The Bern cantonal government's plan to implement the 'Epic' software across its healthcare system as a universal digital health platform is facing significant opposition from the Grand Council. While the Insel Group hospitals already use Epic and report growing efficiency, critics raise serious concerns about potential costs, data security, and vendor dependence, prompting calls for more transparency and a reevaluation of the software choice.
Key Takeaways
- Bern's government proposes using 'Epic' software for a canton-wide digital health platform.
- The Insel Group currently uses Epic, citing successful implementation.
- Grand Council members express strong doubts about costs and data security.
- Critics warn against making the canton's healthcare system dependent on a single software vendor.
- Lawmakers demand a detailed cost breakdown and consideration of alternative solutions.
Bern's Digital Health Vision and Epic's Role
The Canton of Bern aims to establish a digital health platform. This platform intends to streamline the exchange of patient data among hospitals. It also seeks to prevent duplicate efforts in healthcare administration. The cantonal government believes this modernization is essential for an efficient healthcare system.
According to the government's proposal, this new system would be built upon the 'Epic' software. The Insel Group, a major hospital network in Bern, began using Epic in March 2024. The Insel Group reports positive results from its implementation, noting increasing efficiency.
Fact: Epic Software
Epic Systems Corporation is a leading provider of health information technology. Its electronic health record (EHR) system is widely used in the United States and increasingly in other countries. The software is known for its comprehensive features and high implementation costs.
Growing Concerns in the Grand Council
Despite the government's positive outlook, members of the Grand Council have expressed significant reservations. They find the government's presentation of Epic's benefits overly optimistic. Two parliamentary motions have been submitted, highlighting these concerns.
One motion specifically requests a detailed breakdown of the costs associated with Epic at the Insel Group. This includes not only direct software purchases but also hidden expenses. These hidden costs could involve training, staff dedicated to IT tasks, and server utilization.
The second motion challenges the government's predetermined choice of Epic. It calls for the software selection process to remain open. Initially, the project for the digital health platform was even named 'Epic as a Service,' suggesting the decision was already made.
"There have been too many financial disasters already," warned GLP Grand Council member Casimir von Arx. He is the lead signatory for both parliamentary motions.
Unclear Financial Implications and Hidden Costs
Casimir von Arx, a representative of the Green Liberal Party, voiced his concerns in an interview with BärnerBär. He emphasized the lack of clarity surrounding the financial impact of Epic on the canton and its healthcare system.
Von Arx stated that the potential follow-up costs for the canton and Bern's healthcare sector are currently unknown. He stressed the importance of reliable figures from the government before making such a significant investment. "We do not want to buy a pig in a poke," he said, referencing past financial issues with cantonal software projects.
Direct costs, such as software purchase and licensing, are often easier to quantify. However, indirect costs are more challenging to assess. These include internal training for medical staff, customization of the software to local needs, and consulting fees. Such items can significantly increase the total expenditure.
Context: Past Software Project Challenges
The Canton of Bern has experienced financial difficulties with previous large-scale IT projects. These past issues contribute to the current skepticism among some politicians regarding new software implementations and their associated costs.
Estimated Costs and Comparisons
The estimated cost for implementing Epic at the Insel Group, including an eight-year license and maintenance, is approximately 83 million Swiss francs. Including VAT, this figure rises to 90 million Swiss francs. However, the extent to which indirect costs are included in these figures remains unclear. This lack of transparency suggests the actual total cost could be substantially higher.
Von Arx highlighted that 83 million Swiss francs appears very high when compared to other established hospital information systems. This comparison suggests that Epic might be a more expensive option than alternatives available in the market.
During Epic's introduction at the Insel Group, a "Command Center" with 150 specialists was set up. This center aimed to quickly address all user inquiries, indicating the extensive support and training required for the system's rollout.
Fundamental Reservations Against Epic
Beyond financial concerns, von Arx raised fundamental issues regarding the Epic software itself. A primary concern is data security, given that Epic is a U.S.-based product. U.S. law allows American authorities access to data stored by U.S. software providers under certain conditions. This access can occur regardless of where the data is physically located, potentially affecting patient data in Bern.
Another concern relates to the software's usability for medical professionals. Epic is often described as "click-intensive," meaning it requires many interactions to complete tasks. This can be a significant time-consumer for medical staff, who already work long hours.
Furthermore, von Arx criticized the government's idea of using the same software across the entire canton. This approach would make Bern's healthcare system entirely dependent on one software vendor. Switching to a different system later would involve immense effort and cost. Such vendor lock-in can limit competition and potentially drive up future costs, which would ultimately be paid through health insurance premiums.
Exploring Alternatives and Data Standards
Von Arx asserted that alternatives to Epic exist. He also argued that it is not necessary for all hospitals and healthcare providers in the canton to use the same software. The key requirement is simply that patient data can be exchanged easily.
To achieve this, agreeing on a common data standard is sufficient. If a data standard is in place, hospitals and doctor's offices can use different software systems while still ensuring seamless data exchange. This approach promotes competition among software providers and avoids vendor dependence.
Von Arx pointed to established alternatives, including Swiss products. He mentioned KISIM, a hospital information system from Zurich. According to a scientific study involving nearly 2,000 Swiss doctors, KISIM performed better than Epic. He stated he trusts these practical experiences more than the Bern government's descriptions, which he felt read like an advertisement for Epic.
Broad Support for Motions
The parliamentary motions regarding Epic have received cross-party support. Representatives from all factions have co-signed them. This broad backing suggests that concerns about Epic are widespread across the political spectrum, with the exception of the cantonal government.
Von Arx believes these motions have a good chance of success. The main goal of the motions is to gather more information about Epic's use at the Insel Hospital and within the Bernese healthcare system. They also aim to prevent the government from creating a fait accompli regarding the software choice.
A final decision on the matter is expected next autumn in the Grand Council. Von Arx emphasized that the motions do not oppose the broader goal of digitalizing healthcare and improving collaboration among providers. He stated that these are good ideas. However, he stressed that the path to achieving these goals must be chosen carefully, not by rushing into the first available option. The decision's implications are too significant to be taken lightly.