- 1 Overview
- 2 Introduction
- 3 History
- 4 Software Details
- 5 Epic applications and the implementation process
- 6 The Certification process and Requirement
- 7 CCHIT Certified Product
- 8 Recognition and Awards
- 9 Executive team
- 10 Related Articles
- 11 References
Epic Systems is a medical software company that provides multiple utilities for medical practitioners in one patient-centric database. The databases house all computer physician order entry, medical records, scheduling software, and practice management applications. Epic runs on a 47 year-old programming language called MUMPS(Massachusetts General Hospital Utility Multi-Programming System), as does VistA. Unlike VistA, Epic is closed source platform, which makes it incompatible to interface with software from other companies for the purpose of consolidating patient data, and thus expensive and challenging for hospitals. Their differing origins, business models, and trajectories offer useful insights into the development, diffusion, and potential future of EHRs. In a RAND report, Epic's weaknesses are VistA's strengths: affordability, usability and interoperability.  According to Epic, one of the main objectives is to “improve the patient experience, provide more effective care, streamline administrative tasks, and strengthen their financial health."   Epic claims that their propriety software lays the framework for interoperability. Critiques claim that Epic is not interoperable due to vendor locking. 
Epic is a private and employee-owned company. They develop, install and support all our applications in-house and the leadership team includes clinicians, developers and process experts who have patient care experience and knowledge of healthcare technology. Currently Epic medical records serve 54% of U.S population, while covering 2.5% population worldwide. Some of the customers included are: Kaiser Permanente, Cedars-Sinai Medical Center in Los Angeles, Cleveland Clinic and Johns Hopkins Hospital. In addition to this list, the University of Texas Medical Branch in Galveston has been currently using Epic medical records throughout its health system. This had made Epic accessible to providers, staff, students and recently to patients through the personal medical records.
On the other hand, in October 2014 Epic electronic health record worth 200 million pounds was implemented at Cambridge University Hospital UK, however it had to be shut down due to some critical problems. Epic touches more than 760,000 patient records per month on the CARE Everywhere network which involves the secure exchange of patient data between Epic EHR and non Epic EHRs, HIEs and government agencies. KLAS, an independent IT reviewer for health-care clients, has consistently rated Epic as one of the top healthcare IT companies in the world. In 2007 KLAS names a total of seven Epic products in its top 20 IT programs; to date, no other healthcare IT software programing vendor has had more than two. In addition, Epic was named the #1 Overall Software Vendor in 2010 by KLAS and has ranked highly in customer satisfaction and response times  Epic was named the #1 Overall Software Vendor in 2013 by KLAS and has ranked highly in customer satisfaction and response times  In addition, it has recently been awarded in hospital and provider domain a certification by the Office of the National Coordinator for Health IT ONC in 2014.  Epic dominates in large and medium hospital markets and continues its success with smaller institutions and ambulatory practices. The emerging monopoly of Epic in USA is due to its compliance with Centers for Medicare & Medicaid Services (CMS)’s documentation guidelines, its savvy marketing plus total package approach, aids by federal incentive (and) penalty program, and inferiority of other EHR systems.
Epic creates and provides integrated software to health care organizations so they can take better care of patients by improving outcomes, enhancing the patient’s experience, and supporting research. All of Epic’s applications are built on a single database, providing an integrated solution that supports patient care and continuity throughout hospitals, clinics, and physician offices. Using these applications, health care organizations and professionals can access the appropriate patient information instantly whenever and wherever needed.
Epic boasts a reputation for on-time and on-budget implementations, as rated by independent reviewers. Their software is promoted as quick to implement, easy to use, and highly interoperable. Epic’s MyChart product has also given patient’s access to their own medical information from anywhere in the world. Epic has internationalized their software so that it can be translated into multiple languages and therefore creates an international network of health care users that can share knowledge and best practices around the world. Epic's software has already started to be implemented around the world with contracts with Cambridge Hospital in the UK  and Royal Children's Hospital in Australia.
The fundamentals for Epic was first introduced by Judith Faulkner, a computer programmer who pursued graduate studies in computer science following a mathematics degree. During the 1970s-1980s, Faulkner worked as a consultant and taught computer science at the University of Wisconsin-Madison, which according to Dan Balaban, it was “During this time, she led the design of clinical records systems for various departments serving the university's hospital and for the Milwaukee County mental health department” . In 2013, Forbes called her "the most powerful woman in healthcare", and in 2015, the magazine estimated her net worth at $2.6 billion. 
Then in 1979, Judy Faulker, along with a dozen or so other programmers and information managers, pooled around $70,000 to found Human Services Computing, Inc., which would later become Epic . This system was the commercialization of a clinical records system that they had built for The University of Wisconsin-Madison. This system, called Chronicle, was written in the MUMPS language which was created in the late 1960's and still used today. Chronicle was a patient-centric enterprise system designed to manage inpatient, ambulatory, and payment information.
Throughout the 1980's the company largely focused on billing and inventory tracking systems. Systems such as Cadence Enterprise Scheduling, a program application for improving the efficiency of scheduling patient appointments was released in 1983, and Resolute Professional Billing, a program which connected patient scheduling and billing, released in 1987, quickly became some of the industry's top scheduling and billing applications [9, 10].
Then, in 1992, Epic released the first Windows-based EMR called EpicCare, now known as EpicCare Ambulatory and used in outpatient settings.  After just five years, the popularity and interest in EpicCare grew substantially resulting in more than 15 million dollar profit for Epic . By 1995, Epic had 133 employees and a larger new headquarters. In 1998, Epic released their first EMR for use in an inpatient/hospital setting, EpicCare Inpatient.
In 2000, Epic releases MyChart, a software program which gives patients access to their medical records . While it is a highly regarded EMR system, Epic Systems also garnered an unwanted amount of notoriety as a result of an engagement with Kaiser Permanente (KP) to develop and rollout KP's HealthConnect system, a comprehensive EMR system developed to empower health care providers and patients alike. However, in November 2006 a project manager for KP sent an alarming email that predicted losses of up to $7 billion dollars resulting from the HealthConnect implementation . A publicity firestorm ensued for KP. In the end, though, HealthConnect has proven to be a successful system, and KP recently received 12 awards from HIMSS Analytics for achieving the highest levels of EMR implementation . Patients have also been pleased with the system which enables them to be more involved in the management of their own health issues.
Epic had a partnership with Philips to develop a scaled-down version of Epic's software, called Xtenity, which was marketed to mid-sized health care organizations. This partnership ended on September 29, 2006, and no organizations used Xtenity in a production environment. Epic hired many of the former Philips employees from the Netherlands who helped establish Epic's European location.
Since 2006, Epic has increasingly been working on expansion into the international health care market. In 2007, Epic established a subsidiary in the Netherlands to market Epic software.
In 2010, Epic announced its intention to pursue green energy sources including solar, biomass, and wind power. The company hopes to eventually obtain 80-90% of its energy needs from alternative sources .
Epic is a commercial locomotive experiencing financial growth that definitely breaks the mold of Wisconsin’s manufacturing tradition and is on its way in utilizing clean energy sources on a large scale. 
As of 2011, Epic serves approximately 240 customers globally with nearly 220,000 physicians using EpicCare and sharing information via Epic's Care Everywhere network. 
What started out as a relatively small company over 30 years ago has transformed into a company which employs over 3,000 people and generates over 500 million dollars a year in revenue .
In 2011, Epic’s total revenue was $1.2 billion. Epic currently devotes approximately 37% of their annual spending on research and development, which is double what their major competitors allocate for R&D. Conversely, Epic spends less money on sales and marketing compared to its competitors. ==
In 2012, Epic reports having 270 customers, serving over 42% of the US population and approximately 2% of the world’s population. Epic’s client base includes group practices, community hospitals, academic facilities, multi-hospital organizations, and safety-net organizations. When current rollouts are complete, approximately 250,000 physicians will be using Epic EHRs to serve more than 130 million patients. Epic currently has more than 5,400 employees. ==
In 2012, Judy Faulkner was named to the Modern Healthcare list of 100 Most Important People in Healthcare.
In 2013, Oregon Health & Science University Department of of Medical Informatics & Clinical Epidemiology announced a partnership with the EpiCare electronic health record as part of the OHSU Informatics Discovery Lab. The purpose of this partnership is to advance education and research in informatics.
In February 2014, CVS Caremark Corporation's MinuteClinic announced the transition from a proprietary EHR to EpicCare. When this transition is completed over half of all Americans (51%) will have an Epic record.
In June 2014, Apple formally announced a partnership with Epic, with the focus of the alliance centering on the new Apple HealthKit. As a result of this partnership, future data from wearable consumer mobile sensors could be incorporated within an institution's electronic health record. According to Forbes, Epic fostered a relationship with Apple, when it developed in 2010 an app for doctors, called Haiku, which gives them access to a patient’s chart. It has been closely following the proliferation of health apps and monitoring systems, and last year partnered with popular tracking devices Fitbit and Withings to integrate data into Epic’s electronic health record for patients called MyChart. 
The 2014 EHR Medscape survey of 18,500 physicians indicated that 23% of the physician respondents used an Epic product. Of the 83% of these respondents who stated they used an EHR, Epic had the largest market share. A confounding factor would be if physician respondents were linked with large health care systems. Epic is the leader in inpatient EHRs with 297 customers, representing several large health systems in the United States.
An Epic Space Race
In 2014, the Epic team and and Lehigh Valley Health Network developed a game "that would assist all Lehigh Valley Health Network employees, and possibly medical professionals nationwide, in the switch to the EPIC systems." 
Epic uses a MUMPS/Cache database  to offer an integrated software system.  This system is based on the interaction of multiple modules communicating with Epicenter, the patient-centered backbone of the Epic system. An integrated health care systems may benefit from data sharing, improved communications and enhance team-based care abilities and increased ease and reliability of available data access.
The EMRs are EpicCare Ambulatory and EpicCare Inpatient. These systems interact with each other and with department specific modules such as;
- ASAP Emergency Department System
- Willow Inpatient Pharmacy
- Willow Ambulatory Pharmacy
- Radiant Radiology Information System
- OpTime Operating Room Management System (Pre, Intra, & Post Operation)
- Epic Anesthesia Information Management System.
In addition, health care organizations can purchase practice management applications such as:
- Cadence (scheduling application)
- Prelude (registration application)
- Resolute Professional Billing
- Hospital Billing
- CRM (Customer Relations Management application)
- Tapestry (Managed Care Administration application) 
- Haiku (for iOS and Android) gives physicians secure and portable access to patient charts, whether they are in the hallways of the practice, rounding at the hospital or away from work. 
- Canto (for iPad) offers access to Epic charts, messaging and other EMR functions. Physicians can use the dashboard-style front end to check schedules, respond to messages, dictate notes and review lab results from anywhere. 
- MyChart (for iOS and Android) gives patients controlled access to the same Epic medical records their doctors use. Its self-serve online functions enable patients to manage their own health. 
- Bedside is a patient-driven, interactive tablet app, designed to strengthen the patient's relationship with the care team – making the hospital stay more enjoyable and productive. 
- Care Everywhere, a physician-guided framework that promotes exchange of healthcare data between systems so that providers can have information they need to provide care irrespective of location. Information can come from another Epic System or a non-Epic EMR. 
- Lucy is a patient-guided module that is a freestanding personal health record for patients to enter health data directly and readily access and organize their personal health information
- MyChart is Epic System's patient portal which allows patients to access their own chart through a computer or a mobile device. Patients can view upcoming appointments, set up future appointments, review past lab results, refill prescriptions, and view reminders.
- Device Integration allows Epic to connect with various patient monitoring devices. Data from those monitors will automatically be inputted into the system and a clinician will then have the ability to validate the data before it is actually added to the patient's chart. "Epic offers a standard HL7 Device Formatted Medical Device Interface that can be used for receiving discrete alphanumeric data from monitoring systems." 
- EpicCare Link allows indepedent physicians to easily refer and follow up with their patiient's progress through a read only, "secure, Web-based access to information about the care you provide to their patients" . This function allows for better care coordination and interoperability.
- Cogito serves as the main analytic reporting platform for the Epic applications. While the Epic applications run off MUMPS (a hierarchical, array-based database), Cogito allows data to be transferred to relational databases. This allows health care organizations to run released Epic report templates or write their own Crystal reports. 
Specialty specific modules also exist including;
- Beacon for Oncology practices
- Cardiant for Cardiovascular services
- Kaleidoscope for Ophthalmology
- Phoenix for Transplant services
- Stork for Obstetric services 
- Wisdom for Dentistry
For many specialties that do not have their own separate application (including ENT, Psychiatry and Orthopedics) pre-built specialty content is available for utilization with EpicCare Ambulatory.
These systems offer clinical decision support services and computer physician order entry. In addition, Epic also inspired the development of clinical trial applications such as CTA (Clinical Trial Alert), at the University of Cincinnati, and the Cleveland Clinic Foundation in Ohio, using Epic's CDSS.
The Epic system also allows for connectivity with third party vendors. For example, data coming from a wide range of monitoring devices can be entered into Epic system to monitor trends.  The system supports Clinical Context Object Workgroup standard to allow for interoperability across various applications.  
Interoperability and Data Exchange
Epic criticised about their resistance to share patient records and data exchangeability as it has designed in a closed system. The critics within the healthcare industry as well as end-users argued that Epic hasn't took any action to allow healthcare providers "to share clinical data with non-Epic facilities".  These criticisms come from the fact that it is difficult "for third-party vendors to integrate with Epic". Judy Faulkner, the founder and CEO of Epic believes opposite by stating that Epic puts the patient at the center of their attention and to ensure their openness, they provide their application source code to their end-users "so they can use these programming exits to write their own code". However, she stated that they receive numerous integration requests but they are eager to work with those who have requested by their customers. 
Epic applications and the implementation process
This is the current list of applications that Epic Systems offers. 
- ADT (Inpatient and Outpatient Admission-Discharge-Transfer Application) 
- ASAP (Emergency Department Application)
- Beacon (Oncology Application) Beacon runs within Hyperspace and shares the same database as other Epic applications. It expands upon the specialty features in EpicCare Ambulatory and EpicCare Inpatient that assist with chemotherapy ordering and administration. Beacon's key features include protocols and treatment plans, cancer Staging, documentation and reporting and radiation oncology. 
- Beaker (Clinical Laboratory Application) Beaker is laboratory information Retrieved from https://userweb.epic.com/ released in 2012. < ref name = “Epic, Beaker (LIS 2013)”> CAP Today http://www.captodayonline.com/productguides/software-systems/laboratory-information-systems-november-2013/epic-beaker-lis-2013.html</ref> It is integrated with Epic EMR for seamless interface and workflow among Laboratory staff and other care providers. Beaker has three tools which connects laboratory to Phlebotomist, Clients and Billing office. It also includes Anatomic Pathology and Public health laboratory applications that support Surgical Pathology and Public health trends respectively. < ref name = “Departments and Ancillaries”> Epic https://www.epic.com/software-ancillaries.php</ref>
- BedTime (Bed Management Application)
- Bridges (Interface Application)
- Cadence (Scheduling Application)
- Cogito ergo sum (integrated analytics and reporting)
- Cupid (Cardiology Application) (fka Cardiant)
- Care Everywhere (Information Exchange Application)
- Clarity (RDBMS Management Application)
- Data Courier (Data Environment Propagation Utility)
- Diagnose Behandeling Combinatie (Dutch Billing Module)
- EpicCare Ambulatory (Ambulatory Medical Record Application)
- Epic Everywhere (allow communication between Epic clients)
- EpicCare Home Health (Specialized Home Health Application for use in Patient Homes)
- EpicCare Hospice (Specialized Hospice Application)
- EpicCare Inpatient (Universal Hospital System)
- EpicCare Link (Web-based Application for Community Users)
- EpicWeb (Web-based Clinical Application)
- Haiku/Canto (Device Mobility Clinical Application)
- HIM (Chart Tracking, Chart Deficiency Tracking, Release of Information Application, Coding & Abstracting)
- ICU module
- Identity (Master Patient Index [MPI] Application)
- Kaleidoscope (Ophthalmology Application)
- Lucy (Free standing PHR)
- MyChart (Patient Chart Access)
- Nurse triage
- OpTime (Surgical Application)
- Phoenix (Transplant Application)
- PlanLink (Service for providers and employers)
- Prelude (Inpatient and Outpatient Registration Application)
- Radar (Dashboard Application - formerly known as 'MyEpic')
- Radiant (Radiology Application)
- Reporting Workbench (Operational Reporting Application)
- Resolute (Billing Application)- includes HB (Hospital Billing) and PB (Professional Billing)
- Stork (OB/Gyn Application)
- Tapestry (Managed Care Application)
- Welcome (Patient Self-Service Kiosk)
- Willow, formerly named EpicRx (Hospital Pharmacy Application)
- Willow Ambulatory (Outpatient Pharmacy Application)
2015 Epic Applications
- EpicCare Ambulatory Electronic Medical Record (EMR): EpicCare combines chart review, order management, and documentation in a fast system that can learn your preferences while you work. It organizes patient information, suggests actions, and guides coordinated care across physical care settings. EpicCare's embedded analytics and population management infrastructure support the transition to value-based care models. 
The Certification process and Requirement
- To work on an epic project, the vendor (and customers) requires that you demonstrate your knowledge and understanding of the module(s) you intend implement. They have two ways to demonstrate this understanding-proficiency and certification. The certification is module specific and the process involves a written exam and hands-on project. The initial training take places at the Epic headquarter in Verona, Wisconsin. Once certified, you are required to update your skills and knowledge of the module you are trained in by undergoing periodic re-certification, known as new version training (NVT).
- Re-certification may be done remotely-proctored exam service.
- The certification requires employer sponsorship 
CCHIT Certified Product
- EpicCare Ambulatory EMR Spring 2007, Expires Nov. 30, 2010 (This product has not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the American Recovery and Reinvestment Act of 2009 (ARRA).) 6
- EpicCare Ambulatory - Core EMR Spring 2008 & EpicCare Ambulatory - Core EMR Summer 2009, Both expire December 31, 2014 (CCHIT and also Preliminary ARRA IFR Stage 1 certified) 6
- EpicCare Ambulatory EMR Spring 2008, Expires Sept. 30, 2010 (This product has not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the American Recovery and Reinvestment Act of 2009 (ARRA).) 6
- EpicCare ASAP - Core EDIS Spring 2008 & EpicCare ASAP - Core EDIS Summer 2009, Both expire Dec. 31, 2014 (CCHIT and also Preliminary ARRA IFR Stage 1 certified) 6
- ASAP Emergency Department Information System Spring 2008, Expires 11/12/2010 (This product has not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the American Recovery and Reinvestment Act of 2009 (ARRA).) 6
- EpicCare Inpatient - Core EMR Spring 2008 & EpicCare Inpatient - Core EMR Summer 2009, Both expire Dec. 31, 2014 (CCHIT and also Preliminary ARRA IFR Stage 1 certified) 6
- EpicCare Inpatient Clinical System Spring 2008 (Exp. 11/12/2010) & EpicCare Inpatient Spring 2007 (Exp. 11/5/10) Both products have not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the American Recovery and Reinvestment Act of 2009 (ARRA). 6
Epic Certified: 9/30/2010; 2014
 Versions: Spring 2008, Summer 2009,2010. In addition, 2012 and 2014.
- These versions of Epic’s software are fully ONC-ATCB certified for 2011-2012 as Complete EHRs . Use of ONC-ATCB certified EHR technology is a required first step in qualifying eligible healthcare providers for incentive funding available under the American Recovery and Reinvestment Act (ARRA) .
Epic’s unique certification numbers: 
- CC-1112-574355-1 (EpicCare Inpatient, Spring 2008)
- CC-1112-574355-2 (EpicCare Ambulatory, Spring 2008)
- CC-2014-574355-8 (EpicCare Inpatient 2014)
- CC-2014-574355-6 (EpicCare Ambulatory 2014)
Clinical quality measures to which Epic has been tested and certified: 
- Hospital: All in the Hospital Domain
- Eligible Provider: All in the Eligible Provider Domain.
Recognition and Awards
Gartner, Inc. (2010) identified Epic as a Leader in its Magic Quadrant. 
The following is a summary of Epic’s KLAS rankings for 2011: 
• #1 Overall Software Suite: Epic
• Best in KLAS Acute Care EMR: Epic EpicCare Inpatient EMR
• Best in KLAS Ambulatory EMR (Over 75 Physicians): Epic EpicCare Ambulatory EMR
• Best in KLAS Patient Accounting and Patient Management: Epic Resolute Hospital Billing
• Best in KLAS Pharmacy: Epic Willow
• Best in KLAS Practice Management (Over 75 Physicians): Epic Resolute/Prelude/Cadence
• Best in KLAS Radiology: Epic Radiant
• Best in KLAS Surgery Management: Epic OpTime
• Best in KLAS Emergency Department: Tie between Epic ASAP ED and MEDHOST EDMS
• Category Leader for Medication Administration: EpicCare Inpatient MAR
• Category Leader for Patient Portals: Epic MyChart.
Health care organizations that use Epic have won more HIMSS Davies Awards than customers of any other vendor, which recognize excellence in the implementation of and value from HIT, especially EHRs. 
72% of HIMSS Analytics US Stage 7 organizations use Epic. 
According to a June 27, 2012, research report by Wells Fargo Securities, Epic has nearly twice as many total physician attestations than its nearest competitor (AllScripts) and ranks third in total hospital attestations for the CMS EHR incentive program. 
The following is a summary of Epic's KLAS rankings for 2013: 
Number One Overall Software Suite: Epic
Best in KLAS Ambulatory EMR: EpicCare Ambulatory (over 75 physicians)
Best in KLAS Ambulatory EMR: EpicCare Ambulatory (11-75 physicians)
Best in KLAS Acute Care EMR: EpicCare Inpatient
Best in KLAS Surgery Management: Op Time
Best in KLAS Radiology: Radiant Radiology Information System
Best in KLAS Pharmacy: Willow Inpatient Pharmacy
Best in KLAS Patient Accounting and Patient Management: Resolute Hospital Billing
Best in KLAS Practice Management (over 75 physicians: Cadence, Prelude, resolute Professional Billing
Best in KLAS Health Information Exchange: Care Everywhere
The following is a summary of Epic’s Best in Klas awards for 2014:
Best in KLAS Health Information Exchange (Care Everywhere)
Best in KLAS Acute Care EMR (EpicCare inpatient EMR)
Best in KLAS Ambulatory EMR (Over 75 Physicians; EpicCare Ambulatory EMR
Best in KLAS Ambulatory EMR (11-75 Physicians; EpicCare Ambulatory EMR
Best in KLAS Patient Portals (MyChart)
Best in KLAS Patient Accounting & Patient Management (Resolute Hospital Billing)
Best in KLAS Practice Management (Cadence, Prelude, Resolute Professional Billing
Best in KLAS Laboratory (Beaker)
Best in KLAS Surgery Management (OpTime)
- Judith R. Faulkner, Epic’s President and Chief Executive Officer, is the original developer of Epic’s underlying enterprise data repository. She first developed healthcare information systems more than 30 years ago. In 2005, she was presented with the first CHIME Lifetime Achievement award “in recognition of her exceptional dedication and outstanding contributions to the healthcare IS industry.”
- Carl D. Dvorak, Executive Vice President, leads Epic’s development and service areas, as well as many executive and strategic activities of Epic. He has been with Epic for over 20 years.
- Stephen J. Dickmann, Chief Administrative Officer, is responsible for corporate finance, accounting, and planning. He also manages our facilities and campus development.
Epic Systems Corporation
1979 Milky Way
Verona, Wisconsin 53593
5216 PP ‘s-Hertogenbosch
Phone: +31 73 692 7400
Fax: +31 73 613 1787
Middle East Office
Al Shatha Tower
Dubai Media City
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old references, convert to new format in future
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