Judy Faulkner talks lessons learned from Epic's COVID-19 response
Epic CEO Judy Faulkner on Monday offered her perspective on how the company has responded to the COVID-19 crisis – and described some of the lessons learned along the way.
She spoke during a discussion at HLTH VRTL 2020 Monday with longtime Kaiser Permanente CEO George Halvorson, who is now chair of the Institute for Intergroup Understanding.
"The pandemic has taught us that there are some massive failures in the American healthcare delivery system," said Halvorson. "We have poor access to information. We have poor connectivity. We have inconvenient care for many patients. We have caregivers that do not work as teams with each other in the way we would really like them to work with each other. And we have some serious delays in learning and in sharing information between caregivers."
At the same time, he said, "the COVID-19 situation has actually created some opportunities."
Halvorson asked Faulkner what Epic has done to help solve some of those inherent challenges, and how it expects to learn from those opportunities going forward. Here's some of what she had to say.
On the experience of standing up rapid-response COVID-19 field hospitals this spring:
We got calls from one of the states to say they needed several thousand extra beds with our software in it and a brand new site and they'd like it in three days. It takes a lot longer than three days to put a brand-new system in!
But then we figured, "OK, we have to figure out how to do it. And we actually got it done for a number of different places. The average was between one day and seven days, and I think we put 92,000 new beds, with software. We had to learn how to redo everything.
We did a lot of other things too: drive-through testing sites; setting up Javitz in New York and McCormick Place in Chicago and Hope in Boston. My favorite was the U.S. Navy ship Comfort, which we did set up but didn't in the end have that many patients.
So that was for COVID-19. Now we're trying to figure out what we learned that we can make these things better and faster for health systems, so that it doesn't take so long and cost so much to keep information about their patients.
On the promise of telehealth and virtual care:
Telehealth is going to be a real change for healthcare around the country. It's huge. It's not [going] back to where it used to be, and it never will. And we as a country have to figure out what we do with telehealth for the indigent population who don't have the access to it.
One of our mental health providers for pediatrics said to us that he thought he was going to lose a lot, not having the child right there. But what he was able to see is what the child's room was like, what the posters are on the wall, who the siblings are as they run by, the stuffed animals on the bed – a whole different view of the patient that made him feel he'd learned a lot about the patient.
We have a lot of training to do, especially in telehealth. All together we're trying to figure it out. Learning is so important. Like with the electronic health record: The very first thing for our customers that has been studied is that the most important thing is good training, good learning. And then the second thing is setting the system up to personalize it for how you specifically work. So learning and training is the most critical thing.
On how the Epic Health Research Network is enabling faster insights about COVID19:
We created a website called EHRN. Studying the data from our customers' patients allows us to have access to somewhere between 100 million and 200 million patients right now. Eventually, it will be more than 200 million in the whole database if everyone contributes. EHRN is looking at that data and trying to find out, especially with COVID-19 right now, what is there that we should share.
The reason we created the EHRN is we started doing some studies on the data and then realized that if we sent the results of those studies to some of the very highly respected journals, it will take months for it to get out. And things like mortality rates with ventilators were important to get out right away. Or is there any preventive drug that helps reduce the effects of COVID-19? That would be important to get out right away. And so we created EHRN so that a study can be done and it could be published rapidly.
Eventually EHRN will go beyond COVID-19 study. But one we just did that I thought was very interesting was a COVID-19 study on asthma; we found out that young children, through 20 years old, if they have asthma, they get COVID-19 worse. And if you're older, it doesn't hurt as much. That was a real surprise.
Another thing we're doing that I think is really interesting is called Best Care for My Patient. And that means that we're going to take the data, which we brought into a great big database called Cosmos, and that data will help the clinician by telling the physician what has worked best for patients similar to the patient the physician is trying to decide what to do.
We've been told that there's only about 10% evidence-based medicine. Everyone wants to make a decision based on the evidence. They don't want it just to be anecdotal. So this will help clinicians make decisions on observational evidence-based medicine. Now that there's a learning curve going on, yeah, really good to share the learning curve and to get the information to and then to get it out in ways that are useful to the caregivers.
On how Epic technology is enabling care coordination:
Care Everywhere pulls in the data from all over about the patient. Think of it as if you're on the [hospital] ship Comfort and here comes a gurney with the patient. And all you know is the patient's name. You could estimate the age and a few other things, but it's just a body lying there. How do you take good care of that patient?
But if you have interoperability and can you look up all that information about the patient, suddenly you see what's really going to be important to help you treat that patient. To me, it's a huge difference. And that's what interoperability is able to do.
We have 6.7 million exchanges every single day, and about 40% are not with Epic, it's between Epic and another vendor. Care Everywhere will pull in data about the patient from Epic and from any other healthcare system that uses the standards and has signed up with Carequality, and if they have done that, then that data can be pulled in too.
On the value of FHIR for data exchange:
I think the key to many things is standardization. We have to standardize the data elements so that when they're shared, it could be understood what the developments mean. If, in fact, we send over information that's uninterpretable to the receiver, it doesn't make any sense to send it. So there's a great importance in standardizing the data so it can be shared.
On how her husband's experience showed the 'critical' need for interoperability:
He's a pediatrician, and one of his patients who was under good control went with their family to another city and was taken ill, went to an ED and died. And over and over again, he kept saying if they just had a record, she would have lived. And so that's why we started interoperability years before meaningful use required it.
And when we started interoperability, it was really interesting: No one would take it. They were afraid to. The compliance officers and the lawyers were too hesitant. So they didn't want to send their data out, they didn't want to bring information in. And so finally, when we got some people to install it – and I was a little bit part of it slowing down because I said, if you are going to have Care Everywhere, you need to be able to send it wherever the patient goes and not pick and choose where it goes.
And so, finally, we had a CEO give a talk at our users group meeting who said that his CIO came in and handed him a piece of paper and said, "Sign this, I need some software." He signed it without knowing what it was. And had he known what it was, he wouldn't have signed it. And that's what got Care Everywhere started. So it was really a lucky mistake.
On the recent innovations she's most proud of:
There's a whole bunch of things I can point to. It's creating a journal, sharing the information with so many people as we find this information. I think the ways to do installs quicker and to do them less expensively is huge. How to train personally and do well. We've had several go-lives that are virtual, and they're going well.
We're learning lots of interesting things. I think our publication on ventilators and mortality was a very critical publication because people then tried to take the patients, put them on their side or put them on their stomach, rather than give them ventilators right away because the death rate with ventilators was pretty high.
That was one of the studies that made us want to get EHRN into existence, to make sure that that data can get out there.
One of the things we're doing that's really interesting is as we study a new topic, we're putting two teams on it. The teams have data scientists and software developers and analysts and clinicians. But we're putting two teams onto the same problem. So a new one coming up is sepsis and COVID-19 – putting two people, two teams on it and saying what do they do differently? And how do you compare the results of the two teams? I think it's going to be really interesting.