A decade ago, many academic medical centers built homegrown EHRs based on the innovative work of their own informaticians. Now, by and large, those same health centers use commercial EHRs from Epic or Cerner. Seeking to encourage continued innovation by informatics researchers and clinicians, a few years ago Vanderbilt University Medical Center (VUMC) created the Vanderbilt Clinical Informatics Center (VCLIC) as it made the transition to Epic.
Adam Wright, Ph.D., a professor of biomedical informatics at VUMC, serves as the director of VCLIC. During a May 21 presentation to the virtual AMIA Clinical Informatics Conference, he explained the thinking behind the creation of VCLIC and some of its goals and activities.
Wright, who directs clinical decision support operations at VUMC and previously served as clinical lead for clinical decision support and clinical informatics at Partners HealthCare in Boston, said that when systems such as VUMC and Partners maintained their own EHRs, they were able to develop their own tools such as computerized provider order entry, decision support, and adverse drug event warning systems. “It was not just a partnership between operational IT and academic informatics because they were almost the same thing,” he said. “It was a golden era of informatics, and then all of a sudden it changed.”
VUMC made the switch to Epic more than two years ago, and a lot has changed, Wright said, much of it for the good. “Before, we had the source code and could do whatever we wanted with it,” he said. “Epic works with us to extend the EHR’s capabilities, but it is not the same as possessing the source code on your own.” He said they have had to address questions about intellectual property if VUMC makes something cool. Would the vendor own it? Could VUMC commercialize it? There were also concerns over showing screen shots, but he said those have mostly been worked through.
Another good thing is that now there is someone else dealing with regulations and certification requirements. Wright said that with its homegrown EHR, VUMC spent so much time keeping up with requirements that they almost didn’t have time to do innovation and research. “We have turned that work over to Epic, and our researchers can focus on innovation,” he said.
Another benefit, he said, is that sometimes when they would present about innovations in their system, people would see it as an “ivory tower” creation because these leading health systems had many more resources to play with. But now VUMC is on the same EHR as a majority of people, so their work is more representative of the community. They can disseminate innovations in places such as Epic’s App Orchard.
VUMC realized, however, that there was a need to learn new ways of interacting and structuring work in the organization, and VCLIC was born as a place where people using the EHR to innovate or do research projects can collaborate and get help. “It is a place where people can get data out of the EHR or build an app or visualization and put it back into the EHR. We have lots of representation from across the organization, with people from every clinical department,” Wright said.
As its website states, VCLIC coordinates clinical informatics activities across VUMC and is working to "pave the road" for clinical informatics researchers and practitioners, ensuring that faculty, students, and staff throughout Vanderbilt find it easy to access data, test innovations, and evaluate results. VCLIC also offers lectures, trainings, competitions, and funding opportunities for Vanderbilt informaticians.
Wright mentioned some key organizational goals. One is they want people who do applied and research informaticians to find it easy to get their work done. Some felt like they knew how to do things previously but “find it hard to crack the Epic nut,” he said. Perhaps they don’t know who to talk to in order to get access to data. “We want them to think, ‘When I have an idea or want to try something. VUMC is the place to do it.’”
Another goal is to make the people in VCLIC useful and a trusted source of advice to the overall VUMC organization.
VCLIC also seeks to bridge the gap between operational IT and researchers. “There were many cool projects being done in health IT but no formal way for them to be evaluated and disseminated,” Wright explained. “We wanted to build partnerships between IT and informatics staff,” he said, so innovations can be evaluated and disseminated.
One internal contest project he described, called “Clickbusters,” is designed to reduce the number of Best Practice Alerts (BPAs) that can lead to EHR burnout. Clinician leaders can go through a 10-step process to analyze BPAs, including surveying end-users and seeing whether they match current guidelines and then suggest changes. So far, Wright said, the Clickbusters have eliminated 184,00 clicks per week.
Training is also central to VCLIC. They have built a wiki-like Knowledgebase of how-to articles on topics such as how to build FHIR applications in the VCLIC sandbox or the steps required to get access to data in Clarity, the Epic data warehouse.
Wright concluded by noting that Epic can serve as a catalyst to help spread innovations from VUMC to its other customers. “We want to share good ideas. They offer a fast way to take a cool thing and get it out to the universe.”