In the past, Vanderbilt University Medical Center has been in the dark ages with regards to the "paper shuffle." Patient records, clinical notes, test results, phone messages, physician orders, faxes, and many items were recorded and transmitted by paper. This process was not only costly, but very time consuming. Staff had to spend hours sorting, copying, transporting, filing, and managing records. Physicians had to take time away from patient care in order to complete all the paperwork necessary for continued patient care. In January 2002 staff and doctors within the department of Medicine began using a new system. The E 3, electronic by 2003, project allows physicians and staff to process paperwork on a computer network.

From office computers and other locations, a patient's record can be accessed through a web server. All the previously mentioned messages, notes, orders, and etcetera can be processed without paper. E 3 also connects and aligns with Vanderbilt's clinical improvement program in an effort to improve operations throughout the University Medical Center. Dr.

Jim Jirjis, assistant professor of Medicine and medical director of the clinic, and Dario Gi use, Ph. D. , associate professor of Biomedical Informatics both headed the project. Nancy Lorenz i, Ph. D. , professor of Biomedical Informatics and assistant vice chancellor for Health Affairs, was project director for E 3.

The E 3 system is still in the introductory phase of its life cycle. Although the technology is in place, Vanderbilt employs close to 30, 000 faculty, staff, and physicians, and residents. At present, all departments have not converted to the new system. The new methods and tools will be integrated into each department. The Adult General Internal Medicine clinic runs with eight attending physicians and seventeen residents.

Its entire suite is now processing all patient records electronically. This department will, of course, move ahead in the cycle as technology and knowledge advances. Since Adult General Medicine is the pilot department, advances and upgrades to the system will most likely be initiated there. For several years, Vanderbilt has used computer applications such as StarChart. The first step for E 3 and going paperless was to convert StarChart into a new application called StarPanel.

StarPanel allows the staff to retrieve patient information faster and in groups. It pulls information from three systems: StarPanel, Epic, and Med ipac. These applications are used for electronic retrieval of clinical information, outpatient scheduling, and hospital admitting and discharge. A Vanderbilt doctor can instantly retrieve data on all patients he has seen in the last year, patients with a specific diagnosis, today's clinic schedule, or any number of defined sorts and filter searches. In less than a few seconds, StarPanel can access a multitude of information and allow the decision making process become more efficient.

This process truly makes StarPanel indispensable and invaluable. The immediate benefit is that physicians and staff no longer need to request records and shuffle through stacks of paper to find patient information. A new route to creating patient registries and measuring practice improvement has emerged. This system mimics the old "paper world" process.

StarPanel tools take the place of eighty percent of written documents. The other twenty percent of the remaining documents must, somehow, be submitted into the database. The beginning phase includes hand scanning. Outpatient order forms, faxes sent to physicians, insurance inquiries, medical history, and a photocopy of the patient's insurance card are the remaining documents being scanned. The scanned data is then associated with the patient's records and are accessible through an interface in StarPanel.

At a later phase in the project, scanning documents should be eliminated completely. The idea of "going paperless" was not only one of efficiency, but also cost cutting. With a paperless system, Vanderbilt has the opportunity to begin reducing clinical record-keeping costs. Many hours are spent managing patient records, assembly, transport, and retrieval. The cost reduction will be achieved through labor cuts as well as decreasing paper supplies.

The projected labor savings is approximately $1. 7 million per fiscal year and the project will save additional millions in future years. As the project, now called E 5, continues, Vanderbilt is working to set up an outpatient electronic order system, an electronic dictation and transcription system, and to focus attention to inpatient areas. Computers have been ordered for all outpatient exam rooms that will allow immediate retrieval of patient information. Although physicians, in the near future, may not enter data into the computer while examining the patient, they will order tests and further exams while in the exam room.

Most physicians are currently using telephones for their dictation, but the goal will be for a system that will insert dictation notes directly into the patient's chart electronically. In order to manage this technology and change, Marilyn Du bree, Chief Nursing Officer, and Dr. C. Wright Pinson, professor of Surgery and Chief of Staff have been appointed co-leaders.

The co-leaders, along with the help of Vanderbilt's Department of Information Sciences will track the flow of the project through completion. By 2005, the E 5 system is expected to be in the latter introductory phase should begin moving into growth. More departments will be adopting this technology, as well as, other hospitals and healthcare facilities. As technology continues to advance, Vanderbilt must also continue to advance. The E 5 system may never reach its maturity because upgrades will continue to be installed and the system will be maintained. There is a possibility that years from now a much better technology may emerge, but at the present, Vanderbilt is trying to stay on the edge..