Apple partnering with the largest medical records system in the U.S. -- update

From Andrew Orr's "Medical records company Epic partners with Apple on a Mac tool" posted Wednesday on AppleInsider:

Medical records company Epic Systems has partnered with Apple to bring its electronic health record tools to macOS.

Apple wanted Epic to create a native version of the service for macOS, but Epic is reportedly developing a tool that would easier to run than a native app.

"Epic does have development underway to make it easier for physicians to access Epic on Macs," a source Axios in Wednesday's report.

Epic Systems is the largest electronic health records vendor in the US. According to a report in 2021, over 250 million patients have a medical record held by Epic.

My take: Epic is the Windows of the medical world -- ubiquitous, complex, unloved. Apple and Epic have a long-standing disagreement about how much access patients should have to their medical records.

See also: Atul Gawande's "Why Doctors Hate Their Computers" in the New Yorker.

UPDATE: Epic PR has asked for a correction...

The original article that Axios posted on Wednesday had inaccurate information about what’s happening at Epic related to Apple. There is no partnership. This is what we sent to the Axios reporter on Wednesday afternoon.

Epic’s EHR, which is now web-based, already works on Mac. Now that we have released Hyperdrive, our latest client for access to our web EHR, that option will soon be available again on Mac.

Hyperspace is our EHR platform which is, as of the Epic May 2022 release, a web app.  The Hyperspace app, since it is a web app, needs a browser to access it.  It can be accessed via browsers like Chrome (which we support on Windows, Mac, and Chrome OS), but we also created a specialized browser client, which we call Hyperdrive.  Hyperdrive provides some additional capabilities to Epic’s customers like additional security controls, some additional management capabilities, and the ability to integrate with other vendor software also running on the same device.  Hyperdrive is currently only available for Windows, but we are working on creating a version of the Hyperdrive client for MacOS. Our current plan is to make Hyperdrive available on Mac sometime in 2023.

22 Comments

  1. Michael Goldfeder said:
    It would make me much more comfortable with this partnership if they changed the name of their company to anything other than Epic.

    3
    November 23, 2022
    • Robert Varipapa said:
      I’ve been heard to say Epic is an epic mess ;-‘

      4
      November 23, 2022
      • Neal Guttenberg said:
        Robert,

        I used to say that I was an EPIC moron

        1
        November 24, 2022
  2. Robert Varipapa said:
    We have been using Epic for the last several years on Macs with the Citrix client, which has the unique ability to turn a 2022 Macintosh into a Windows 98 PC!

    6
    November 23, 2022
  3. Medical records are at once a goldmine and a land mine. This sounds like a new app more than a higher level business partnership.
    Apple’s subsidiary Claris International, maker of FileMaker Pro and once-upon-a-time, Bento, would be involved in a serious effort to corral medical records securely. They may well be, I don’t consult on database software anymore despite teaching SQL for decades. I once wrote a SQL query that helped the Pentagon find billions in US military assets warehoused overseas. I began the genre teaching Paradox, literally invented by a pair of docs seeking a solution for their medical records in the 1980s.

    6
    November 23, 2022
  4. Fred Stein said:
    I recall a vignette about Jobs coming out of anesthesia with tube in his mouth going nuts about how horrible the Epic UI was. Does anyone have the detail?

    I’ll start looking.

    2
    November 23, 2022
    • Robert Varipapa said:
      I can vouch for the horrible UX/UI.

      4
      November 23, 2022
      • Neal Guttenberg said:
        Robert,

        I agree with you 100%. What I heard is that the back office stuff, the financials, were really good with EPIC and was very helpful to hospital systems. But some of the issue was the training we received before starting using the system. The other thing also depended on whether the hospital bought the cheaper version or if they went for the more expensive version as well as how the hospital systems like the lab, blood bank, pharmacy etc interacted with EPIC. Some of the systems interacted better than others.

        All that aside, I am not sure what they are planning to accomplish with this collaboration. Is this for patient access to their medical records or is this for improving physician access on a Mac, both or neither?

        1
        November 24, 2022
        • Brian Loftus said:
          With Epic – the IT department and hospital administration are the client – not the doc and nurses. In many states, the doctors do not work for the hospital and therefore the hospitals saved the ward clerks that had to transcribe orders and the doctors had to do this function.
          Even today, order systems are not more sophisticated than the industry systems I used in 1986 before I went to Med school. If l have to out a patient on a drug like limitictal where they take 150 twice a day and 200 st night, I have to select the drug, select the pill size, and then the time of day the patient is to get it. I therefore need 2 orders and a bunch of clicks and pull downs instead of just fighting lamictal 150 po bid & 200 po qhs.

          2
          November 24, 2022
          • Neal Guttenberg said:
            Brian,

            I agree with what you said. If you could put together order sets for your most common diagnosis, it helps that you don’t have physicians writing illegibly as well as making sure that you don’t forget important orders that should be part of someone’s hospital stay with that diagnosis. The problem was having enough people to make the changes that you needed. Also, if the order set is part of a hospital system, then you need all the stakeholders at the hospitals to agree to the changes that need to be made if treatments change as new evidence comes out. Often, needed changes can take weeks to months to happen.

            1
            November 24, 2022
            • Brian Loftus said:
              Thankfully, I use the hospital very little in my older years as I am 90% headache and increasing. I always use order sets but my point was not that I want to hand white notes but rather I want to enter orders as we use to write them and then have the computer translate on the fly. Ultimately, the doc would have to confirm translation but the fact e cannot have this simple feature after all these years shows how user unfriendly they are.
              Unfortunately, in the EHR world, computer aided entry means the user aides the computer.
              On a positive note, outpatient billing rules now emphasize medical complexity which is 10x Better than the prior system.

              0
              November 24, 2022
      • Alan Birnbaum said:
        As a doctor, I told agree with Robert. What a hot, stinking @#$%%^ !! I have retired and one cause is EMRs like Epic/Cerner / Allscripts/ NextGen….

        3
        November 24, 2022
  5. Hap Allen said:
    When Jim Cramer brought this up a few years ago, my first thought was, “Wow, I bet Apple could design an interface that’s really user-friendly and practical for docs, not to mention for patients.“

    What are the chances of that happening?

    3
    November 23, 2022
    • Robert Varipapa said:
      I’ve been waiting for over 30 years for this.

      I bought a Mac Plus when I started my practice and wrote my own medical office management program using Helix, which worked for us for many years, until the government came up with an 8000 page book of rules for EHR programs. It’s been downhill ever since.

      2
      November 24, 2022
  6. Brian Loftus said:
    I personally have been on Aprima since 2004. Started own practice in 2006 and inoperable I get to retire one day never having to change.
    Killer features I would like to see are
    1). Privacy to data interchange. Right now medication history, labs radiology is being exchanged on a good faith system. Some medical worker checks a box that says you have consented and until you repeal it, it goes on forever. Much better to have on your own app where all providers to whom you give permission to fetch your data have been confirmed by you. You can then delete any medical provider when you choose.
    2) medication histories are a complete mess. A central place where the patient can track their current medications which can then be pushed to providers will save millions.
    If Apple publishes an API to make this interchange work – it can. Instead we have governments making requirements that cannot be secure claiming they are because they put the word secure in the rules.

    3
    November 23, 2022
  7. John Butt said:
    This is an epic (small e) opportunity around the world for Apple. An App Store for accessing health data. We have the beginning of one in NZ with a single database and private apps to access it. The private apps vary from useful to incomprehensible – often in the same app.
    NZ is centralising health care to resolve this basic issue, but I think it is going to be harder than they expect by a mile. Apple meanwhile knows how to build and run a secure store and App Library

    Go Apple!

    2
    November 24, 2022
  8. Gregg Thurman said:
    If ever there was a firm Apple should buy, it is Epic. Epic’s management has an our way or no way attitude about how things should work. I never worked in the health industry but have friends that do. Listening to them talk about Epic surprises me that it ever sold a single system. One friend, a doctor, refuses to use it, instead uses a hospital staff member to do his data input work.

    2
    November 24, 2022
    • Neal Guttenberg said:
      Greg,

      All the EMR companies are bad. The joke is that the one you are using is awful. The only thing worse is the other systems that you are not using. It probably would be better to try to build something from the ground up instead of trying to fix an already broken system. One of the problems is that there are lots of systems with lots of data in them that may need to be transported over to any new system. And trying to get legacy systems to talk nicely to anything new that comes out will be a daunting task. IMO not worth it for Apple. Only if they are truly interested in fixing the problem and are not worried about the cost.

      1
      November 24, 2022
  9. David Emery said:
    To combine this and the previous thread on Siri: My doctor’s office left a message on my phone. The actual message was “on your hand, um, even with the co-lividity of, um, the diabetes”. I got 2 different speech-to-text translations (one in iMessage, the other in the Phone app.)

    One Apple speech-to-text generated: “on your hand him even with your of the call of the duties of the diabetes.” The other generated “on your hand. um, deep coma titties, um the diabetes.”

    So “Siri” speech recognition will have to get A Whole Lot Better for medical use!

    0
    November 24, 2022
  10. David Emery said:
    Many of you have probably heard the term “technical debt.” https://en.wikipedia.org/wiki/Technical_debt There should be another ‘term of art’ for a system where functions continually get cobbled together, without any conceptual integration. The ‘hot mess’ that is Epic Medical is by no means unknown. UNH’s IT is similar, a bunch of commercial packages loosely tied together by Active Directory (which is a big problem in its own right.)

    2
    November 24, 2022
    • Romeo A Esparrago Jr said:
      Borgation.
      Short for the Borg Assimilation model which adds whatever it runs into or captures into The Collective.

      2
      November 24, 2022
      • David Emery said:
        Or maybe “assimilation debt”, because the intent is to communicate that absorbing all those disparate functions ends up with something that is worse than it was before.

        0
        November 24, 2022

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