Beyond the core Electronic Health Record

Hospitals have been either implementing or replacing their core electronic health record (EHR) in recent years. The work has included the entire suite of applications that make up the revenue cycle, patient access, and advanced clinicals in both inpatient and outpatient settings. But as we look beyond the core EHR, there is much more potential for technology.

This week at UMHS, clinicians and staff did a two day “deep dive” into the next group of applications as we move forward with our EHR. Teams from transplant, anesthesiology, radiology, cardiology, and home care reviewed Epic’s capabilities so we can decide what will be included in our next phase of work – what we call MiChart Stage 4. These important assessments require an in-depth review of current capabilities, and an understanding of the product roadmap.

Organizations that pursue a primary integrated vendor strategy rather than a “best of breed” approach face a challenge with departmental systems. This is particularly true in academic medical centers like ours. Departmental systems may have been internally developed with very custom, unique functionality or be a cluster of interfaced vendor products that each support a specific area of the department’s work.

We have been guided by some principles since the early days of our MiChart project that reinforce a primary integrated vendor strategy:

  • The primary vendor strategy for applications is supported throughout the organization
  • Departmental information technology project priorities are institutionally governed
  • The enterprise strategy for clinical and administrative information systems supersedes local preferences

So, when we make decisions and tradeoffs with departmental systems, we keep in mind the overarching goal – a comprehensive, longitudinal, integrated EHR that works in all care settings.

In another month, many from UMHS will be attending Epic’s annual user group meeting – UGM. We will learn from Epic experts and colleagues from other organizations how to fully leverage what we already implemented and what’s coming yet. I look forward to the “Cool Stuff Ahead” session when we will hear what new functionality is in upcoming releases, and what is in the R&D stage.

I’ve encouraged UMHS executives to attend UGM this year. It’s time for them to start connecting with their C-suite colleagues and learn about what’s coming so we can fully leverage our Epic investment. Last year, we heard about new modules such as dental, orthopedics, dermatology, and dialysis. We also heard about a bedside module that runs on an iPad given to the patient. It informs them and their family about their schedule and care team, assists with pain management, as well as offering patient education. And we heard about additional functionality for the patient portal – maps/directions, health coach, text and video chat, mobile check-in, and mobile payment. This year I expect we’ll hear about planned integration with Apple HealthKit.

With more patient care moving outside the hospital, we need to capture data from monitoring devices into our EHR. Epic has a product that captures data in the patients home and is integrated with a number of home monitoring devices.

UMHS is the only health care provider in Michigan that sees patients from every county in the state so we need extensive telemedicine capabilities. Other organizations are using Epic’s telemedicine solution; reducing patient travel and enabling video visits between clinicians.

There are many players in the HIT market offering new niche solutions. But at the end of the day, they must seamlessly integrate with our EHR vendor. So its critical that we understand the capabilities that Epic offers, and leverage them to the extent possible.

Moving forward, we will look first to deploy additional Epic capability as part of the integrated EHR before we purchase and interface a third party niche product. We will develop our own internal solutions if there is a market gap or we are so far ahead of the innovation curve that we just cant wait.

The vendor market continues to evolve; technology innovation moves rapidly. As CIOs, we need to stay current, figure out where and when to jump in with pilots, and remember the need to eventually scale to enterprise level. What an exciting time to be a health care CIO!

11 thoughts on “Beyond the core Electronic Health Record

  1. Patrick on said:


    This seems like the right kind of approach. I haven’t been here that long (about 3.5 years), but I can see how having a different vendor for different needs has led to waste and confusion. Trying to report across clinical and billing information has been particularly difficult in the past. Our attempts to re-source the Data Warehouse feeds using Epic-sources instead of the various legacy systems of the past seems to be paying off, and it has made me appreciate the value of a single-vendor solution.

    • Sue Schade on said:

      Patrick, thanks for the comments from your vantage point on the data warehouse team. Another reason our primary integrated vendor strategy makes sense!

  2. Sherry Mason on said:

    Hi Sue,

    I agree that this is indeed an exciting time to work in Health IT. There are many opportunities to advance the IHI’s triple aim. I have no doubt that we will continue to successfully strike the right balance between cost, quality, and access through critical analysis of new technology and processes, interprofessional collaboration, and research. I’m pleased to be a part of the team!

  3. Chuck Marshall on said:

    Great post Sue! Slightly off-topic but relates to the capabilities of Epic is the MyChart integration available in 2014 for patients to track their health and exercise data using Fitbit and Withings. I can’t think of a better way to save on health care costs than to promote preventative medicine for the patients seen at UMHS. Given that UMHS sees patients from every corner of the state, this type of added features for our patients should enhance the overall patient experience and provide them with tools to help manage their health with their provider.

    • Sue Schade on said:

      Chuck, agree that integration with fitness sensors is something to pursue in the future as we focus on wellness of our patient population.

  4. Shon Dwyer on said:

    Sue, it was great to hear the constructive dialogue as the groups assessed the products available for MIChart stage 4. The move to an integrated, single system is never easy and I have been, and continue to be, proud of our IT and clinical groups in making principle-based decisions.

  5. Interesting perspective on the single vendor approach. Although, from an analytics perspective the EHR will never have all of a hospital’s data. There are always going to be other systems that have data that need to be assessed. This will likely grow even more as we start getting into genomic medicine for example. So, what’s your approach to analytics when not all the data will be in the EHR?

    • Sue Schade on said:

      John, good point. In general, we look to leverage Epic as far as we can. As part of our enterprise analytics roadmap (covers clinical care, education and research tri-partite mission) will be considering vendors for broad data warehouse/analytics capabilities knowing there are many more sources of data than the EHR.

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