[crabmusket]

It is really interesting to hear how this was a competitive advantage for them, and certainly a product advantage. The comparison between Epic (one database for everything) and Cerner (result of like 20+? acquisitions/mergers, patchwork of systems) around the Kaiser deal puts it in stark contrast.

[odyssey7]

Why is “acquisition” a bad word at Epic?

Is it because the workers at a normal company would jump ship if Epic’s culture were imposed?

If companies like Cerner, Google, Apple, Microsoft, etc. are all able to acquire and integrate software that was initially developed by others, why not Epic? Surely Epic is not less competent?

[weitendorf]

Epic has a pretty unique way of doing things in corporate america (maybe not that unusual for big tech companies, but very unusual for healthcare and general corporates) and I think acquisitions would cause them a lot more trouble than they'd be worth. For example, Epic has one giant HQ campus where they do actual-allhands in giant auditoriums and a really extensive training program with onsight classes and IIRC an entire massive building for it.

Technically speaking I think they see buying software + changing it to be more like Epic (or continue to operate/develop/support it independently) as a waste of money when they could spend that time/money on improving what they already have.

I also think it's probably a branding/marketing promise to their customers that if you buy Epic software, you're not going to have that contract morph into one with some other generic corporate company who causes problems trying to integrate/migrate your setup. Nor will you have wallstreet begging Epic to juice their customers for all their worth just because they might get away with it and it'd make the stock look good temporarily. (I have no idea how expensive Epic is comparatively but I do know EHR is very difficult to migrate from and Judy is known for playing the ultra-long-game).

I think basically the idea is that acquiring another EHR vendor would only be for the benefit of expanding Epic (the company) market share but detract from making Epic's software a better product for their customers.

[epicdev]

Epic's design philosophy from the beginning was "one patient record" for the whole hospital. Everything being well integrated has been a standout feature over the competition for a long time. An acquired product would have to be rewritten to work with the database. And since healthcare is such a dense field, a new product is more than just code, it's also domain expertise which would need to be integrated into the company.

Since Epic has good relationships with its customers, working with them to build that expertise from the ground up is considered better.

[crabmusket]

> able to acquire and integrate software that was initially developed by others

I can't tell you for sure, but the way it was pitched in the recent Acquired episode on Epic is that no, they* aren't able to integrate software from acquisitions well.

Without knowing this in detail, it sounds like the choice is between one system that does everything, and a patchwork amalgamation of systems, databases, UIs, which are not well integrated.

I can't say this for any kind of fact; it's just the impression I get. It seems highly plausible to me.

*Meaning, Epic's competitors

[xnorswap]

Among other reasons, if you allow acquisitions then you allow being taken over through a reverse takeover.

If you're a small company, then you can "acquire" a larger company which then absorbs the original company. You can fund it through borrowing against the company you're buying.

You then let the large company eat the small company despite on paper the ownership being the other way around.

[red-iron-pine]

to put a finer point on it, it means the owners don't have to dilute shares or give up control.

no new execs from acquisitions coming in, no risk of spinning off in different ways because of new blood, just organic growth

[odyssey7]

A leader with absolute authority over the company isn’t necessarily a good thing.

Publicly traded companies have accountability to more stakeholders in additional ways.

A private company isn’t necessarily better for being able to avoid that accountability.

[shigawire]

They touch on this in the episode and there are myriad reasons.

One interesting one is vertical vs horizontal software dev. Epic's advantage is deep domain knowledge of healthcare (relative to competitors at least - a Dr or nurse will dispute that lol).

At Google, Apple, Microsoft they want to make software for everyone. Epic hyper focused of their niche and has decades of knowledge built into the business logic. It's also why the aforementioned companies have failed to take a piece of the EHR market despite more technical knowhow and huge war chests.

Lastly, Cerner is a bad comparison since Epic ate their lunch over the years. If anything it might be a data point that their approach is poor. Cerner rev cycle still doesn't work and Oracle has said they are scrapping the product they spent $28B on.