From the Society

Identifying the right database

Transitioning to Epic


Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-2018 year, offering two options for students to receive funding and engage in scholarly work during their first, second, and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.

Vanderbilt University Medical Center will be converting to the most common electronic medical record (EMR) systems used today: Epic. Until that time, Vanderbilt used a homegrown system to keep track of patient data. The “system” was actual comprised of a few separate programs that integrated data, depending on the functions being accessed and who was accessing them.

Ms. Monisha Bhatia

The advantage of a homegrown system is that it allows the institution more control with customization, but it was often cumbersome to deal with, as each add-on and upgrade was not always seamlessly integrated. In using a vendor EMR, the efficiency, appearance, and functionality may improve, but the disadvantages include all of the issues inherent in dealing with an outside vendor. The whole medical center is curious to see how our transition goes. Of course, we’re all hoping that “go live” goes without a hitch.

For many research projects across the hospital, including my own, we are going to be limiting ourselves to data from the time period when our homegrown EMR was functioning. This is thinking a few steps ahead, but it would be interesting to see if our model, once validated, performed similarly in a new EMR environment. Unfortunately, this is thinking a few too many steps ahead for me, as I will have graduated (hopefully) by the time the new EMR is up and running reliably enough for EMR-based research like this project.

The first step in our study was identifying the right database to use, and now the next step will be extracting the data we need. Moving forward, I am continuing to work with my mentors, Dr. Eduard Vasilevskis and Dr. Jesse Ehrenfeld closely. We resubmitted our IRB application now that we have identified how we can pull the data we need, and we identified a few specialized patient populations for whom a separate scoring tool might be useful (e.g., stroke patients). I am looking forward to learning the particulars how our dataset will be built. The potential for finding the answers to many patient-care questions probably lies in the EMR data we already have, but you need to know how to get them to study them.

Monisha Bhatia, a native of Nashville, Tenn., is a fourth-year medical student at Vanderbilt University in Nashville. She is hoping to pursue either a residency in internal medicine or a combined internal medicine/emergency medicine program. Prior to medical school, she completed a JD/MPH program at Boston University, and she hopes to use her legal training in working with regulatory authorities to improve access to health care for all Americans.

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