1. H.I.S.-tory
by Vince Ciotti
Episode #96: Epic, Part 2
© 2013 by H.I.S. Professionals, LLC, all rights reserved.

2. An Epic Tale
• The story of Epic starts with its founder, Judy
Faulkner, with whom I have a bit in common:
– She too came from Philly, where we both
remember dodging the red SEPTA trolleys!
– We both were math majors, with English
minors, she at Dickinson College in Carlisle,
PA not too far from her father’s drug store in
Erlton, South Jersey, near Haddonfield.
– We both won scholarships in the ‘60s, but
that’s where the resemblance ends: I flunked
out of Temple & got drafted to ‘nam, coming
back to school later to major in English Lit.
– Judy studied Radiation Physics at University of
Rochester – sound familiar? Neil Pappalardo
of Meditech came from Rochester and as
we’ll see, had a surprising impact on Epic...

3. It Was All in the Program…
• When she showed up at U of Rochester, they expected her to
program. She knew nothing about it so they gave her a Fortran
book and access to the computer for a week. She was on her
own, and fell in love with it, feeling “like a kid playing with clay” –
it was combination of language, math, and art: her 3 passions.
• She earned a masters in math at the U. of
Wisconsin in the frozen northlands, and won a
fully paid-up PhD in computer science. She
never finished her dissertation, but years later
UW surprised her with an honorary doctorate.
• So here’s another HIS vendor starting in the frozen north, besides:
- IBM’s SHAS in Minnesota, Frank Poggio’s HMDS in Madison,
Steve Click’s Dairyland in Wisconsin, CliniCom in Boulder,
Meditech & Keane in Massachusetts, IDS in Vermont, PHAMIS
in Seattle, Lockheed’s MIS pilot at the Mayo Clinic in Minn...
What is it with the frozen north and so many HIS start-ups??

4. “Bi-Polar” Geographic Theory
• Judy had noticed this trend in the
northern origins of HIS vendors
too, and we bandied about an
interesting theory that has many
historical/geographic parallels:
– Think of how many countries
around the world are split
between an industrial north
vs. a more agricultural south:
• US (Yankees vs. Rebels)
• Italy (Milan vs Sicily)
• Vietnam (Hanoi vs Saigon)
• Korea (Pyonyang vs Seoul)
– Are we on to something??

5. Meditech Connection (“Epitech?”
• Back to Epic, Judy took a class in “Computers in Medicine” taught
by UW’s Warner Slack, MD, who went to the Beth Israel Medical
Center, an associate of Neal Pappalardo from the MIT project
that gave the IT world its most contagious disease: MUMPS.
• Even the acronym denotes its origins as one
of the only programming languages
designed specifically for Healthcare:
Massachusetts General Hospital Utility
Multi-Programming System, the only
language with its own “built-in” data base.
• As you may remember, Pappalardo created his own version of
MUMPS that he used with his new start-up firm “Medical
Information Technology,” (pun on his school?), which he called
MIIS, short for “MEDITECH’s Interpretive Information
System.” And so Judy started her programming in MIIS, just like
Ron Apprahamian did at Compucare (episode 69 at hispros.com).

6. First Work Assignment
• After grad school, she worked with John Greist MD, on a project
at the U. of W. to build a system to track clinical data over time.
This was a radical idea in the early 70s, since there were no dbms
available back then (Ellison didn’t form Oracle until 1977…), only
a few small, unknown ones, such as the one from Beth Israel.
• Judy built a system that put the patient at the
center, surrounded by reports, displays, etc.
An innovation was to place “exits” all through
the code so it could be easily customized.
- This kept the source code sacrosanct, using exits to modify the
system for individual clients. Most MIIS vendors without exits
had to change the source code itself to customize their systems.
• She wrote 3 discrete data sets: (1) constants (eg: patient #), (2) data
that occasionally changed (eg: diagnoses), and (3) data that was
constantly changing (eg: TPR). In essence, this structure is the
underpinning of the “Chronicles” data base Epic uses to this day!

7. Careful How You Pronounce This…
• You can visualize this time-oriented db structure by these charts
presented at the 1978 MUMPS User Group by Judy & colleagues:
• As you might imagine, the acronym “PISAR” did not catch on…

8. First Applications & Big Raise!
• Somehow I had the impression that Judy started writing systems
for her husband, a pediatrician, which explained Epic’s strong
physician practice modules. I was surprised to learn Gordon didn’t
become an MD until long after he got his biology Ph.D., and Judy
was well down the road toward writing applications for a number
of ancillary departments at the University Hospital, including:
– Inpatient ICU, Psychiatry, Tumor Registry, OB Gyn, Rehab, and
Cardiology • So it was working with end users in these
various departments that taught her about
health care day-to-day inside operations.
• These apps worked so well, she was given a
raise in 1975 from $5 to $10 an hour!
• Even at this “high” rate, she didn’t earn much because she set things
up in Chronicles so quickly, eg: Ophthalmology hired her to write a
system they thought would take 6 months, she finished it in 45
minutes! So to start making a decent living, she formed a company:

9. Human Services Computing, Inc.
• In March of 1979, with $70K in capital partly raised by selling
some “inside” stock, Judy formed HSC Inc, later changed to Epic.
• There were 3 employees, each working
about 1/2 of their time per day, so 1.5 FTEs.
Their offices were in the basement of an
apartment house pictured on the right.
• Their first computer was a “monstrous” DG
Eclipse S/130 with an amazing 194 KB (kilo-
bytes) of memory and a 50 Meg disk drive!
• They bought used desks for about $50 each,
and started writing systems for a number of
early clients in MIIS and Chronicles, such as:
- Green Bay Mental Health Center
- Denver Children’s Hospital
- Healthcare International (a chain)

10. Early Mentors
• Judy was guided in setting up her firm by 2 other HIS-tory heroes:
– Dr. Phil Hicks, of LCI, the large-hospital LIS, who made her get:
• (1) UW’s permission, (2) a lawyer and (3) an accountant.
– Neal Pappalardo of Meditech, to whom Judy is indebted for his
help in many areas besides MIIS, such as policies, forms, etc.
• Indeed, that explains so many of the similarities between
Meditech and Epic that I noted in an earlier episode (#16 on
hispros.com):
– Everyone resides near the corporate HQ, no “field” offices
– No hardware sales, just software, implementation & support
– Privately held, no Wall Street pressures for quarterly earnings
– Hires a lot of young, bright college graduates, [note – not
exclusive - about 1/3 of our hires are experienced] no outsiders
• And to show her gratitude, that is why Epic has focused on larger

11. One More “Super-CIO!”
• Next week, we’ll pick up this “epic” tale with their amazing
growth in the large hospital AMC/IDN market, but I must first
apologize for forgetting one of the best CIOs I worked with in my
intro from last week, who kindly contributed the following:
“You didn’t ask me about Judy and we are her second biggest customer after
Kaiser! But alas, I would have told you the same: smart, diligent, hard-
working, works to do the right thing and really listens to her customers. I
think you were one of the influencers that made me reject Epic in the day
and I definitely resisted joining the Epic “cult.” But it has been good albeit a
wild ride since last we spoke. We signed with Epic at the end of 2010. And
here I am 2.5 years later, going up Big Bang with 3 more hospitals on Epic this
weekend. We are up in almost all our ambulatory clinics (over 1900
providers) and as of this weekend, LIVE in 17 acute care hospitals with 16
more to go. It is not perfect and we have years of optimization work to make
it what we want it to be, but I don’t know of any other system that we could
have implemented at the pace we are implementing and getting the results
we are getting from a standard build of an integrated system.”
Laureen O’Brien, Vice President and CIO, Providence Health & Services