672. What Makes Judy Faulkner Run?

Epic Systems, the dominant U.S. electronic health‑record (EHR) vendor, and its founder/CEO Judy Faulkner are the episode’s subjects. Dubner opens on Epic’s improbable rise from a 1979 basement startup to a private company that now runs charts for roughly 80% of Americans, sits on a 1,700‑acre Wisconsin campus with an 11,000‑seat auditorium, and reports about $5.8 billion in revenue with roughly 14–16,000 employees. Faulkner—an introverted coder and former University of Wisconsin computer‑science student—explains the company’s long‑standing philosophy: build an integrated system, avoid outside capital, and prioritize customer success and product quality over short‑term shareholder returns. Those principles are codified in Epic’s Ten Commandments (e.g., “do not go public,” “software must work”) and in Faulkner’s ownership structure (value goes to Roots and Wings charity; voting constrained by a Purpose Trust), which she says is meant to lock in the company’s mission and prevent sales or IPOs.

The conversation traces Epic’s technical and cultural choices as well as current tensions. Faulkner and colleagues describe major product efforts: Care Everywhere (circa 2007) to share records across systems; a Discovery platform to broaden clinical‑trial access beyond academic centers (Seth Howard framed this as democratizing clinical research); and a recent push to the web and to AI. Faulkner offered concrete AI claims (a sepsis detection deployment that went from ~2.5% sepsis rate to zero in one hospital, saving “over 100 lives”) and described tools that surface outcomes for thousands of similar patients while protecting identifiers. She also defended Epic’s openness: the company supplies many APIs but requires health systems’ permission to export data because the data belong to providers. Points of friction are clear: Epic faces antitrust suits (Texas AG and Particle Health), many frontline clinicians complain about usability and typing burdens (a consequence, she said, of past policy choices), and regulators and rivals press for easier third‑party integration. Faulkner admits she lost a policy argument (making doctors type rather than use scribes), worries about AI being “gamed,” and remains publicly private about succession—she is 82 with no set retirement date but has layered governance to preserve Epic’s mission.