The hallmark of Smart-Agile healthcare IT systems and a critical aspect is their ability to “demonstrate unprecedented potential for fast delivery of automated intelligent and sustainable healthcare services,” 103940 which EPIC clearly attains. Smart-Agile health care IT systems also promote coordinated services through auto-connectivity and comparable notes, especially patient notes—an additional Smart-Agility aspect for which EPIC scores high too. EPIC’s potential for providing Smart-Agile healthcare lies in its ability to quickly connect information and retrieve standardized data for comparative analysis and because it requires pre-determined data outcome measurements. 282966, 4647484950515253545556575859606162636465 EPIC is able to generate accurate and timely reports based on requirements for entry of standardized data (e.g., EPIC “hard stops”*) 284866. These can be immediately queried for programmatic evaluation and modification research. Yet, EPIC allows for modification/inclusion of evidence-based prompts and hard stops for identifying and mandating standardized data entry. 48

However, there has been concern about a disadvantage of a monopoly or market dominance that locks purchasers into a monoculture and maintains antiquated programming and retards responsiveness, de-confliction, flexibility, enhancement, and the ability to evolve—antithetical to the very essence of Smart Agility. 284810 Nevertheless, EPIC provides “…the additional software layers for easy access to (standardized) clinical information and serves as an accessible, evaluable platform for collecting and analyzing clinical outcomes….”28 EPIC can be conformed to shepherd data entry and pre-identify errors and error patterns at the moment clinicians enter data. 285152 Thus, data points can be identified and evaluated virtually in real time, almost immediately enhancing accuracy and quality of data as well as informing medical service adjustments. 2860616364, 67686970717273747576777879,

A reported challenge was that EPIC is ill-suited for back-loading data and information in the standard format, which results in multiple and expensive remediation efforts. 4780 Back-loading continues to be a chronic and long-term problem, resulting in maintenance and the attendant expense of supporting several different systems that EPIC was supposed to eliminate in the first place.80 Conversely, EPIC is easily able to capitalize on its standardized real-time workplace data entry of medical-condition-service-for-fee codes to identify patterns and practices.80 It permits non-intrusive, accurate, and virtually real-time identification for analyses that could continuously operate unnoticed in the background.282949515382

EPIC’s standardized data-ready feature can be leveraged to track medical procedures and substantially reduce unplanned outcomes as well as facilitate clinically-based decision support.464781 EPIC’s front-end-back-end standardized data entry, and query and data report generator, have been validated to eliminate the expensive, repetitive loading of data into multiple different systems.8283

EPIC also scores high in terms of the Smart-Agile aspects of provision for the development of targeted automatic algorithms to inform and support cost-effective medical and organizational decisions while taking into account possible risks.28301044 Smart-agile systems consider responsive knowledge management key to high-quality, efficient healthcare, and they can alert and trigger marshalling of a substantial amount of comprehensive data to do so.10 Put differently, EPIC has shown the potential to support Smart-Agile healthcare through better information that increases quality with earlier, more appropriate, and less expensive treatments.1084 Decision-makers can be enabled to make efficient and effective use of vastly increased amounts of data in modern information-driven healthcare industries. The capacity for more data in turn means more performance measures can be gauged. 1 This means a higher probability that healthcare organizations can quickly delivery the right products at the right time, with the right quality, and at the right price—the essence of Smart-Agile.1858687 Furthermore, adoption of Smart-Agile processes has been shown to direct service delivery toward a customer-oriented paradigm, which in turn supports agile decision-making in organizations, if not agility itself. 88

Regarding technological constraints, EPIC fairs less well according to the Smart-Agile criterion of “quality.”25 Smart-Agile IT systems permit a degree of non-standardization in that customers/patients/stakeholders and their needs are non-standard with differing “preferences, personal characteristics, and conditions.”1041 Then there are healthcare providers with differing backgrounds, professional roles, skills, training, and experience that must be accounted for.1039 Therefore, to be Smart-Agile, healthcare IT systems must have both novel and standardize inputs, though EPIC tends to favor standardization.

Hard-stop-enabled standardized data entry comes with a downside, namely, risk of reflexive and non-reflective technology-driven hypnosis and even sleepwalking.70717290 EPIC suffers from issues surrounding all EHRs with meaningful use capabilities. Specifically, front-end data collection is shepherded, entailing overreliance on pre-determined (i.e., “canned”) forms and templates for information collection—as opposed to producing truly meaningful data.29 This may be further complicated by polished and slick-veneered electronic systems. This can be remedied by a dedicated team of medical experts, software designers and vendors updating and customizing forms and templates to capture relevant medical information throughout the medical care cycle—but those come at a steep price299151 In this regard, a similar drawback with EPIC is that it does not permit entering more specific or different information28, except through the incorporation of expensive add-ons that detract from its overall efficiency.27829293

In terms of EHR product development, because the EHR development cycle is regulated, and thus lengthy, it also is expensive—anathema to Smart-Agile healthcare IT systems aspect 41055749640586478798393949597. Yet EPIC offers modifiable off-the-shelf packages that that keep costs relatively low and have the capability for continuous innovation and improvement in general. 27 Nevertheless, those innovations do involve costly teams of experts and designers, and so they score low in terms of Smart-Agility healthcare IT systems10411 It is probably no better or worse in this area than other meaningful-use EHRs.

This is another area where EPIC does not fare well according to Smart-Agile IT healthcare systems aspects; specifically, additional expense and work burden on end-users.1041 Several issues are unescapable with all meaningful-use EHRs that turn clinicians into data entry clerks. One is the additional time commitment of entering data loaded onto the already time-intensive commitments of clinical practice.50568283899097 ^{also see 27}4781 EPIC seems to be no different. Added documentation in EPIC also adds burden on healthcare providers.8398 However, the resulting seamless data analysis may be well worth the effort from providers’ perspectives. Nevertheless, there is that substantial “after hours’ time tax” to enter information.56839899100101102

Two, what really makes EPIC truly desirable for outcomes measurement, program evaluation, and research are its hard stops. 29657696100101103104 However, they also pose a severe detraction or Achilles’ heel in that they disrupt smooth workflow and also result in end-use dissatisfaction.706847 Nevertheless, it has been noted that medical providers’ productivity work volume, charges, and work relative to volume units actually increases with EPIC; the caveat is that it takes several months of a painful learning curve to realize increased productivity. 8110563808399¹⁰⁰¹⁰¹102106

Critical to Smart-Agile healthcare IT systems is the “provision of informed seamless patient-centric for actionable healthcare delivery paramount of which is the maintenance of patient safety.”10432588 EPIC’s ability to quickly and accurately derive outcome measures is critical in terms of efficient and timely identification of potentially deadly patient hazards and targeting those patients for intervention.4959617475819710010610710811111211311411511657 EPIC is a powerful tool to monitor adherence to prescribing best practices, but only with rather expensive add-ons with which to conduct analyses and a lot of hard stops interfering with workflows.298189117757779

EPIC facilitates the coordination of patient healthcare to promote safety and long-term wellness, while remaining cost-effective through comparable patient notes.103940 And Smart-Agile healthcare IT systems lend themselves to the aspect of “development of tools to better real-time monitor processes and outcomes to include safety, and in particular for the healthcare industry, patient safety.”10 EPIC’s ability to standardize and connect resources “accelerates patient recoveries, enhances evidence-based practices and less-expensive preventive medicine—and thus, provide Smart-Agile improved care.”1022

A critical cornerstone of Smart-Agile healthcare IT systems concept is systems integration, i.e., inter-operability and inter-connectivity that permits ease of follow-up in the interest of continuity of care and also safety. 1041 ^{also see 25} EPIC’s ability to accurately derive and report information in almost real time to identify patient safety risks also lends itself to excellent patient tracking, monitoring, and follow-up.28294661739495107117 EPIC is an excellent system for electronically tracking patients and their procedures, and documenting complications, risks, and sources of unplanned outcomes.46 EPIC also provides an excellent data recording system for conducting inexpensive, continuous four-year longitudinal patient surveys; it also permits easy aggregation by type and level of complications, though this requires expensive add-on algorithms.11769 In this regard, EPIC also scores high on another Smart-Agile healthcare IT system criterion, service provision, including personalized medicine and the connectivity features to support that104125.

According to Smart-Agile IT healthcare systems, end-users’ satisfaction is critical because it relates to a large degree to stakeholder buy-in (as end-users are one group of stakeholders).1041 Specifically, users’ satisfaction with their healthcare IT system is important because “healthcare organizations represent powerful stakeholders whose concern is high-quality healthcare provision and delivery, not learning or wrestling with IT.”1041

End-user satisfaction is one area where EPIC scores are mediocre or even low or failing; the range of physician average satisfaction rates are between 50 – 75% depending on the particular EPIC feature. 32710210410610911847 One key feature that resulted in the most end-user dissatisfaction was EPIC’s “Reminder(s)”; they operate much like its hard stops in that they must be addressed before proceeding with workflow.29477089106 This clearly detracts from EPIC’s usefulness in terms of preventive medicine and patient safety. Overburdening and overwhelming medical treatment providers with best practices advisories in large numbers generate scores of complaints.47106 Marked improvement on end-user satisfaction was noted when limits were placed on Reminders.7089 Nevertheless, Reminders significantly improve compliance among providers in terms of orders and rates of adherence to directive and documentation.707172 This may be why EPIC works better than other EHRs that use passive collection in terms of outcomes. But extreme dissatisfaction has been noted with it and results in less-than-optimal use of some key EPIC functions. One reason the end-users feel this way is that data entry for them is inefficient and too time-consuming.3294755637076777989106110 Smart-Agile healthcare IT systems must be efficient to warrant their cost, and EPIC probably needs improvement regarding this end-user feature. Put differently, it needs to clearly demonstrate value-added in terms of time-consuming data entry.1044

A critical aspect insinuated throughout Smart-Agile healthcare IT systems is patient involvement in their healthcare via IT systems—an area where EPIC has shown a track record and vast potential.1039 Specifically, Smart-Agile healthcare IT systems must involve patients as primary end-users (a.k.a., stakeholders).1039 The promotion of patient-centric wellness involves the unified amalgamation of different IT delivery systems.

EPIC’s connectivity and ability to electronically transmit real-time medical chart information securely over the Internet has vast potential regarding proactive integration of patients into the management of their own healthcare273447, even older non-tech-savvy patients.93 This can enable and empower patients to easily and smoothly transfer or upload images and documents from outside sources and physicians to shift their patient management to more virtual vs. less face-to-face encounters.47

According to Smart-Agile healthcare IT systems aspects, EPIC’s aim to consolidate processes and simplify, demystify, and automate business practices—while involving patients in their healthcare—creates and synchs a collaboration between patients as valued partners with providers.1041 As such, EPIC has the potential to involve both patients and providers as co-producers in Smart-Agile medical treatment, and this will alter the fundamental pattern of those interactions.

Of course, all this requires a common (i.e., standardized) language that EPIC facilitates. And according to Smart-Agile healthcare IT systems rationale, process orientation has been shown overall to support cost reductions, improve product quality and customer satisfaction, and decrease the production cycle time.104188

The literature on Smart-Agile healthcare IT systems appears to understate ongoing training that must necessarily accompany dynamic IT systems. Thus it is considered non-critical25 Nevertheless, there has been identification in the EPIC literature of the essential need for ongoing training in terms of transitioning and exploiting EPIC’s potential to its fullest475961637710410510912180 Smart-Agile healthcare IT systems literature tends to view training as an additional expense and encumbrance to be avoided, as opposed to an investment in the future in terms of responsiveness and efficiency.11912079 Perhaps this is an area that the Smart-Agile IT systems researchers and proponents should reconsider as vital and revisit.

The Smart-Agile healthcare IT systems proponents recognize that Smart-Agile systems represent a platform from which to deliver healthcare training to healthcare professionals; this is considered a critical aspect.104144252639 EPIC also has potential as a tool for the delivery of medical training and education. 27296083909598105106121 However, EPIC’s standardized templates impose limits on documenting and dictation and thus detract from its potential for medical education in terms of extemporaneity.90272998. Hence, EPIC appears to adhere to the Smart-Agile healthcare IT systems criterion of encouraging the involvement of healthcare providers—the “powerful” stakeholders in healthcare organizations—in the IT systems as generators of high-quality data and recipients of up-to-date healthcare training with the aim of ultimately improving patient care through informed analytic decision of best practices. 104439

The findings in the literature review in this article on EPIC’ meaningful use features graded in terms of Smart-Agile healthcare IT systems aspects are summarized in the “Report Card” that is depicted in Table 1. Scoring of themes was simple nominal presence or absence in terms of synthesized summary statements of meaningful use featuress with referenced citations in the literature. Nominal presence / absence avoids subjectivity that would be encountered with Ordinal – Ratio numeric scoring. Criticality was determined according to the necessity / criticalness in terms of Smart-Agile aspects. Note: EPIC’s meaningful use features potential to meet or not meet Smart-Agility aspects were also counted as presence and absence respectively—not a subjective matter of degree.

(Table 1) depicts that, when EPIC is graded in terms of Smart-Agile healthcare IT aspects, EPIC’s meaningful-use components appear mediocre at best (7 out of 11), and fail at worst (6 out of 11). However, EPIC succeeds and excels on Smart-Agile healthcare IT systems aspects that are the most central, critical and valuable (7 out of 8) in terms of informing healthcare organizations’ decisions and their patients’ care, specifically: Standardized Data Collection / Connectivity, Real-Time Data Warehousing/Outcome Measures, Enhanced Patient Safety, Patient Tracking and Follow-up (Continuity of Care), Patient Involvement, and Potential Use in Medical Education. Also, this work highlighted an area that Smart-Agile healthcare systems should consider, namely, IT education.

Non-applicable, this was a review of open-source documents and analyses of anonymous publically available data.