by Madison Agee
EpicLeap, a project that will transform patient care at Vanderbilt University Medical Center (VUMC) through new technology and processes, started in 2015 with a notification from a technology vendor. A few of the key pieces of software VUMC uses to currently provide care were no longer going to be supported by the vendor. Vanderbilt’s HealthIT team was then faced with a crucial decision — they could provide support for the software bundle themselves, upgrade to the vendor’s suggested replacements, or consider a totally different solution altogether. 
The first option was not ideal, as there are information security risks in supporting software that was not created in-house. The second option was appealing, as it was the “safe” choice and represented a moderate amount of work and the smallest volume of change for the Medical Center. But what if the decision-making leaders thought more boldly?
“Of course we needed to find a substitute for the applications that were being sunset,” said Kevin Johnson, M.D., Senior Vice President for Health Information Technology. “And there is some remarkable technology out there — a lot of which is designed to do so much more than the four in-scope applications. So we started considering replacing other pieces of software at the same time.”
The team’s first step was to take a close look at VUMC’s existing software system, made up of more than 500 applications. It had grown over the years as different areas and teams around VUMC had specific requests and needs, forming a complex patchwork of clinical and operational applications that provided the digital backbone for patient care at Vanderbilt.
At the heart of the system was StarPanel, an electronic health record (EHR) developed in-house by Vanderbilt engineers. StarPanel was much loved around the Medical Center, as it was built specifically for VUMC. It also benefited from continuous support and enhancements from the very team that created it, meaning that the possibilities for StarPanel’s utility were boundless.
“StarPanel was always in flux. We were continuously adding new features and fine-tuning things so it would do exactly what we needed it to do,” Johnson said.
Yet StarPanel’s dedication to VUMC was a double-edged sword: it existed nowhere else but Vanderbilt. This isolation made it difficult to share information with other providers, such as when referring physicians want to electronically transmit detailed medical records for a patient and have them instantly appear in the system.
It also meant that new faculty and staff who trained or worked in other health care institutions had a steep learning curve in front of them when it came to adapting to StarPanel. Conversely, clinicians who trained at Vanderbilt and went to other institutions would have to learn new systems wherever they went.
As VUMC becomes more of a destination for health care within the southern United States, this isolation increasingly presented an issue. “It was so important, as we were exploring our options, to really focus on solutions that would help us stay better connected to other institutions,” Johnson said.
In the end, the team selected Epic and its robust software solutions, largely because its software is used in many leading medical centers across the country. In fact, Epic is either currently in use or in the process of being implemented in 19 of the 20 top hospitals ranked by U.S. News and World Report. Furthermore, more than half of patients in the United States have a medical record in Epic.
“As an Epic institution, we will be part of a much larger community. We can collaborate with other providers on a patient’s care, in ways we never could before,” Johnson said.
An integrated system
This ability to now be part of the interconnected Epic world was just one of the reasons that VUMC selected the company as its technology partner. Epic also offers a wide range of software applications, all designed to work together. Epic will not only replace the four applications that were no longer going to be supported, it will also replace StarPanel as Vanderbilt’s core EHR.
In addition, Epic offered other applications that present attractive options for VUMC, including non-clinical modules that support functions such as scheduling and billing. In total, VUMC will implement 25 different Epic modules as part of the EpicLeap program. Built like a set of Lego bricks, these applications “click” together to form a cohesive whole.
The new Epic software means that VUMC can take a close look at all of the applications currently in its software system to determine which will be replaced by Epic, which will remain, and which will be retired altogether.
And just like the individual Epic modules fit together, many of the applications that will remain will have robust integrations with the new Epic software, sharing information in real time.
“Clinicians don’t need to have multiple windows open at once,” Johnson said. “In our new integrated system, lab and test results will appear in one system, even if they’re not created using Epic.”
The optimal design for VUMC
Epic’s off-the-shelf solutions are powerful and responsive, but they needed to be tailored for Vanderbilt, which resulted in a nearly year-long process of customizing all 25 applications just for VUMC. This process also presented a unique opportunity.
“Part of the configuration effort was reviewing workflows so they’d be reflected in the software design,” said Chris Costello, EpicLeap’s program director, referring to the actual processes and steps that VUMC employees perform as part of their jobs. “We now had the chance to update — and standardize — workflows throughout VUMC. So now the way a patient service representative checks a patient into a Bone and Joint clinic is the same way it will happen at a neurology clinic.”
But information technology team members could not make these decisions regarding workflows on their own, so experts from nearly every area of the Medical Center were recruited to participate in the critical part of the design process. These recruited employees had the deepest, most extensive knowledge of each of their respective areas.
“As we’re reviewing workflows and system design for Stork (Epic’s module for labor and delivery), you bet we want Vanderbilt’s most experienced L&D nurse in the room,” Costello said.
In all, more than 1,000 VUMC employees participated in this design process, working through multiple rounds of feedback and revisions to create the software that will work best for VUMC’s unique needs.
What happens after Go Live?
The intensive design process was a huge focus of the EpicLeap program for most of 2016, but January ushered in the testing phase of the project. Workflows, system design, content, integrations and more would all have to be thoroughly tested to ensure a smooth transition to the new system in November.
Known as “eStar,” a nod to the legacy of StarPanel and the future of Epic, the new system will also require a massive training effort to get 17,000 employees familiar with the new technology, as well as a detailed transition plan that governs the actual cutover process.
After this transition, which will take place in the morning hours of Nov. 2, the EpicLeap project does not immediately stop. “We’ll have an entire phase where we work through bugs and issues and stabilize eStar,” Costello said.
Then the project enters what is known as “optimization,” a period during which requests and changes that were not considered critical for a smooth Go Live are prioritized and implemented. Additionally, the team will review all new requests.
This review process, which will be governed by formal rules and groups of experts, will not only take responsibility for eStar, but all of the applications that integrate with it.
“With an integrated system as complex as the eStar galaxy, we have to consider every downstream implication of every change we make,” Johnson said. “Even a simple bug fix could have disastrous ramifications if we don’t do it right.”
Johnson and Costello — along with the rest of the EpicLeap team as well as the thousands of people who have been involved with the project to date — are excited for November’s transition.
“eStar represents the future of care at Vanderbilt,” Johnson said. “This will be a transformational experience for the Medical Center.”