To those outside of Vanderbilt University Medical Center, Nov. 2, 2017, may have seemed like any other Thursday, but to members of the Medical Center community, the day was full of anticipation and anxiety with occasional bursts of excitement.
In the early morning hours, activity inside the two command centers was buzzing. The two centers, one located in the Critical Care Tower to lead operational change, and the other located across campus in 3401 West End Ave., to oversee the more technical aspects of migration of the clinical IT platform, were charged with supporting the organization’s largest project to-date: the switch to a new electronic medical record (EMR) system — called eStar — that supports almost every aspect of the Medical Center’s clinical operations.
The more than 18,000 physicians, nurses and staff who used the legacy system, StarPanel, would begin to use eStar on the same day at the same time following months of intense training and preparation.
This month marks the one-year anniversary of VUMC’s transition to eStar, and, as expected, there have been challenges and successes along the way.
“Our Go Live effort was more difficult than most other Epic implementations, since we used a ‘Big Bang’ approach,” said Kevin Johnson, MD, MS, Cornelius Vanderbilt Professor and chair of the Department of Biomedical Informatics (DBMI) and senior vice president of Health Information Technology. “That meant we had every single possible issue, from the most simple to the most complex, arise at exactly the same time.”
The initial “Go Live” phase lasted roughly five weeks before the command centers closed and the enterprise transitioned into Stabilization, the phase where adjustments were made in eStar to ensure it was working as originally designed. Given the size and scope of the original implementation, Stabilization lasted several months, giving way to the current phase that began in August — Continuous Improvement. Entering into Continuous Improvement means that all major issues with the system remaining from Go Live have been addressed. The team can now focus on making eStar work even better.
“I think given all the moving parts of eStar and the size of our institution, the transition has gone quite well,” said Sharon Albers, MD, director of Pediatric Dermatology and assistant professor of Medicine and Dermatology. “The exciting thing is now that we are through the implementation phase, the institution is working on optimization and innovation to enhance the eStar experience.”
Although Nov. 2, 2017, is the day that will go down in Medical Center history, a lot of milestones have since been reached, including a 90 percent reduction in document scanning errors, a more streamlined process for checking patients into VUMC’s clinics, and a more closed-loop experience for referring clinicians.
Additionally, Vanderbilt’s patient satisfaction scores returned to baseline much quicker than anticipated, with only a single quarter — the quarter following Go Live — showing a slight dip in VUMC’s overall patient experience rating.
“Other health systems that have implemented Epic have seen more sustained impacts to their patient satisfaction scores,” said Paul Sternberg, MD, Vanderbilt’s Chief Medical Officer and Chief Patient Experience Officer. “Our relatively quick recovery is a testament to VUMC’s culture of service and our focus on taking the best care of our patients, even when we might be struggling behind the scenes.”
The eStar team realizes there is a lot still left to address to make the system function as desired, including the design of eStar’s InBasket messaging system, which created some immediate dissatisfaction among users and continues to experience a high volume of unread messages.
“There are a lot of things you can’t really test and train people on until the system is live and they’re actually using it, and I think the messaging system is a great example of that. It was hard to share with providers how this new messaging system was going to interact with their workflow,” said Travis Osterman, DO, MS, assistant professor of Biomedical Informatics and Medicine and assistant clinical director in VUMC’s Office of the Chief Health Information Officer (CHIO).
“StarPanel benefited from having decades’ worth of provider input, so we came into this from a culture that was communication-heavy, having come from a system that was tweaked and fine-tuned to our providers. Epic deals with its messaging differently than what we were used to, so that culture shift was really challenging.”
According to Osterman, roughly 130 issues were identified with the messaging system following Go Live, ranging from quick-fix bugs to longer-term design flaws. Approximately 70 of those issues have been resolved.
Another heavy lift over the last several months has been implementing a sustainable support network to ensure colleagues are getting information on updates, receiving help when they need it and participating in ongoing education. The eStar Representative and Clinician Champion program launched in stages over the last few months, though it took longer than expected to come to fruition given its scope and complexity.
“This collaborative network does more than just support our users, though that is a core part of its mission,” said Neal Patel, MD, MPH, professor of Clinical Pediatrics, associate professor of Biomedical Informatics and VUMC’s newly named Chief Information Officer for HealthIT. “Our Champions and Representatives also prioritize issues at a local level, so they can bring up through our governance process a list of items that are most important to them. It’s so much easier to map out our Continuous Improvement work when we know what’s most pressing for each area.”
Other areas of continued focus include the collection of consents for procedures, ongoing payer denials and the process for medication reconciliation.
“One of the great features of eStar is this incredible level of transparency we now have. We’re understanding better than ever where we need to make improvements,” said Marilyn Dubree, MSN, RN, Executive Chief Nursing Officer. “For example, we’ve known for years our medication reconciliation efforts needed to be tweaked, but eStar’s detailed reporting helped us understand exactly where we had to focus our efforts.”
“We certainly haven’t worked out all the kinks with the system, but I think we’re getting there, and we’re moving closer to a phase where we’ll be able to do some innovative and fun things with it,” said Osterman.
“To me, changing an electronic medical record was like this: I had been playing the piano for years, and I got pretty good at it. Suddenly, one day, my piano was taken away, and I was given a violin to play,” said Sara Horst, MD, MPH, associate professor in the Division of Gastroenterology, Hepatology and Nutrition, who has worked at Vanderbilt for 10 years. “It takes a while to learn. All while we are still trying to give great medical care. Thankfully, we have a great team that came together to work through issues.”
