Last summer, the killing of George Floyd in Minneapolis sparked uprisings to demand racial justice around the country.
As happened at many other companies, employees at the electronic health record vendor Epic Systems saw the movement as a renewed opportunity to drive transformation within their own organization.
“In June, we started to have conversations about what we could do,” said Ava, a current Epic employee who asked to be referred to by a pseudonym out of fear of retaliation.
“I was feeling really proud,” Ava said, of the employee-led diversity, equity and inclusion – commonly referred to as DEI – efforts at Epic.
She said she remembers thinking, “They’re going to let us fix the gaps.”
Ava was among the current and former employees who spoke with Healthcare IT News about their endeavors to push for meaningful shifts at the organization. The individuals are passionate about the role Epic can play as a leader in healthcare. However, they feel that the company does not value DEI as a key part of its mission – and they see Epic as sidelining grassroots attempts to drive change.
For instance, employees told Healthcare IT News that their attempts to lead DEI discussion groups were stymied, with company representatives saying such groups could not take place during work hours and then deleting internal wikis used to provide resources.
The sense, said one former employee, was that “there’s no place for this, before or after work.”
“That’s just so wrong,” said the employee, who asked to be referred to as Tani.
Employees say that other workshops, such as those focused on dismantling white privilege, were halted in January out of concerns they were “taking too much time,” and that the replacement offerings – while still valuable – tend to be more focused on issues like workplace inclusivity rather than on in-depth explorations of systemic racism.
“The whole idea is it’s not just in the workplace, it’s in the work we do,” said Ava.
Changes after last summer
Epic representatives say the vendor has implemented a number of programs focused on diversity, equity and inclusion at the company.
“Since our company’s founding, we have been committed to promoting a culture at Epic that appreciates and strongly supports diversity,” said Epic CEO Judy Faulkner, in a statement provided to Healthcare IT News. “We have always welcomed staff from all walks of life.”
Epic does not have a chief diversity officer or other high-ranking manager with a team charged with managing equity and inclusion. As reported by Madison.com, this makes it unusual among other companies of its size.
Last summer, Epic created a Diversity Council composed of five employees of color who are tasked with creating an “inclusive and equitable work environment,” in addition to their full-time jobs.
“When we formed the Diversity Council in July 2020, we considered a variety of approaches, including creating an individual role … or establishing a council,” said Jesse McCormick, a member of the council, in a statement provided to Healthcare IT News.
“We decided to proceed with a council, because we think we can be most effective when multiple roles, identities and experiences are represented and when we can work as a team, rather than placing the responsibility on a single individual.”
According to McCormick, the council’s goals include maintaining software that “enables our community members to provide inclusive and equitable care.”
“If an employee has a concern related to diversity, equity or inclusion in the workplace, they can escalate that to their manager, other managers on their team, the personnel team, the Diversity Council, individual council members, specific representative [team leads] within Employee Resource Groups and many others,” said McCormick.
The company also made DEI orientation training mandatory for new employees.
“Since our company’s founding, we have been committed to promoting a culture at Epic that appreciates and strongly supports diversity. We have always welcomed staff from all walks of life.”
Judy Faulkner, Epic CEO
The moves came after Epic president Carl Dvorak sent an email in early June directed at DEI-focused employee groups warning against unconfirmed plans for a virtual walkout aimed at supporting Black Lives Matter.
Starting this month, McCormick said Epic is opening up a diversity-focused class to all staff, “directly applicable to the work we do supporting health systems around the world.”
“The course is designed to be relevant for each role, and it includes Epic-specific information for incident reporting and escalation processes, internal support and resources, and external resources like the Employee Assistance Program,” said McCormick.
The course will not be mandatory. Team leads are also required to take a course on how to manage a diverse team.
With regard to the workshop on white supremacy, McCormick said it is available in the larger Madison community.
Some employees who took on DEI work in addition to the jobs they’d been hired for say they were not offered any extra compensation for doing so, even when the company made the training they’d helped to develop required for certain groups.
“There are staff members across the company contributing to DEI projects in support of an inclusive and equitable work environment,” said McCormick. “We moved resources relating to DEI to a central internal website that is available to all staff, including information like discussion group guidelines and reading material covering a range of DEI topics including privilege, intersectionality, gender and race.”
“Biased people create biased technology”
Employees say what they see as a lack of institutional commitment to DEI has a tangible effect on Epic as a company.
The effects, they say, range from oversights and insensitivities such as having an “Asian-themed” building that blends elements like Japanese architecture with a single mannequin dressed in a sari, to a staff meeting that consistently takes place on Martin Luther King Jr. Day, to software offered to customers that previously used race as one predictor for no-shows.
“Recent analysis showed that this variable was not as strong of a predictor as other factors, so the most recent edition of this model does not include race as a variable,” said an Epic spokesperson about the no-show model.
“Our process for designing machine learning models includes reviewing the ethical considerations with experts from the community. This review informs the guidance we provide to organizations using each model, such as the nature of models and their variables or each model’s potential role in clinical workflows,” the spokesperson added.
Employees also say there is no designated pronoun field for employees in internal profiles, although customers have that option on Epic’s customer-facing site. Instead, employees can use a character-limited “contact information” box or a hidden-by-default “personal notes” section. An Epic spokesperson confirmed that staff has been instructed to use the contact information box for “shifted work schedules, pronouns, name pronunciation guides,” and other information.
“Biased people create biased technology,” said Tani. “When we deploy biased technologies, it propagates health disparities.”
“You can’t make good software without considering the patients your customers are serving,” agreed Sandy, another current employee who asked to remain pseudonymous.
Most recently, Sandy raised concerns that conversations among colleagues about Epic’s role in the COVID-19 vaccine rollout were not adequately addressing the disparities Black and Latinx communities are facing with regard to the effects of the coronavirus, including vaccine access.
“I had to explain to them that if you don’t talk about race, you can’t talk about vaccine distribution,” said Sandy. “That’s what happens when you don’t have diversity training.”
“Reaching underserved communities – including communities of color – is an important part of the conversation around the nationwide vaccination effort, and Epic is playing an important role in that effort,” said the Epic spokesperson, noting that many of Epic’s customers operate federally qualified health centers that primarily serve people of color.
“We continue to update our software and create resources to support equitable distribution efforts based on feedback from our customers. For example, our software allows health systems to reserve appointments for patients who face technology barriers and need to schedule over the phone. We’re also providing resources such as webinars and guidance on creating patient education materials to improve vaccine confidence in underserved communities,” added the spokesperson.
The employees say the dynamic results in “brain drain,” with some workers of color in particular leaving rather than continuing to feel unsupported.
That was the case for Tani, a person of color who left the company late last year. “Epic was so willing to publicize the progress DEI leads were making in recruitment materials and phone calls, yet they were simultaneously stifling DEI creativity and efforts,” she said.
“My coworkers and I [would] do anything for our customers because we realize how important EHR tech is to the country and the world,” said Tani. She loved her job, she added, “but I didn’t feel that Epic was willing to support my values and identity.”
Looking to the future
In order to take real steps toward change, say the employees, Epic should hold up DEI as a core part of its work.
“You cannot extract being inclusive from having a role in any healthcare company,” said Sandy. “Any company, but especially in healthcare.”
She stressed the importance of executive-level support for DEI. “We need people whose sole role is to oversee DEI,” she said.
Ava also suggested that Epic should track the demographic information of who it is promoting and placing in leadership positions.
“My worry is that if we don’t have data on that, we don’t know if we’re doing a good job,” she said. Though she appreciates that Epic doesn’t want to put people “in boxes,” she said, “We don’t have a way to evaluate if we are disproportionately giving those opportunities to white men or to straight white women.”
“We are no longer the scrappy underdog,” Ava continued. “Because we are an industry leader, it is our responsibility to get in front of issues that affect access to care and quality of care.”
“That’s the thing that really grinds my gears,” said Tani. “It’s not mutually exclusive to support operational needs and DEI. There’s no excuse anymore; it’s the 21st century, and we owe it to each other to be socially responsible.”
This content was originally published here.