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Vanderbilt to Make August Decision on New EHR

Vanderbilt University Medical Center's evaluation schedule of the two finalists for its new clinical informatics platform is on track for a late August decision.

Kevin Johnson, M.D., VUMC's chief informatics officer, recently posted online that Aug. 24 was Decision Day with either Epic or Cerner getting the nod, which he confirmed in an interview with Health Data Management.

"We are completely on time for the August-ish decision," Johnson said. He also said he did not consider the fact he publicly announced a target date for the decision as well as the two finalists to be particularly groundbreaking.

Also See: Mayo Clinic Selects Epic to Build Integrated EHR-RCM System

"If you're in the business, you kind of know who Mayo looked at or who the Department of Defense is looking at," Johnson said. "At this point, everybody is more or less saying which one of these two or three or four vendors will these large groups select, and it's usually fairly public pretty quickly when you're down to two."

As for announcing the target date for a decision, he said, "To not answer that question publicly essentially means I will be constantly answering it privately. This way, I've answered it and everybody else can find it – and maybe it will even help our vendors to realize that when we say we need to talk about something, they'll know the date they need to talk with us."

If there's anything the two finalists, and the health informatics community at large, should take out of the VUMC process, which Johnson called Clinical System 2.0, it's that he intends to enter the new relationship as a full partner in advancing HIT capabilities in ways he hopes go far beyond the VUMC organization.

"There were two vendors very clearly poised to both help us have a level playing field across Vanderbilt, meaning ensuring the same functionality everywhere you go at Vanderbilt, as well as to potentially be transformed by Vanderbilt," he said. "What I mean by that is both Cerner and Epic are terrific companies with strong leaders who recognize both what's right about their products, and where there are opportunities to innovate.

"I wanted to come at this from a position of partnership, that there really is an opportunity for us to work with one of these two companies, if they are so inclined to work with us, to fix some things that we are now experiencing nationally, in the spaces of documentation, medication management, and potentially with what we're thinking about with patient engagement. We have the opportunity to take one of these two groups, choosing open tools to the extent that's possible, and scale, nationally and internationally, some of the things we think can transform healthcare."

Such collaboration is nothing new at Vanderbilt; VUMC, after all, developed and licensed its WizOrder physician order entry system to McKesson for its Horizon Clinicals, which the new platform will be replacing, and much of its EHR technology has been developed in-house. As electronic records have become more ubiquitous, Johnson said it was time to adopt a new approach.

"We're among the last of the homegrown EHR environments," he said, "and while a great level of control is one of the secrets to the success we've had at Vanderbilt, it's also an Achilles heel because, like any vendor trying to do the right thing from a regulatory perspective, we're finding our ability to innovate is thwarted by the time we have to spend keeping up. What we want to do is stop having to manage the things that are now commodities."

Johnson said the principle of data liquidity – that is, the ability of users to utilize data that can be transformed from one state to another and back, remaining useable throughout – will be a foundational philosophy in developing new platforms. To that end, he said VUMC technologists will be addressing interoperability issues using emerging platforms such as Substitutable Medical Applications, Reusable Technologies (SMART) and Fast Health Interoperability Resources (FHIR).

He also said the selection process did not give short shrift to the patient experience. In fact, he said, because VUMC is self-insured, much of the feedback that has been received from the more than 600 employees surveyed about what they would like in the new EHR has been offered from their points of view as patients.

"One of the most pressing examples was, people said 'We work here and we can't schedule our own appointments, you would think that it would be easier to make appointments at the place where you work,' and I listen to that. It will absolutely impact our patient-facing side."

While VUMC has settled on the two finalists, Johnson also said that its overall evaluation of the EHR landscape in arriving at the final contenders has heartened him as to the overall progress of HIT.

"What's been surprising is that, as a regular attendee of HIMSS and a member of the board of Tennessee HIMSS, and obviously a pretty active member and leader of AMIA, I really felt the gap between what we have at Vanderbilt and what a lot of the vendors are now selling was bigger than it is. Frankly, I really congratulate the community, because so much of what we've talked about in informatics in the last decade has really turned out to be available in some form or another in all the products that we looked at."

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