Three and a Half Years Administering Epic
Stuck in Fresno away from familiar lucrative and challenging IT positions, I wanted to return to the Bay Area or another more metropolitan area. But my aging parents needed my help. My brother passed away in 2008 and my sister lived near Los Angeles while my daughter studied Cognitive Science at UCSC. So Eileen and I felt bound to stay in Fresno.
Then a recruiter called. Recruiters typically call. However, this recruiter asked whether I could live and work in Fresno. That was ideal!
The hospital where my mother and I were born needed a clinical systems administrator. I attended a lunch interview with the lead and the manager of the group at a Mexican restaurant, and they called me back for a second interview or series of interviews in one setting. And the folks I would be working with were awesome. They made an offer, and I accepted.
I wanted to get an early start studying to prepare for work, so Mark lent me books on Epic and Cache to read, and I began studying to get started as quickly as possible.
Learning Epic: Drinking From a Firehose
My first day was August 1, 2011. We had a major “go-live” with several Epic modules on September 26. I knew how to spell Epic and Cache, but I had much to learn.
Rich and I shared a cubicle. He took me under his wing and taught me everything I needed to become productive with Data Courier and imports quickly. Immediately after, I was burning midnight oil with the rest of the team making the Epic go-live a success under Mark’s leadership. We comforted ourselves thinking of what the overtime pay would buy us. Mark wanted a new motorcycle.
Within a year, I would go through certification in Chronicles, Hyperspace, and Cache Administration. I completed my certifications for Chronicles and Hyperspace and Installation Tools with high scores, completed all the coursework for Cache Administration, completed three grueling two day projects, and two out of three of the exams.
During this time, I developed skills in the following:
- Data Courier
- Chronicles imports, exports, ad-hoc KB-SQL queries
- Cache administration, ECP application servers
- Replication for disaster recovery and for reporting
- Updates, upgrades, creating new Cache instances and Epic environments
- Clarity ETL administration and related work with SqlServer
- Creating and maintaining Interconnect Servers and SOAP proxies,
- Setting up and configuring CareEverywhere and CareElsewhere,
- Managing and changing load balancer methodologies
- Change management/change control.
- various ancillary systems.
My 30 or so years of Unix administration and SQL database experience helped the team significantly for analyzing performance issues, breakages, facilitating some activities by creating shell scripts and perl scripts as needed, or helping to mentor others in our team in matters involving Unix.
My skills in time management, project management, people management, mentoring and professional customer support helped to the point where my last review had scores in teamwork that indicated a top level of performance above and beyond what was expected of a person in our position.
I had a chance to work through several large Cache and Epic upgrades upgrades and applied countless smaller updates. I installed updates to administration scripts, created new installations based on Production as well as Test environments, and became familiar with many of the 700 or so INIs (tables) in the Epic databases not to mention shadowing and journaling, BCA, web blob, printing configuration, and security.
In my own time, I studied ITIL, PMP, Six Sigma or CISSP certifications just for the fun of it and considered becoming certified but never did.
However, although my reviews were excellent, my performance was very good, and I got along well with everyone on our floor, I reported what I felt were ethics issues involving Epic’s training and certification policies, and for the first time in my career spanning several decades, I was fired. I later learned that some felt that many people at CMC had been fired this way.
Later, Epic called me personally to let me know they had come to agree with at least one of my concerns and changed their policy. However, later, I learned that someone in management made a disparaging and untrue statement about me and a friend spontaneously laughed and asked a question sort of mocking what this person said. While others told him it was a good question, he, too was fired.
What I learned from this is that it is possible to do an excellent job, act honorably, and still end up in the cross-hairs of management if the work place is hostile to those who bring issues to light. And a company policy of non-retaliation is not always honored by management or Human Resources. Even so, it is best to work hard and honorably and to stand by your ethics.
While it is better to be fired than to live without ethics, it can also pay to be more astute than I was. One thing I would change is face unethical behavior more carefully, especially if it involves a vendor. Vendors often strive to maintain control over management and to gain strength to remove any management who may interfere with their wishes in any way. I had seen this practice before when a situation threatened the sales of a vendor.
The situation with Epic involved a more complex web. Epic promised a $250,000 Good Maintenance Discount contingent upon CMC obtaining a full set of certifications for its employees supporting Epic environments or modules. However, Epic gave the tests and granted or withheld certification as they wished, granting passing grades to some and informing employee’s whole line of management of exam failures, real or not. And nobody but Epic staff seemed to have any opportunity to see their exams or verify the scores.
For this reason, it appeared Epic could grant passing grades and cap off scores to prevent the last one or two people from getting certified. I passed all my exams and certifications until I completed all my requirements for the most challenging certification–the CSM or Cache Systems Manager certification–all but one. And then I began coming away from this exam feeling confident I had turned in a perfect, 100% exam, and the results would come back between 79% and 81%–approximately one question short of passing.
The strange thing is that the two most highly respected members of our team–our lead, Mark, and our previous lead, Steve, were both within about one question of my score. Mark received the same score I received, but Epic gave him the point after talking with him on the phone. Steve was said to have received 85%, the minimum passing score.
I returned to Epic to re-train. I rented a car so I could show up early and sit on the front row so I could identify any gaps in my knowledge and fill them in. I stayed late each day to make sure I got through every in-class project and understood each one completely.
When I returned home, the exam changed format and I was uncertain whether the exam was still open-book, open-system as it had been in the past. It was, but because of my uncertainty about the rules, I put my laptop away and took the exam. I still felt I had turned in a perfect score, but it ended up between 79% and 81%.
I learned it was open-system, open book. I studied again for exhaustive knowledge. I made sure my books had appropriate page marks so I could check anything fast. I made sure my systems were optimized so I could look up anything fast where I might be in doubt. And before that time, I asked advise from the training staff and studied the areas where they said I was weak. And I knew my score should have already gone up since the first time I received between 79 and 81.
When I took the exam, I saw one question that could be proven ambiguous mathematically, where it would be impossible to state legitimately that one answer was more true than the other.
One may speak of overthinking, but it was like asking whether a person must put peanut butter on the bread after jelly to make a PBJ sandwich. Answer yes, and the proctor will say it’s wrong because you could put those on in any order. Answer no and the proctor can say you’re wrong because you should know that both peanut butter AND jelly are needed.
In other words, the mere structure of the question made it utterly impossible that it could not be considered ambiguous. Many questions could be considered “near ambiguous” while leaving room for a person to demonstrate how ambiguity could be removed by a more complete knowledge of the technology required. But in my opinion, it is just as possible that Epic’s staff could be on the wrong side of enough pseudo-ambiguities to run almost anyone with a perfect understanding down to 85% and allow for a real ambiguity to cause some people to land on the same side of a real ambiguity to be removed arbitrary from the list of those who passed their examinations.
In the end, this can be highly profitable for Epic as Epic could hold onto the Good Maintenance Discount money if they wished. Or they could grant it on grace saying that is because a company is still in-progress actively pursuing complete certification.
In this case, Epic keeps itself in a strong position with management. No manager would dare cross Epic lest he cause his employer to lose the discount. So, if Epic does not like a customer’s employee, they could simply report him or her to management and have him disciplined or fired.
However, when an employee who never fails exams passes several and begins failing one exam, that is highly suspicious. When the score is about one question short of passing each time, it is more suspicious. When this happens and the employee is embarrassed repeatedly before his or her whole line of management for each failure, that is *extremely* suspicious because people, especially those who are accustomed to excellent performance, absolutely dread being embarrassed that way.
If the candidate is allowed to continue repeating the exam, it becomes suspicious when the candidate’s score drops. People don’t typically lose knowledge when they study–they gain it. When they rise above passing, the whole scenario ends and the candidate receives certification.
The only way Epic can keep a candidate from passing is to keep capping off his scores just below the passing threshold or make up a new rule to limit the number of attempts a candidate can make.
But how reasonable is it to ban someone like me FOREVER? Forever? My two senior coworkers received scores within one question of my score and were certified without any more issues. But I appeared to be capped off within one question of their score. That is, until they made up a new rule.
But this way, Epic could keep their $250,000/year discount if they wished to do so. Or they could use that as a spoken or unspoken threat to keep CMC management in compliance with their every wish.
My termination paperwork claimed I was terminated for unprofessional communication. However, I believe it was in retaliation and likely at the request of Epic to my line of management.
For this reason, I have had time to think about why large companies and government organizations choose to spend hundreds of millions or billions of dollars on Epic or similar commercial EHR software when the VA has produced a system called VistA which is in the public domain and has been used to improve every VA Hospital system that used it, and has been tested on many of the largest health care systems worldwide.
Is it because of political muscle that Epic is selected? Are there really advantages so significant that they cannot be custom built more cheaply with better results either by an individual system or by several companies pitching in together? Is there a benefit to being owned by a single vendor instead of being free to choose from among vendors for support, for training, for certification, for consulting services?
One more question comes to mind regarding Epic. Is it even *ethical* to buy services or software from a company that is most likely engaging in a very heavy amount of age discrimination?
We have all seen unfair discrimination. We have seen people try to hide it when it seems to be obvious. “Oh, we have black employees. I don’t know where they are, but I heard that we have some somewhere.” “We never discriminate based no age. It’s just that only young people apply or only old people apply or only middle age people apply.”
And you know what people are thinking when they hear that only people of a certain race or age or gender or religion apply. Right? Nobody else applies because nobody else believes they have a chance.
When a company’s management is sincere about diversity, you see them pursue it proactively. They see there are too few women, so they look for candidates where women are found. They see too many young people, so they look for older candidates or they’re short on younger employees and search the universities. They go to where the people are, and people begin to expect their workplace to be diverse. It begins to feel weird when their workplace is not diverse.
How many old people do you see working at Epic? Ask, and I am sure you will find that they’ll tell you they have a thirty year old here or there, and perhaps that is what they would consider “old”. I’m 61. Where do you find a 61 year old? Perhaps in the office of the CEO? Anywhere else? Perhaps. You may see 61 year olds, but where are they? Where customers train?
I think hospitals and consulting firms are often much better at pursuing age diversity than software firms. Is this because old people are hard wired to program in COBOL only? Is this because old people cannot learn new technology? Or is it because people often feel it is more fun to train young people than old people?
Working with old people can be every bit as fun. Try it!