Judy and I met at a Healthcare Summit and Judy was
the keynote speaker for
a panel. Judy Faulkner has been an absolute hero,
particularly over the last year and a half,
because she made it possible
for patients like my patients in
clinic to have access to virtual telehealth visits,
and that got us through that really tough time.
I don't know if Judy knows how
much patients appreciate that,
but thank you, Judy.
As you know Judy Faulkner is the founder
of the biggest electronic medical record system,
I think in the world, but you can
correct me on that, Judy.
I just wanted to start by
asking you just a few questions.
We've only got about 15 minutes.
We know you've got an incredibly busy agenda
today but I appreciate your joining us.
How did you decide to start Epic?
What was the instigation for that?
Well, my background
is Undergraduate Math, Graduate Computer Science.
It was in graduate school, I took probably
the world's first ever class in computers in medicine.
The person who was teaching it, Dr.
Slack asked me to work with him as his team and I did.
At some point they brought me in and said,
"Can you keep track of patient information whether it's
inpatient or outpatient as it
changes over time in both clinical information?"
We want to be able to define
our own data elements and design our own screens.
At the time, there were a couple systems
available for lab systems.
There was a building system
but there wasn't any really clinical system,
and things were pretty much hard-coded
into either FORTRAN or COBOL.
I didn't know it was going to be that hard,
so I sat down and wrote the underlying system,
which is called Chronicles.
I reassured people that not a lot of it is still in use.
It got used all over the country eventually,
but the way that started was that my own customers at
the University of Wisconsin who
used it would call me up and say,
"Judy, start a company.
My colleagues want this too."
I would say no and they would repeat,
"Please start a company," and I keep saying no.
Finally after two years,
I gave up and said,
"Okay," and started Epic.
We were one and a half people in a basement.
So that was the start.
I worry about that half person.
But anyway. [LAUGHTER]
There was actually three one half so I was [OVERLAPPING]
You and I got to chatting and we almost forgot
a very nice meeting
and you were telling me about Cosmos,
and I actually had never heard of Cosmos.
Can you tell us a little bit more?
It seems apropos considering we
just had a discussion about space,
but it's really about a different topic.
If you can tell us what Cosmos is, that would be great.
Cosmos is a great big repository of data.
We have so much patient data among
our customers that we thought there is
so much good value in that information.
About half of our customers submit
their data to us now with more coming on all the time.
We have at this moment about
a 120 million patient records in
Cosmos which is most
of the electronic health record data.
So it's hundreds of different data elements in there.
The only groups that can access it are those
who submit data, and we at Epic.
We're doing studies using Cosmos
that are really, really interesting.
Let me back up to another use of
Cosmos that is very important,
is called Best Care for My Patient.
Best Care for My Patient means
that physician or clinician taking care of a patient.
Typically there's only supposed to be
about 10 percent evidence-based medicine available.
The other 90 percent of the decisions are not
made on the basis of evidence.
Cosmos has that evidence.
So we are feeding it back
to the physician so the physician
can see if you use drug A, here's the results.
Including not just the results based on the problem,
perhaps problem is hypertension or say,
the average result in
hypertension changes if medicine A is given,
but also the cost and
what other consequences there may
be such as probability of stroke.
That will all go to
the physician so the physician can make
a much more objective analysis and prescription.
What I was really impressed by,
sorry to interject there Judy,
but the real-time data evaluation.
How quickly you can amass data here.
I'd ask you a question and you
got me the answer in 48 hours.
I couldn't believe that it would
take me 48 months to get that answer,
more specifically, how many people in
this country have myelofibrosis?
How many people have wernicke encephalopathy?
Ten thousand, 15,000 respectively.
How many people have both?
Six. That really helps patients all ready and
this post-marketing analysis is
something we can sell them to do.
Even actually in the context
of clinical trials, it's hard.
Can you tell us more about
the dual team system and ehrn.org.
Two things that I didn't know about until we met.
With COVID, we realized that we needed to
get information about what was
happening to the COVID patients quickly.
We could analyze the data but if
we gave it to
New England Journal of Medicine or
John or something like that,
they would want it to be peer-reviewed
and it would take months.
With COVID hitting so rapidly and so drastically,
didn't think it could wait months.
We started looking at the data
ourselves and we said we can't get it wrong.
Therefore we'll create two teams;
team A, team B.
Each team has a physician or a clinician,
a data scientist,
a software developer, and a few other folks.
The two teams get
the same challenge and then they separate,
don't talk to each other,
and both work on the problem with the data.
They compare the results and if
their results are the same,
then we feel comfortable that we could publish.
That's how we do the two-team approach.
That's why we can get things out fairly quickly.
Well, I think that's an awfully
effective, really transformational system.
Is this something we should be applying more to
our studies in science and medicine as
we move forward with these rather large data-sets?
It seems like a subtle to me.
Yeah. Some of them really nice things
we've done cancer screenings,
and what happened to
all the cancer screenings that should have
been done during COVID that weren't.
We did a really early study.
This is one of the things that got us going with EHRM,
which was a study on ventilator use.
One of our customers CEOs
a position happened to just
comment that he couldn't get a hold of ventilators,
and they were putting patients on
their side or on their stomachs,
we thought that they were surviving more.
We went right to the data and did
a study on death rates
with the ventilators and published it.
Just this week, I was talking to someone in
the South who was saying
that it was like a light switch changed.
The extreme use of
ventilators that had been there just stopped abruptly.
I think that was
just an amazing effect that probably came from EHRM.
One we just did was opioid use,
which is our people
now prescribing opioids appropriately.
What we found was that indeed they are being
prescribed appropriately
for everything, but orthopedics.
Orthopedics use of too much opioids has decreased,
but it's still not where it needs to be.
We're getting a couple of questions in the chat here.
One that we all worry about is
physicians and scientists and that is patient privacy.
How do you ensure protection?
Now that we're getting genomics data
and you and I have talked about the integration of
genomics data in the medical records so patients can
actually graph their variantial frequency.
I'm meeting with your genomics team about that.
But as these genomics data and
other pieces of data become more identifiable,
how do we assure patient privacy?
I don't know the answer to the genomics data,
that's still to be decided.
It isn't in Cosmos yet.
But you're right it shouldn't be and
eventually to make the right decisions for the patient.
But genomics data is going to be extremely important.
We know because we have customers in Singapore,
they will tell us that some of
the medication that's used typically in
America with great effectiveness
will not work in Singapore,
and some things that don't work in
the US work very well in Singapore,
because of the different genomic makeup.
We know how important it is.
We haven't dealt yet with how we're going to deal with
patient privacy once the genome is in there.
We do work with a limited dataset
and you can't get down to the individual.
One of the ways we help with privacy is you can only
get a group of patients at a time, not an individual.
Good to know. I know
that you've been in touch with loudly touch capture data
about making apps for
this and I know that's a nascent conversation.
But is this an opportunity for patients to
get their own data in their own hands?
I certainly have the Epic app
here on my phone so I can get secure messages.
Is this something that we can do for
patients because I've got my little Epic app here.
At my chart.
[LAUGHTER] Beyond my chart
where they get all the alerts,
what can we look forward into the future?
Chris Mason was telling us about 500 years,
but you move very quickly so in the next year,
what do you see as advances in
the EMR just in technology in general for healthcare?
For EMR, for the patient and unnecessarily
Cosmos or EHR, those things.
I think we're going to see continuation of telehealth.
That has certainly been a biggie.
There's going to be more
easy-to-use through voice commands.
I would have to ask the folks working on
those projects what was in
the list for what's coming up next?
I know they have lot,
but I don't know anything right now to say,
here's a brilliant one, that's going to be next.
Question that is a little bit
I'm delighted in that has to do with how did you
start a company with no external finances and
half a team that is just incredibly responsive.
I know I sound like I'm somehow advertising for Epic,
but I have been very impressed
with how quickly your team will mobilize.
How do you do that sustainably for those of us
here who are interested in
starting companies or are part of companies?
Well, I think first of all,
don't get an MBA [LAUGHTER]
because they might teach you things you have to then say,
no, I don't want to do that [LAUGHTER].
Don't go with venture capital, at least for us,
we didn't go with venture capital
because then they would just want to flip it.
You have to decide is that
your goal to flip it or is your goal to grow it?
Which one? Don't go public.
Because then you're going to have the
tyranny of the quarter.
You're going to have to focus on not your customers,
but new customers and doing
acquisitions and other things like that.
We don't have budgets.
We say if you need it buy it,
if you don't need it, don't buy it
and that works very well.
We're just able to do
things in a way I think that's different.
One of the things we do is we have
individual offices which in
most cases you don't
have in companies nowadays, it's cubicles.
So many people can you put into a room.
But people are your greatest expense
and your greatest area of productivity.
At Epic, we give them
individual offices and we
find that when we have boomerangs,
people who leave and then come back,
the number one thing they say
that they missed was productivity.
That when they were here,
they were able to be more productive and I
think a lot of it is the individual rooms.
There's a few other things
like no more than three stories high.
Because people will walk up and down
two flights of stairs, but not three.
Now, you're in California.
That's different than Wisconsin where we
can have cornfields and put buildings in.
Well, I'm hoping Judy that there will be
some grand challenges and questions we
can really take on together through the stem cell field.
We've talked about environmental pollutants,
don't drink the water,
don't breathe the air and the song by
Tom Blair. We'll look into that.
I know that patients are very grateful to
you and your team and we just
want to give you a big hearty thank you
for the last more than a year and a half,
and we're really looking forward to
the future of working more with you here
in California as we expand the stem cell initiative.
Maria Milan has continued at the helm
there for the California
Institute for Regenerative Medicine.
We're all united in that effort and we'll have a panel of
our Alpha clinic directors coming
up after the poster session after lunch.
But thank you so much again for being with us today Judy.
Thank you. Bye.