"Everyone's being told, 'Don't go public,'" Ries said. "The most common conventional wisdom now is that going public will mean the end of your ability to innovate."
I thought no one went public because going public requires you to divulge revenues.
I thought no one went public because going public requires you to divulge revenues.
In my experience, If there is consensus around something, it's often a great idea to do the opposite.
I decided to take my company public last year and it has been exactly the right thing for us. As far as I can see it, there is absolutely no reason to wait if your company and your team is ready.
We actually put together a mini documentary about Shopify for our IPO Roadshow: https://www.youtube.com/watch?v=QYl8iwD-6tk It's worth the watch if you are into this kind of thing. We decided to do this because Shopify grew out outside of the Silicon Valley sphere and wasn't that well known before our IPO. That has clearly changed since.
I refer a whole bunch of stuff towards shopify since I get inquiries about building e-commerce stuff all the time where they have some money but not enough to make it worth doing a bespoke solution and frankly unless they want to drop serious money your platform is always going to be better.
I'm over in the UK and I saw a talk a while back by one of the shopify guys (Keir Whitaker iirc, it was a couple of years ago) that was superbly well done which made me look at the platform.
And what does that look like?
Running a Public company looks like a daunting task before you are ready, and it doesn't look like a big deal after you are ready. Building a company is a journey of personal growth, at some point your personal growth as a leader takes you past the point where a IPO looks daunting. Then you make your move.
Anyone in the know could possibly argue that the CEO is also a control freak, but she's used that control to keep the company focused on a high-quality/safe user experience for patients, which isn't a bad thing IMO.
I was promised employee stock at hiring. The company shortly thereafter reneged and substituted a "shadow stock" plan. The rationale I was given explicitly mentioned that having too many private stockholders would trigger mandatory financial reporting, and that the company would rather give me the finger than its balance sheet.
It was just one of the many reasons why I left. The company was fueled entirely by the inherent brokenness of the US health care complex. It seemed to be metaphorically powered by shoveling fat stacks of $100 bills directly into the fireboxes of pre-Watt Newcomen steam engines. They didn't even bother with the seemingly simple expedient of converting the $100 bills into $1 bills to increase the available fuel supply.
The end product that was visible to the customer was good, but it almost certainly cost several orders of magnitude more to produce it than was strictly necessary.
This would be news to my wife (a surgeon), or any one of her coworkers. The software is universally viewed as terrible by everyone I've talked to. It actively results in worse records because (at least as configured) it's so cumbersome to use that many notes are frequently kept out of the system. A management plan that takes seconds to explain verbally requires minutes of data entry.
You either love it or you hate it, and the physicians who hate it typically hate it because of what you said - they're suddenly having to type their own notes into a computer rather than dictate it to someone else.
Personally I'm of the opinion that doctors doing their own data entry is better for liability and malpractice reasons, but I empathize with your wife and people who hate doing it.
Instead, the EPIC complaints are about the UI and workflow, which was modeled after the typical paper H&P (history & physical) forms clinicians would traditionally fill out. It comes down to the same UX lessons we've learned about most offline-to-online form transitions: directly porting a form is rarely the answer.
The anti-note sentiment has to do with the fact that they're copying-and-pasting from previous notes (often the vast majority of a note's content is pasted in), they're using MS Word to draft the notes because of a buggy editor UI, and then when they're in a situation they actually have to read the note, they're sifting through a pile of duplicated, pasted content.
There's a ton of opportunity for change here. There's an equal amount of risk involved, and selling these types of products into healthcare is about as fun as removing your fingernails. That's the piece EPIC does well, and why they're still a behemoth, even if their product is a five out of ten.
First, he'll spin away from you on his stool. Then touch a keyboard with his boogerhooks to re-log-in. (A shared KEYBOARD in a room of transient often-sick people ... did you ever do the biology experiment in high school where you swab surfaces and inoculate a petri dish? The keyboards came out worse than the toilet seats.) Then he'll mouse around on a bunch of screens showing inconsistent or at the least confusingly presented data (listing, for example, all medications you've ever been prescribed with no obvious way to highlight which ones are current). Finally he'll find the right text box for the notes.
As your doctor types in this text box, various auto-completes will come through. Your doctor will then choose from these auto-complete options, which generally make a mockery of the English language and basic grammatical agreement (gender pronouns, etc.).
The idea that Epic has empowered, or even in any benign way nudged, doctors to begin doing as good a job of data entry as they once did of dictation and charting is just complete hooey.
I have also personally had a physician using Epic Hyperspace enter an incorrect immunization for my then months-old child. This doctor in fact had the correct immunization schedule for children memorized and could have written it out longhand perfectly. But it wasn't until the next visit that they detected the out-of-order sequencing of the immunization series. This was perhaps not the fault of Epic, exactly, but was certainly mediated through Epic Hyperspace and it did absolutely nothing to prevent, flag, or otherwise mitigate this completely detectable, violation-of-deterministic-formula situation. (Everyone was fine and no harm ... this time.)
Way off the original topic, here, but let's just say regarding Epic -- whatever it is that's driving adoption of that system is not naively comprehensible to those of us coming from tech/software. It's not quality, cost, UI/UX, safety/accuracy, interoperability, standards, network effect, viral effect, or the rest.
Yet, whatever Epic is doing (or whatever esoteric motive their buyers have), it seems to be turning out well for Epic.
So attempting a tie-back to the OP -- it's not clear that long-termism of a business necessarily has any salutary effects on the rest of the world.
The idea is great, but it just runs into an absolute brick wall of realities of the health care system and human behavior.
The problems with EMRs are really just a symptom of a real problem in medicine which that every department head wants to do things their own way. And there isn't really a good way of selecting which is best amongst the various processes/methods. The more prestigious the institution the larger this problem typically is.
And I used "good" to damn with faint praise. It generally meets customer requirements, and probably doesn't cause as much iatrogenic harm as whatever systems it replaces. For what it costs, I would personally expect quite a lot more out of it than it delivers.
But there's only so much you can do with a perpetual parade of recent college graduates that generally turn over after about 2 years.
I only recommend working there to people if they're right out of college and not in an engineer role, since their MUMPs/Cache stack is pretty dated.
For entry-level business roles they tend to be better suited, especially those looking to go the consulting route.
I very distinctly remember it seeming a bit like a cult with the overbearing CEO that answers to no one creating a sprawling campus out in rural Wisconson that's so comfortable and with so many amenities you'd never want to leave!
Sounds like I made the right choice to decline, even though I'm currently working for a private company with the same type of CEO, only with revenues at half of one percent of Epic. But hey, I read a couple of weeks ago that they were hiring a sushi chef, and I do love sushi!
The Epic campus is very close to the epicenter of the best place for a typical HN reader in Wisconsin. Since the UW-Madison campus is on the west side of town, the geometry of the lakes almost assures that people who work in high tech businesses or academia commute in from the southwest quadrant, if they don't live in the city proper: Cross Plains, Middleton, Verona, Fitchburg, Oregon.
I loved living in/near Madison for the 6 months of the year that it wasn't either winter or unsubtly hinting that Mr. Winter had only just stepped out for a moment, and would likely be back any minute now to finish hitting my other kneecap with a lead-free pipe and then drag me around on a chain behind his Prius for a bit.
The immediate environs are great. But I had to leave for financial reasons.
If you have the opportunity to take a job in Madison, Wisconsin, that is not with Epic, do consider it.
Shameless plug! https://forteresearch.com/
But summers were idyllic.
To your point, why, specifically, is it so difficult to interface with these systems? Could it be by design?
You still didn't elaborate on why you said Epic has no HL7 integration.