn't. The DoD did a bake-off a few years ago and didn't select Epic.
Natural monopolies are sometimes a good thing. Consider utilities like electric and water, the national military, or the local fire department. These are areas where it's most efficient and effective for the customer to have a single provider., I think there is an argument to be made on whether a national EHR should be a natural monopoly. However, I imagine the regulation that comes with that would be stifling to innovation.
Now, if you want to run Epic without using Microsoft in your environment that is a much bigger challenge..
yes, an effective monopoly--with both good and bad elements.
there is no competition.
all the ones who say yes are not on Epic
resistance is futile, you will be assimilated
- Epic