On Jan. 15, an information systems glitch rendered Vanderbilt Outpatient Orders Management, or VOOM, temporarily unavailable for some users. Shubhada Jagasia, M.D., MMHC, medical director of the Eskind Diabetes Clinic, was among clinicians who suddenly had to return to using paper forms to order clinical labs, radiology and other diagnostic tests.
“I had new appreciation for the utility of VOOM when we had to revert back to the older system and the drawbacks associated with it,” Jagasia said.
VOOM has been under development at Vanderbilt for three years and approximately 100 clinicians have become everyday user-testers. It’s a feature of StarPanel, the innovative medical records and clinic workflow program developed at VUMC. Over the next 12 months, VOOM will be adopted by teams in clinics all across Vanderbilt University Medical Center.
Across the country, adoption of hospital and clinic provider order entry systems is being financed through a federal incentive program administered by Medicare. Provider order entry could help improve care and lower costs by delivering automated clinical decision support to clinicians as they write orders. Vanderbilt long ago helped pioneer hospital clinical decision support, creating a system called WizOrder, in use since 1995.
Besides writing orders for outpatient testing, clinicians use VOOM to order vaccinations, return visits and consults from other Vanderbilt clinicians, and to document diagnosis and procedure codes used for billing, clinic management and comparisons of quality, cost and safety.
Orders written in VOOM are not subject to the types of misinterpretation that can befall handwritten or verbal orders, and VOOM orders never lack the accompanying information sometimes needed by pathology or radiology to complete orders.
As VOOM goes into wider use, its clinical decision support features will develop and expand.
• When lumbar spine X-rays are ordered, VOOM will prompt the user to pick applicable items from a list of patient indications, and, scoring this response instantaneously, will either issue the order or suggest alternate tests that may be more appropriate.
• VOOM supports order reconciliation and tracks any overdue test results, giving Vanderbilt Medical Group (VMG) clinicians their first efficient means of checking whether orders are carried out.
• VMG clinics will use VOOM to implement order sets, which are lists of orders addressing specific patient problems, reflecting medical evidence or group consensus about best practice.
• Under a personalized medicine initiative, StarPanel medical records are automatically scored according to the likelihood that each patient will be prescribed certain drugs contraindicated for people who carry certain common genetic variants, and when the likelihood passes a threshold, VOOM suggests a genotyping order.
According to users interviewed for this story, the clinical quality improvement advantages provided by VOOM outweigh any difficulty clinicians may encounter adopting it in the exam room. The Vanderbilt Eskind Diabetes Clinic began using VOOM a year ago and has helped refine it for wider use.
“I think clinicians will find VOOM to be a valuable tool for clinical quality improvement,” Jagasia said. She estimates most providers will feel a time drain for the first two to three weeks, but after that they’ll gain time with VOOM.
“VOOM is a platform for clinical decision support, that’s where its chief value lies,” said another VOOM user-tester, internist Shane Stenner, M.D., M.S., instructor in Biomedical Informatics and Medicine. “It eventually could have a major role in supporting evidence-based ordering. For example, VOOM could eventually be able to prompt action by patient care teams when automated surveillance finds overdue testing or screening, overdue return visits or other gaps in care.”
In February the Adult Primary Care Center and the Digestive Disease Center will both begin using VOOM.
Supported by the VMG HITECH-Meaningful Use Department, the clinic-by-clinic VMG rollout involves a kickoff meeting with clinic leaders, group training for staff, one-on-one training for clinicians and ongoing support by technical staff embedded in each clinic.
The VOOM team is sizeable, including staff and faculty from Biomedical Informatics, the Informatics Center, VMG, the Center for Research and Innovation in Systems Safety, and Technical Systems Infrastructure.
