Epic goes to Denmark
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Lost in translation: Epic goes to Denmark
For three years, a dour anesthesiologist and computer architect named Gert Galster tunneled in the electronic guts of Epic Systems, trying to convert the premier U.S. digital health software into a workable hospital management system for Copenhagen and the surrounding region.
It nearly drove him mad.
After Galster and his colleagues had done what they could, 45,000 clinicians in eastern Denmark were plunged into the Epic system. Like the U.S. Department of Veterans Affairs, the Danes had expected that tech from a big IT vendor would make it easier for doctors in an excellent health care system to work, share patient information and keep tabs on costs. But the Danish experience produced results that varied from frustrating to disastrous — a sobering lesson for the VA, which recently began a transition involving another big vendor.
The problems were evident from the start. Epic’s medical terms were not tagged for easy translation, so Galster and his colleagues had to rely on Google Translate. There were howlers. “C-section,” in the Danish version, referred to an executive suite, not an emergency birth procedure. The American specialty “speech and language pathologist” does not exist in Denmark. The Danish system for a short time offered surgeons the choice of amputating the left leg or the “correct” leg.
The translation problem went deeper than mere words, said Galster, one of 350 hired for the $500 million implementation of Epic in eastern Denmark. Epic might work in the United States, he thought, but its design was so hard-coded in U.S. medical culture that it couldn’t be disentangled.
“When you open the hood in the Epic system, it plays 'U.S.A, U.S.A, U.S.A,'” he said.
