Vanderbilt University Medical Center (VUMC) has announced an agreement with Epic Systems Corp., a privately owned health care software company based in Verona, Wisconsin, to provide key clinical, administrative and billing software to the Medical Center.
In November 2017, staff and faculty will switch to Epic software for medical record-keeping and clinic workflow, ordering of tests and treatments in hospitals and clinics, hospital scheduling and admissions, nursing documentation, medical management of surgical patients, outpatient prescribing, medication administration, (non-retail) pharmacy management and hospital billing.
Patients also will begin a transition to Epic software in order to continue engaging with their health care team and clinical information via the My Health at Vanderbilt patient Web portal.
Other applications to be covered by the agreement are yet to be determined pending a more detailed review of information technology needs across VUMC.
Vanderbilt sought new software because in March 2018 McKesson Corp. will stop supporting applications VUMC currently uses for hospital clinician order entry, nurse documentation, medication administration and pharmacy management.
Leaders say the agreement with Epic signifies a momentous transition at VUMC, which will result in a more integrated, efficient and mature information systems environment.
Most of the major clinical systems in use today at VUMC were developed here. Vanderbilt is among a handful of institutions that have pioneered biomedical informatics and health information technology over the past 25 years.
Meanwhile, the health care IT industry has evolved, and for centers like VUMC, commercial software can appear much more availing than it used to.
Kevin Johnson, M.D., professor and chair of Biomedical Informatics and Chief Informatics Officer, stressed that IT innovation will continue at VUMC, and none of the prized functionality developed here need be lost in the transition. Also, under the agreement, innovations arising at VUMC may be incorporated into Epic software in general release.
At VUMC, “We’ve had an innovation agenda that was catalyzed by having access to and ownership of the clinical data, and an information model that connected the data to the workflow, and we will be preserving that level of access to data and workflow. All the data from our new electronic health record will be available to us outside the vendor product,” Johnson said.
“We’ve been pioneers forever. I see this transition as an opportunity for us to start to mature as an organization around the technology that underpins all our work, while being pioneers, ideally working with Epic, addressing present and future challenges in health care.”
The prospect of directly influencing Epic software in wide release appeals to Warren Sandberg, M.D., Ph.D., professor and chair of Anesthesiology. Over nearly two decades, his department has developed the Vanderbilt Perioperative Information Management System, or VPIMS.
“In recent years we’ve begun to excel with VPIMS at real-time automated process monitoring and process control, that is, anticipating surgical patient needs or care team information needs and automatically cueing them about what to do next. It’s time to fully incorporate this functionality into a commercially viable product,” he said.
This year some 700 staff and faculty participated in a review of information systems needs at VUMC, and helped assess how well these needs matched the capabilities of two prospective vendors: Epic and Cerner Corp. The clinical laboratory uses, and will continue to use, software from Cerner; and Epic software has been used here since the mid 1990s for clinic scheduling and professional billing.
Leaders call the upcoming transition Clinical Systems 2.0, and its guiding principles include reducing unnecessary variability of tools and processes across clinical areas, streamlining workflows, enhancing care coordination, supporting patient engagement and reducing redundancy and wasted effort.
“This will allow us as an organization to evaluate what our workflows are and where we have opportunities to improve efficiencies and reduce variability, while enhancing both the patient experience and the user experience. It’s a big opportunity for us to think differently about how it is that we do our work,” said Titus Daniels, M.D., MPH, MMHC, executive director of Vanderbilt Medical Group.
Decades of intensive clinical IT development have led to a degree of excess variability of tools and workflows across different clinical areas at VUMC, said Neal Patel, M.D., MPH, chief medical informatics officer.
“We’ve had multiple different systems that require a lot of connections, which at times for certain workflows have been very clunky. This is our opportunity to begin to reduce variability that’s unnecessary and was a distraction to how we deliver care,” Patel said.
According to Executive Chief Nursing Officer Marilyn Dubree, MSN, R.N., the transition will aid clinical communication, collaboration and patient safety.
“Having a more integrated platform will allow the inputs that nurses make in the medical record to be seen much more easily by all members of the health team.
“Things learned in the clinic visit prior to admission can be seen on that admission without the effort that we have to make today, and things that happen between nursing handovers or clinician handovers can be seen without all the extra work steps that people go through today,” Dubree said.
Benefits of the transition are also expected to extend beyond clinical care.
“We’re also now going to take advantage of a vendor platform that allows us to have an integrated workflow from front-end clinical care delivery through back-end business processes. Fundamentally we’re going to have a much better integrated clinical and revenue cycle system,” Patel said.
People at Vanderbilt have long talked about consolidating the billing statements sent to patients.
“This will take us from two billing systems to one, and one consolidated billing statement for hospital and professional services for our patients,” said Cecelia Moore, MHA, CPA, associate vice chancellor for Finance.
Early next year some 130 staff and faculty, mostly from HealthIT, will begin traveling to Wisconsin for Epic training.
Vendor selection was led by Daniels, Dubree and Patel, coordinated by HealthIT’s Eric Boehme and Mark Ciampa, and assisted by DeLoitte Consulting.
VUMC is seeking Clinical Systems 2.0 Ambassadors. Staff and physicians volunteering for this role will learn about the transition and help usher it in.
For more information, visit the CS 2.0 website (employee login required).
