Epic Systems Corp., one of several dominant EHR vendors for large hospitals, recently authorized implementations of its EHR system on Intel x86 servers running open-source Linux, virtualized to VMware. Prior to that, Epic ran exclusively on AIX and UNIX servers.
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The move could signal the software company's attempt to expand its customer base by adding more medium-sized hospitals to its present mix, which includes the largest hospitals, physician groups and academic medical centers. Linux servers are cheaper to purchase -- and maintain, too, since Linux administrators are more plentiful, especially in smaller cities.
The announcement came early in May at an Epic Systems Roundtable meeting at its Verona, Wis., campus, after extensive testing by third-party service providers VMware and Dell. Those companies will offer implementation services to hospitals who buy into the system, which they also do for customers of Epic competitors such as Cerner Corp. Dell also provides other services, such as Epic disaster recovery and physician/nurse order-entry helpdesks.
VMware director of healthcare business development Frank Nydam said that Epic, for now, will only support Linux deployments virtualized to its vSphere cloud virtualization platform.
Frank Nydamdirector of healthcare business development, VMware
"Health care's sort of been saddled with very proprietary, very expensive systems," Nydam said, adding that for VMware, Epic's move validates the idea around which the company was formed in 1998: Porting proprietary systems to less-expensive platforms. "Now that Epic feels that we've earned the trust and reliability…it's a boon to smaller hospitals that really couldn’t afford the infrastructure of HP-UX."
Nydam added that cost isn't the only factor driving smaller providers to consider Epic, but interoperability concerns too. If a local hospital's patients typically seek specialty care at a large Epic customer such as Kaiser Permanente or the Cleveland Clinic, it would be more straightforward to exchange patient data when they're on the same system.
Announcement came after two years' testing of EHR system
David Zirl, assistant vice president for Dell Healthcare & Life Sciences, said that while the companies aren't partners per se, its relationship with the EHR vendor allowed it to break down for Epic -- along with VMware and Linux provider Red Hat -- the technical considerations of porting the EHR to Linux on Intel x86 servers. Dell and VMware analyzed Epic-Linux configurations in their respective testing labs over a two-year span.
"We're excited about this kind of a move; to do this kind of thing is a little out of Epic's character," said Jamie Coffin, vice president and general manager of Dell Healthcare & Life Sciences. "They see it -- I think -- as a way to reach customers that are much smaller than they've historically reached."
Gartner analyst Wes Rishel, who sits on the Office of the National Coordinator for Health IT's Privacy & Security Tiger Team with Epic CEO Judith Faulkner, doesn't necessarily see the move to Linux servers as a significant market play for more customers. After all, Rishel points out, server hardware is just a small slice of an Epic implementation budget that includes support, provider training, software purchase and other costs.
Furthermore, he added, hospitals in smaller cities may find it challenging to locate IT specialists versed in running VMware on Linux. He does concede, however, the idea of running Epic on Linux servers has potential to expand the EHR system's reach into more hospitals, especially at a time when competitor Allscripts is enduring internal strife.
"I don't see it as creating any significant shift in market position or anything like that," Rishel said. Later, he added, "But I can't deny that it's a possibility."
Larger Epic Systems customers could also switch, over time
VMWare's Nydam said that the companies will continue testing Epic on Linux servers moving forward. After enough time has passed to establish more results data on compatibility and reliability of the new configuration, he pointed out that the Linux option might appeal to some of Epic's large existing customers, too, during planned Epic upgrades or data center hardware refreshes.
Some health care CIOs might be hesitant about migrating to an open-source platform for security and HIPAA compliance reasons. But all sources interviewed for this article agreed that Linux -- especially from well-known vendors such as Red Hat -- has a long-established track record running on Intel x86 servers in other industries such as the financial sector, where they've developed proven, effective strategies for locking them down in a manner compliant with federal regulations.
"Actually, open source usually improves the security," Rishel said, "because there's more 'white-hat' testing that goes on."