Judy Faulkner readily admits that when she founded Epic Systems she had no idea how to start a company.
Faulkner discussed those early years as well as some of today’s most contentious topics including semantic data interoperability, why the U.S. needs a unique patient ID, and the impact that electronic health records software has on physician productivity.
Semantic standards are key for data exchange.
If you're going to do interoperability between organizations, which I think is critical, it's limited because you have to define and normalize and harmonize the data so that each group can understand the other. Let's examine gender. I may have one for male, two for female, and then two other kinds of genders, ambiguous and something else.
On the other hand, they may have one for female and a range of other values. How do you move that over when different groups have different ways of doing that? You need standards. There's a limited number of standards that we have to be able to transmit the data. I use such a simple example as gender, but as you go into the drug and other databases, there is even greater complexity. Within your organization you want to share. It's critically important to also get information back and forth from other groups who aren't yours.
Unique patient ID has to happen.
I think each person should have a medical identity. I don't care whether it's federal or not. However, the lack of this is not an excuse. You can do a lot of patient matching based on other attribute checking and so the identity would make it easier, but it is not an absolutely critical thing.
Remote care is the future.
Healthcare going to stay local to a great extent. I think it's going to also move to telemedicine much more than it is right now because we have to reduce the resources that we're using and the expense that we have in healthcare. Also people don't want to travel if they can help it. It will be a little slower than people would like.
Physician productivity among Epic's priorities.
Make sure your doctors are productive users. Focus on your doctors being productive users and all your users being happy. Because if that happens, then the rest will just fall out. Doctors happy, No. 1. And doctors happy means that they're taking good care of their patients, by the way, because doctors will not be happy if they're not, and I think that's really important, so I don't want to separate that out.
'I had no idea how you start a company.’
After I built it, I went around to a lot of different departments in University of Wisconsin and worked with them. One department had money for six months for a programmer to do something. There were only 20 data elements, and I remember charging them for 45 minutes of time. You can see why customers all around the country told people, ‘Look what they are doing." They'd call me up and say, "Start a company," and I would laugh and say, "No."
This went on for about two years. Finally I said ‘Yes.’ You have to realize I wore blue jeans. In the summer I wore T-shirts; in the winter I wore sweatshirts. I cut my hair with scissors, no makeup. I was a normal programmer and I had no idea how you start a company. So I went to somebody who had spun off from the university, and he said three things: One, get permission from the university, get a good lawyer, get a good accountant. I did all three. It was great advice.
I started the company, valued it at $70,000, and I invited my customers to join in and be part of the original shareholders. There are a lot of people then who helped start Epic … We divided it up, so if you had 5 percent of the company, you paid $3,500, and that got us started. We started with one and a half people. I had a morning assistant and an afternoon assistant. We were in a basement of an apartment house.
That was it. We signed a bunch of contracts and never took outside money from venture capital or went public or anything like that.