Vanderbilt University Medical Center will go live this Thursday morning with its new eStar platform, comprised of 25 different Epic modules, designed to support a more integrated clinical, administrative and billing infrastructure for the Nashville-based healthcare provider.

The list of Epic software VUMC is leveraging is staggering, covering every facet of the health system’s operations from medical record-keeping and clinic workflow to ordering of tests and treatments to scheduling and admissions, nursing documentation, medication administration, non-retail pharmacy management and hospital billing.

“We are actually replacing our revenue cycle for both inpatient and outpatient and our pharmacy system” among other capabilities, says Kevin Johnson, MD, senior vice president of health IT and chief informatics officer. “We are doing a very big bang across three hospitals and across two and a half million outpatient visits per year.”

VUMC’s eStar project, called EpicLeap, is the culmination of a two-year implementation effort and represents a dramatic departure for the organization, which has internally developed much of its health information technology over the past 25 years—including the StarPanel electronic health record.

“We are making a fairly significant change from a homegrown culture and a homegrown electronic health record to a much more industry standard of both,” adds Johnson.

Also See: Vanderbilt readies for transition to unified Epic software platform

Johnson acknowledges that the eStar journey began about three and a half years ago when McKesson informed VUMC that the vendor would no longer be supporting its Horizon clinical suite of applications used at the health system. In the end, the discontinuation of McKesson’s product line slated for March 2018 forced Vanderbilt to re-evaluate its HIT infrastructure and its overall direction.

“We had to either replace the Horizon suite of applications or look more critically at whether we could essentially upgrade our entire electronic health record infrastructure to one of the major commercial vendors,” observes Johnson. “We looked at Epic and Cerner very carefully and chose Epic.”

Although Johnson declined to comment on the total price tag of the eStar implementation, he said cost was a big factor in VUMC’s decision to go with Epic as well as the robust “community of users” that the vendor supports. Regarding the latter, Vanderbilt points out that eStar’s leveraging of the Epic EHR means it will be interoperable with the medical records used by hundreds of other hospitals.

“At the end of the day, what really excited me was that Epic as a vendor was much more open than people gave them credit for, and Epic as a company had much higher ratings of satisfaction among people who needed support from their vendor,” he adds. “We were intrigued by both what Epic had relative to what we had and where Epic was going relative to our vision.”

According to VUMC, eStar’s benefits—among other features—include:

  • Increased standardization of workflows and clinical documentation for hospitals and clinics that will improve the overall efficiency of care delivery, as well as simplifying communications with patients.
  • Consolidation of fees for hospital and professional services into a single bill instead of two, thereby simplifying payments for patients.
  • The ability of patients to go online to schedule clinic appointments, complete clinic intake forms, as well as submit updates to their medical records.

Neal Patel, MD, chief health information officer, believes the benefits of the new technology “will come from leveraging eStar to improve our ability to communicate amongst ourselves and with our patients utilizing an integrated system.”

VUMC’s patients who currently use the My Health at Vanderbilt web portal to communicate with clinicians regarding their care will see enhancements to the system—such as a new user interface and additional functionality—thanks to the implementation of Epic’s MyChart patient portal. Johnson says the goal over the next year is to have 100 percent of the patients who come to VUMC use the portal.

“The new system will allow patients to transition between specialty groups a lot more smoothly, and provides tools to engage the patient at an even higher level,” said Patel. “We may not achieve all this at go-live, but establishing this platform will allow us to springboard to the next level that Vanderbilt aspires to be.”

Significant preparations have gone into making eStar’s November 2 go-live event a success, not the least of which was taking 17 years-worth of EHR data and uploading it into an Epic production system. “Obviously, that doesn’t happen overnight,” comments Johnson. “And, on October 22, we completed the process on time of moving all future appointments—all appointments that were in our existing system with a date after November 2—into Epic.”

As of October 23, he notes that a command center—called the EpiCenter—is up and running which will operate around the clock to provide technical support to VUMC’s employees during the transition. Johnson contends that what will help the Vanderbilt staff is the fact that the organization has been using a previous system that in many cases was more complicated than the Epic software to operate.

Still, VUMC had to train 16,000 employees to use the eStar system, though 20,000 ultimately received such training even though it wasn’t mandatory. Further, regular go-live readiness assessment exercises were conducted to ensure a smooth transition.

Johnson credits VUMC’s development of an app—called Hubbl—for helping the health system deal with change management. “When you look at sites that have not had great success with an EHR install,” he says, “the biggest issue and the real common denominator was they did not have a pervasive communication structure.”

Available as a mobile app for both Android and Apple devices, as well as a web app, Hubbl was used over the past year to help keep VUMC staff connected to the eStar project in the form of an enterprise communication and task management platform through which they received the most up-to-date information, updates, as well as reporting, responsibilities, and training schedules.

However, Johnson says the November 2 go-live is just the beginning for eStar as Vanderbilt will undergo continuous improvement, while taking the first year after the transition to take stock of its HIT infrastructure and to maximize their investment in the system.

“We’ve long 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’ll be preserving that level of access to data and workflow,” he concludes. “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 healthcare.”

Nonetheless, Johnson asserts that “Epic is a part of our architecture, but it’s not all of our architecture” insisting that VUMC will maintain its independence from the HIT vendor, noting that “we call it eStar not Epic” and that “all the data from our new electronic health record will be available to us outside the vendor product.”

In particular, he emphasizes that even with the transition Vanderbilt will “continue to have a vendor-neutral repository that we can build against” and that “there is an entire world of data that is not in Epic that is a part of our electronic milieu.” In addition to Epic’s 25 software applications in eStar, Johnson points out that VUMC is “bringing up a number of our own innovations at the exact same time to support parts of the workflow that Epic didn’t support.”

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