Vanderbilt CIO: When customizing an EHR, don't get 'hyper-focused on the tech'

Customizing an EHR can be a large endeavor for a hospital, so it is vital that everyone using the technology is onboard and involved in the process.

Neal Patel, MD, chief health information officer at Vanderbilt University Medical Center, has helped lead various EHR customizations at the Nashville, Tenn.-based health system. During these types of projects, Dr. Patel considers the people and the process aspects to be equally important as the technology itself.

In January, Dr. Patel assumed his role as vice president of health IT and chief health information officer at VUMC. He has worked at the health system since 1997, serving in various leadership roles including chief medical informatics officer.

Here, Dr. Patel discusses some of his EHR experiences at VUMC as well as his advice for health systems looking to roll out a customization.

Editor's note: Responses have been lightly edited for clarity and length.

Question: What is one recent initiative you've taken to customize your EHR system?

Dr. Neal Patel: We leveraged our self-deployed, real-time alerts platform and our informatics capabilities with patient data stored in our health data repository to quickly identify patients with a new blood stream infection and a cardiac implant. Often, implants are not easily tracked in the EHR, but we are able to use natural language processing to review all text documents, PDFs and discrete data in a patient's record to pull any evidence of presence of an implant. 

Q: How does this EHR customization benefit patients?

NP: One example is a patient we had recently who had a blood culture turn positive, which put him at additional risk for complications since he had a cardiac pacemaker. His problem list in our commercial EHR, however, didn't discretely denote he had the device — but the care team was quickly alerted of both the infection and increased risk due to him having an implant when our HDR auto-reviewed historical data from various sources, and we were able to amend our care approach on the spot. This is a great illustration of marrying in-house innovation with the best third-party tools that are available.

Q: What advice do you have for other hospitals looking to implement an EHR customization?

NP: I'd strongly encourage that other hospitals do not get too hyper-focused on the technology itself and overlook the importance of people and process. Customizing an EHR requires a great deal of engagement with the providers, nurses and other people who will actually use the technology — did they have input into the customization process? Will the customizations make their work lives better and help them take the best care of their patients? Are they ready for the changes that the customizations will bring from a process standpoint? Often the people and process aspects of the equation require even more energy and focus than the technology.

Q: How do you promote innovation among your team members?

NP: We look for every opportunity available to connect our IT team members with our users throughout the medical center, from shadowing a provider, to sitting beside a patient care specialist who's checking in a patient, to watching a nurse discharge a patient from the hospital. These interactions can create those 'ah ha' moments where an analyst sees an opportunity for improvement.

Q: What has been one of your most memorable moments as CIO?

NP: In a single morning, we launched a whole new EHR across our entire medical center, which impacted three hospitals, hundreds of clinics, more than 135 physical locations and nearly 18,000 employees. Those first 24 hours were incredible, seeing everyone come together: our technology team members fixing bugs and making tweaks, our support staff helping their colleagues get accustomed to the system and our hospital leaders triaging and prioritizing issues. It was challenging and invigorating and humbling — I'll never forget it.

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