In a recent blog post, John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center in Boston, offers his views on why the Epic EHR has gained unprecedented momentum in the market among providers nationwide -- not least among an elite group of hospitals in Boston.

So far, though, BIDMC, which is among that exclusive Boston-based group, is sticking with its in-house built EHR.

An Epic system – or other client-server technology – might relieve some demands on Halamka and his IT team, but it would not likely be as flexible.

"Every day, clinicians ask me for innovations because they know our self-built, cloud-hosted, mobile-friendly core clinical systems are limited only by our imagination," he writes.

In the blog post, "The Era of Epic," (which is nestled between photos and posts about Unity Farm, a farm that he and his wife are building in Massachusetts), Halamka puts forth five reasons Epic – a 1990s-era system – has been able to capitalize on the push to digital healthcare. He also raises the prospect of whether in the next few years a competitor with cloud-hosted, thin client features might replace Epic as a more attractive choice.

Some of the comments on the post raise the problems some healthcare systems have had with their EHR installs; Cedars Sinai is offered up as a prime example.

Difficulties remain today. Healthcare IT News detailed problems with Epic at Maine Medical Center, part of the MaineHealth system.

[See also: Go-live gone wrong.]

But whether those troubles could be blamed on Epic itself, on the implementation process or both, is unclear. And consultants in the field say failures like those infamously experienced by Cedars Sinai 10 years ago are a thing of the past.

Halamka says he’s aware he’s a holdout.  

"At times, in the era of Epic, I feel that screams to join the Epic bandwagon are directed at me." Halamka writes.

Mark Frisse, MD, professor of Biomedical Informatics at Vanderbilt University, commented on the blog:

“John, as you know Vanderbilt integrates and creates software based on sound design principles and produces some important results. But, as you state, the number of institutions using their own software is shrinking. So it would be valuable to turn it around. What is the case for those who build to continue to do so?”