Willy Wonka and the Medical Software Factory

In the farm country of southern Wisconsin, 12 miles from Madison, is one of the nation’s biggest tech companies — and almost certainly the quirkiest. The woman who controls it is a septuagenarian coding savant, its campus contains a human-size rabbit hole and an elevator to hell, and in all probability it stores your personal medical records on its servers.

Epic Systems is a health care services provider with $2.7 billion in annual revenue. Its mathematician chief executive, Judy Faulkner, is a billionaire recluse who hosts P.T. Barnum-esque gatherings for clients. Those clients — big hospitals and health systems around the United States and more than a dozen overseas markets — are served by customer-service representatives known as BFFs. Every month, employees are compelled to gather in a subterranean chamber for two-and-a-half-hour staff meetings that have been likened to a megachurch experience. Workers are discouraged from ordering business materials on Amazon or living more than 45 minutes away from the office, in order to shorten commutes and keep Epic’s wealth in the local economy.

Epic’s software is ubiquitous in doctors’ offices and operating rooms, and companies like Amazon, Microsoft and Alphabet regularly hoover up its young engineers. Yet most people outside of the Madison environs, I’d be confident to say, have never heard of the company.

I certainly hadn’t. I cover Wall Street, not health care or technology, and when I came across the privately held Epic this year I was consumed with questions. Who was this publicity-shy yet spectacle-loving C.E.O., and how did her theme-park sensibility coexist with the mundanity of health care billing protocols? Was Epic’s odd culture a magnet for talent and clients, or was it an indulgence that kept the company from growing even bigger? In August, I traveled to Wisconsin to see what this 1,100-acre Midwestern behemoth might be hiding.

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A treehouse, accessed by rickety bridge, serves as a conference room.CreditNarayan Mahon for The New York Times

When I arrived in Epic’s hometown, Verona, two beaming receptionists at the Fairfield Inn tried to offer me something called the “Epic discount.” When I said I couldn’t accept anything of value from the company, they clarified that the special rate was a gesture of gratefulness from the hotel, on account of the huge proportion of guests who come to do business with Epic. It is by far the dominant player in Verona, where the population of 10,600 is comparable to the company’s head count of 9,800.

Epic’s headquarters were a short drive away, down a meandering road through countryside dotted with Queen Anne’s lace and farm equipment. I drove past a giant Tin Man, the first indication of the campus’s fairy-tale aesthetic, and into guest parking, in one of the campus’s few aboveground lots.

There was virtually no security. I walked past a sculpture of Humpty Dumpty, set on a wall and typing away on an Epic laptop, past the warning against carrying concealed weapons (Wisconsin allows them in most public venues), and into reception. I was asked to sign an old-fashioned guest book, given a “Hello! My name is” sticker and a few pages of directions, and told I could wander the campus’s 25 buildings and numerous footpaths on my own.

Fake trees and sculpture greet guests.CreditLauren Justice for The New York Times

The design theme was childish even by the standards of technology start-ups, where ball pits and scooters are common. I paused at the Cavey Den, a hollowed-out treehouse with stumps for seats and children’s books, then rocked on a rocking horse and ate a cookie from a jar, wondering what time was set aside for naps. There was a long series of clay slabs with handprint impressions from longtime employees, and walls and walls of art sourced from Wisconsin-area artists: a dragon perched in an iron bird cage; expanses of blue and purple stained glass; a clock featuring manicured poodles and Cupid; an old-timey circus ad painted on canvas.

The diversions went beyond art. At the Black Dragon cafe, which was next to an informal band-practice area, a sandwich board advertised oatmeal for 75 cents and bacon for $1. Along the Indiana Jones tunnel, decorated with vines and a golden idol, the sound of dripping water and roaring animals played in a constant loop. A conference room named after a Star Wars planet was reached via a rickety swinging bridge. All around me, young workers in shorts and band T-shirts hurried past. (The company’s dress code is that when visitors are on campus, wear clothes.)

Epic’s employee dress code: When visitors are on campus, wear clothes.CreditNarayan Mahon for The New York Times

The next morning, I woke up feeling off: a throat infection I’d been treating with antibiotics seemed to be getting worse. Verona, while long on breweries, day cares, artisanal pizza and jumbo mortgages, lacks an urgent-care clinic, so I drove into nearby west Madison for some attention.

The clinic I found was, naturally, running on an Epic system that logged me in, took my information and tracked my health statistics. The nurse’s assistant who saw me had visited Epic during her training, as do many medical professionals who work with its technology as part of their jobs.

Epic’s reach is, well, epic. Its systems contain records for more than 50 percent of United States medical patients. It is the dominant software provider to big health systems like Memorial Sloan Kettering, the Mayo Clinic, Cedars-Sinai and University of Utah Health, as well as scores of doctor’s offices and smaller clinics. Its applications handle functions both complex and straightforward, from the emergency room to the bills sent to patient homes. They calibrate drug dosages, monitor vital signs, match blood types, anticipate infection symptoms, and keep tumor measurements. Epic software is elemental to everything from transplants to cesarean sections.

Once you know what Epic does in health care, you see it everywhere. When I left the urgent-care center, diagnosed with a gnarly case of strep, the summary printout I was given was branded on one corner with Epic’s insignia.

An employee passes through the Great Hall.CreditLauren Justice for The New York Times

The next day, back at company headquarters, I sat in one of the less Montessori-style conference rooms with Steve Dickmann, 72, the chief administrative officer. He became animated when explaining some of the more functional, less fantastical features of the space. “The whole campus is designed to promote productivity, creativity, comfort,” he said.

There was a philosophy behind everything. All employees have offices, because studies show that workers in open floor plans get interrupted frequently. Stairs promote socialization, but buildings can’t be more than three stories, because workers are reluctant to climb more than a flight or two. Every conference room must have windows so that visitors don’t feel hemmed in during days and days of training.

The overriding mission, Mr. Dickmann said, was to ensure the safety of patients at facilities that use Epic software. If health care programmers make mistakes, he said, “bad things can happen.”

Epic’s coders often leave campus to embed in operating and recovery rooms, where they watch nurses ripping the tops off blood bags and surgeons opening up people’s chest cavities. It’s an experience that young engineers are unlikely to get at, say, Facebook or Snap, working on algorithms that tailor ads to demographic groups or insert rainbow vomit into photographs.

Programmers regularly faint at the sight of beating hearts, scalpels and bodily fluids. “There were people that would pass out in the hallway” of hospitals, said Aaron Webb, who worked at Epic for 10 years as a software developer. He watched “hundreds” of surgeries, often with his team in tow, before moving to Seattle, where he now works for a business that matches companies with storage space. “But if you can’t understand what your users are going through, you’re not going to design a good system.”

An intergalactic hallway.CreditNarayan Mahon for The New York Times
An elevator to Hell, naturally.CreditNarayan Mahon for The New York Times

Epic works its more than 5,000 programmers hard. Middle-of-the-night technical crises, stress-related illness and employees weeping from exhaustion in airport lounges are not uncommon, say former employees. Long hours are expected. One piece of company lore has it that during a construction project, Ms. Faulkner questioned a plan to install motion-activated light switches, noting that employees might be sitting still at their desks for such long stretches that they’d frequently find themselves in the dark. (The sensors were installed, and she was proved correct.)

“The volume of work at Epic, regardless of what role you’re in, is very high,” said Jacob Lewis, who was a technical writer at Epic before he left in 2014. He later sued the company over unpaid overtime. His case, a class-action suit that hinged on the obligation to sign an employee agreement that forced workers into arbitration, rather than litigation, was combined with similar cases and was heard by the Supreme Court last year. The workers lost.

This combination of chaotic, stressful client visits and isolating, mundane office work might explain the company’s Disney dimension. Epic is a place where wedding music plays on a campuswide public-announcement system when new clients are signed. Dry-cleaning services are found at the “New York Sock Exchange.” Employees can hurtle down an “Alice in Wonderland” slide into a room with miniature furniture. They are encouraged to visit a conference room encased by waterfalls and a shark pond when in need of inspiration. (The shark is fake.) Internal awards for outstanding work are named after Jack Bauer and MacGyver.

The Galaxy conference room in the Andromeda building.CreditLauren Justice for The New York Times

A few hours after my sit-down with Mr. Dickmann, I was granted an audience with Ms. Faulkner herself. We met in her personal conference room, a place of warm earth tones, steaming hot tea and personal memorabilia, including a copy of the prayer “Desiderata” with faux-burned margins mounted on a wall. “I think we save many, many, many lives a year,” she told me.

Judy Faulkner. “I look at our financial information maybe for a minute a month,” she said.CreditEpic Systems

Ms. Faulkner, who bears the same shy, distracted demeanor as Facebook’s Mark Zuckerberg, was wearing a long-sleeved T-shirt and a crocheted cardigan. She is soft-spoken and literal in conversation. But once a year, at her annual client meeting, she dresses up as the Mad Hatter or a wizard and gives an inspirational talk to an audience of thousands. This year, the theme was camp: She dressed up as a park ranger and told a story about catching frogs with her bare hands on a hiking trip and eating them for dinner.

Born in 1943, Ms. Faulkner said she taught herself to code in a week, using a Fortran textbook, during her undergraduate years at Dickinson College. As a graduate student in computer science at the University of Wisconsin, she conceived a prototype for Epic while sitting in her living room one day in the mid-1970s.

“The sun was shining, I was disattentive, I was just sitting there and suddenly it all came to me: Here’s how you build it,” she said. “And I remember running into the kitchen, grabbing a pad of paper and just writing code, code, code, code,” she said. While she went on to teach computer science for a period, she kept coming back to the idea, and in 1979, in a Madison basement, she founded what would become Epic: a start-up called Human Services Computing. Today, some of Epic’s foundational programming still bears Ms. Faulkner’s initials.

Ms. Faulkner is now 75, and over the last four years, the company she built has grown an average of 14 percent a year, according to revenue figures it shared with The Times. She has instructed her heirs (she has three children) and stock-holding employees, who together constitute a majority of the company’s equity holders, that they must always vote their shares in favor of keeping Epic private. They must also ensure that Epic is run by an executive who already works for the company, and that that person is a software developer.

That decision-making may not occur for a while. It’s “more likely that I’d die than that I’d retire,” she said.

The Waterfall conference room.CreditLauren Justice for The New York Times

We talked about her “10 commandments” and other principles for doing business, which are hung in most public spaces around campus and discussed in detail at the monthly staff meetings. Ms. Faulkner said that staying private ensures the company can make decisions without public shareholder pressure — such as forgoing revenue when a client’s facilities are damaged by severe weather and it can’t afford to pay software maintenance fees for a time. Avoiding both debt and budgets is another Faulkner goal. But she leaves the enforcement of these principles to lieutenants, preferring to focus on software and customer relations.

“I look at our financial information maybe for a minute a month,” she said.

One criticism that has dogged Epic is that its software sometimes won’t connect with that of competitors, meaning that patient information can’t move around as seamlessly as it should. The company has chipped away at the problem in recent years, but much remains to be done.

“The problem isn’t the lack of effort, it’s the lack of standards,” said Jim Turnbull, the chief information officer for the University of Utah system and a longtime Epic client. “Until the federal government and all the vendors recognize that we have too many standards, I just don’t think it’s going to be possible to completely interoperate,” he said, using the industry term for connectivity.

The day after meeting with Ms. Faulkner, I took a final tour of Epic with its head of media relations, Meghan Roh, who was hired in 2017 as the first person ever to occupy that position. We went down a slide connecting the ground floor of a building called Heaven, with a white interior, to a lower level with an elevator whose floors were marked Devil, Satan, Lucifer, Beelzebub and Mephistopheles. (When you press a button, you hear audio of an imaginary demon saying, “Please come in. It’s nice and toasty in here.”)

Emily Sakaguchi, 24, demonstrated a slide between floors in a building called Heaven.CreditLauren Justice for The New York Times

Underground is also where you’ll find Epic’s auditorium. Built partly to preserve the sightlines on campus and minimize water and waste runoff, the gathering place hosts the Verona high school’s annual graduation ceremony as well as Epic’s monthly staff meetings, at which attendance is required. On the way in, employees are served popcorn and coffee, an homage to an earlier point when the company used movie theaters for large meetings, and shown a reel of pictures of recent staff weddings, newborn babies and beloved pets. Then they hear presentations on new products and priorities, matters of company philosophy, and new “armies” being formed for employees to brainstorm software-based solutions to epidemics like the opioid crisis and maternal morbidity.

Workers who fully commit to Epic — who survive the long hours and grisly sights — are treated to a remarkable perk. After five years, they get a sabbatical, including round-trip airfare for two to travel somewhere they’ve never been for a month, plus a per diem for meals and lodging. (They get another sabbatical after 10 years, 15, and so on.)

Epic is constantly scanning the undergraduate ranks for new hires. Rather than sticking to engineer incubator schools like M.I.T. or Stanford, it scouts institutions like Carleton College in Minnesota and Clemson University in South Carolina. Candidates take online tests to gauge their problem-solving skills and, if they pass muster, are whisked to Madison for an on-campus interview and tour of the area.

Once on board, employees take a multiweek training course that includes basic business etiquette as well as Epic-specific skill building. Officials preach a flat structure in which it’s never O.K. to turn down colleagues for help. They also teach a tactic called “badgering” — remember, it’s Wisconsin — or the art of being persistent but not maddening.

Epic’s broad recruiting strategy and perks help draw people in, but over time, it’s the cultures of both Wisconsin and Epic that help keep people there.

“The only reason I left Epic was so that my family could move out West,” said Mr. Webb, the former Epic programmer. “Every day was different. And it was fun. And just being able to go see the impact you were having, that was really, really cool.”

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