On the morning of Nov. 2, 2017, the development of health information technology at Vanderbilt University Medical Center took a major turn.
VUMC, which has one of the largest biomedical informatics departments in the country, had also for many years been recognized as a leader in clinical informatics — the application of computer science and information science to the delivery of health care services.
“The primary idea driving clinical informatics is that we should use computerized information systems to help people make better clinical decisions,” said Adam Wright, PhD, who joined Vanderbilt last August as director of clinical decision support and the new Vanderbilt Clinical Informatics Center (VCLIC).
“Systems can be engineered to take all the data we’re collecting on patients and efficiently spot patterns and likely pitfalls. Then we can issue, within the clinical workflow, appropriate alerts, reminders and tailored clinical recommendations.”
Wright, professor of Biomedical Informatics, was formerly an associate professor at Harvard and clinical lead for clinical decision support and informatics at Boston-based Partners HealthCare.
In the early 1990s, to advance clinical decision support at VUMC, faculty and staff created and began continuously upgrading medical record-keeping and order-entry systems used to support inpatient and outpatient care.
By 2017, an industry had rapidly grown up around health IT. Electronic health records (EHRs) had been adopted by 99% of large non-federal hospitals and 86% of U.S. office-based physicians.
At VUMC on that November morning in 2017, key decision support systems were shut down in favor of commercial software from Epic Systems Corp., based in Verona, Wisconsin.
VUMC is among several clinical informatics leaders that have abandoned homegrown systems in favor of software from Epic, which, according to KLAS Research, as of 2018 had a 28% market share with respect to EHR systems used in U.S. acute care hospitals.
Out of the box, Epic systems provide only a basic level of decision support, but Epic gives hospitals tools to augment this support as they choose. VUMC has continued to maintain ample in-house resources for devising, implementing and governing clinical decision support.
“In leaving behind our prized legacy systems in favor of commercial software, we’ve reaped all sorts of benefits. And what helped to clinch our decision was knowing that we would retain the ability to push clinical decision support in new directions at VUMC, while also perhaps more directly influencing how commercial decision support systems are engineered,” said Kevin Johnson, MD, MS, chair of the Department of Biomedical Informatics and informatician-in-chief at VUMC.
“With the recruitment of Adam and the establishment of VCLIC, we’re adding still more support for clinical informatics, ensuring that Vanderbilt continues to lead in this field.”
Through VCLIC Wright will seek to promote and support optimum collaboration in clinical informatics at VUMC.
“One main goal of VCLIC is that people throughout Vanderbilt, when they have an idea or innovation that involves clinical informatics, will feel that Vanderbilt is the place to do it, that they’re going to have the resources that they need to do it and they’re going to succeed,” Wright said.
“People here have a lot more control than they may realize over how Epic works in our hospitals and clinics. If there’s something we don’t like about how Epic is working, in most cases there’s a step that we could take to change the way it works, to align more with what we wanted to do.”
Wright is enthusiastic for the task of advancing clinical informatics at VUMC. He speaks eagerly of collaborating with clinical teams and clinical quality and risk management departments and spreading innovation beyond Vanderbilt by assisting faculty with projects that can lead to research publications.
“With Epic we’ve achieved one dream, which was the adoption dream, and now we want to achieve the next phase, which I’d say is the effective use dream. Epic systems give us a platform to do things we could never do before in terms of decision support and learning from the data,” Wright said.
Programming for decision support at VUMC is provided by Health IT. Wright has been working with Health IT to understand their work processes. He’s also working to develop new channels to allow users to give more ample feedback with regard to decision support.
“One of the things we need to do is identify the subset of decision support we have right now that is unhelpful, or distracting, and turn it off or retarget it or improve it so that people are less annoyed by the large volume of alerts they may be getting,” he said.
For more information visit the VCLIC website.
