Vital Engine Adoption Interview Notes

Current status of Vital Engine

• There isn’t any usage currently. The interviewee stated explicitly: "There isn't any. We don't use it at all. We had our faxes going through there. We tried to tried to make it work, but it just did not work for us."
• The physician services group at HCA Plano stopped using Vital Engine, and there was a contract with HCA Plano that had been in place but encountered issues. The plan now is to start using Vital Engine again on a larger scale due to a new, bigger contract with HCA Plano.
• The re-adoption is framed as a return to broader usage across multiple service lines, after past limitations.

Why Vital Engine didn’t inhibit workflow initially and what changed

• Original problems centered on workflow fit and adoption, not only on the platform’s technical capability. The service lines had licensed Vital Engine for only three offices, focusing on two specialties: surgical oncology and orthopedics. Demographics and referrals from other areas (e.g., family practice) were not driving usage initially.
• The main issue was not just whether Vitual Engine could be used, but whether other offices would be willing to adopt it. If staff would have to enter data into multiple platforms, the value diminished. The answer given: many offices already used other platforms; staff had to input data repeatedly.
• Specific problem: there was no smooth interface setup between eClinicalWorks (the EMR) and Vital Engine. Staff at the client site had to enter data into ClinicalWorks, then into Vital Engine, then into LeadingReach. This multi-system data entry created friction and reduced adoption.
• Attempts to promote adoption included QR codes and physical cards with QR scans to direct referral sources to use the system, but after ~18 months of effort (noted as a long period), no meaningful traction was achieved.

Current referral workflow (what works now)

• The client uses the eClinicalWorks EMR for referrals, with most referrals arriving via fax.
• There is a P2P (peer-to-peer) transfer system with eClinicalWorks that can transfer information automatically to a patient’s chart and appear as a referral rather than a fax. This is a key component of the intended Vital Engine integration, but it did not materialize in practice.
• The interviewee confirmed the intended interface between eClinicalWorks and Vital Engine would streamline referrals into the EMR, but it never occurred as implemented or operational during the pilot.
• The current setup supports referrals entering eClinicalWorks via P2P, and the organization relies on these existing channels rather than Vital Engine.

Licensing and service-line strategy

• The initial approach licensed Vital Engine for only $3$ offices. The specialties funded were Surgical Oncology and Orthopedics.
• Those two specialties are typically fed by other sources such as Family Practice, internal medicine, GI doctors, and oncologists. The misalignment between where referrals originate and where licenses were funded hindered adoption.
• The prioritization issue: without uptake from hospital-based and primary-care offices, the benefits of Vital Engine could not be realized. The observed workflow problem was that the doctors who would benefit most (e.g., hospitalists, ER doctors) were not using Vital Engine.
• The client notes that hospital referrals constitute a large proportion of their referrals. They emphasized that if hospitals (particularly the ones involved in the contract) are not using Vital Engine to send referrals, the system cannot deliver its intended value.

Interface and workflow gaps in detail

• Interface gap: The interface between the EMR (eClinicalWorks) and Vital Engine was never set up properly, causing staff to input data into multiple systems (ClinicalWorks, Vital Engine, LeadingReach) instead of a single streamlined workflow.
• Operational gap: Even with QR codes and referral-source cards, uptake remained low because offices already had workflows and platforms, and adopting Vital Engine would require changing established processes.
• Workflow fit issue: It was not viable to push Vital Engine on offices that were not ready or willing to adopt it, especially if staff were required to duplicate data entry.

Complete referral package and data requirements

• The interviewee defined a complete referral package as including:
  • Demographics (full demographics)
  • Copy of the insurance card
  • Driver’s license
  • Medical records
• For an HMO referral, an authorization number is needed.
• These elements would need to flow into the EMR (eClinicalWorks) and be readily accessible for clinicians.

One key problem Vital Engine could solve (if it could): core pain point

• The primary pain point identified was the data transfer into eClinicalWorks without staff having to manually input all data across multiple systems. In other words, an interface that would seamlessly populate patient demographics and referral information into eClinicalWorks without extra data entry by staff.
• The interviewee acknowledged that even if Vital Engine solved the data transfer issue, adoption by other facilities was essential for real value. If hospitals and clinics aren’t using it, marketability and scalability suffer.
• The dual challenge is (1) achieving a true EMR interface, and (2) achieving broad adoption outside the organization (marketing and onboarding across service lines).

Marketing attempts and adoption barriers

• Marketing attempts included a dedicated marketer working with offices and distributing QR cards; this effort lasted for about $18 ext{ months}$ and did not yield adoption.
• The market approach needed to demonstrate tangible workflow benefits for external referral sources to switch from existing platforms to Vital Engine.

Key contacts and upcoming touchpoints

• Randall Lowe — Director (mentioned as a point of contact who has been connected with the client; he has previously introduced the client via email).
• Sarah Utech — another key contact mentioned; the client has previously communicated with her about Vital Engine usage and its limitations.
• Judy — IT contact, the person the interviewer plans to coordinate with for scheduling.
• Upcoming meeting in Texas: Randall Lowe and Sarah will visit on $17^{ ext{th}}$ and $18^{ ext{th}}$; the client is available on the $18^{ ext{th}}$ at $09:00$ (09:00 AM). The plan is to include the director Sarah in the meeting.
• The client’s calendar note: the 17th is unavailable due to jury duty; the 18th is acceptable.
• The interviewee is coordinating to confirm schedules and would send an email confirmation; they plan to have a short, 9:00 AM meeting to provide a general update.

Specific operational and strategic insights discussed

• Hospital referrals: A large share of the client’s referrals come from the hospital. If the hospital (HCA) implements Vital Engine, hospitalists and ER doctors should be using it to send referrals to the clinical teams. This is seen as a critical enabler for broader adoption.
• If hospital adoption occurs and Vital Engine is used by multiple facilities, adoption across the area would increase, creating a positive network effect that would help overcome initial resistance.
• The client emphasized alignment with hospital referral flows as essential to achieving the intended benefits of Vital Engine.

Summary of implications and next steps

• The major blockers are: lack of a seamless EMR interface, multi-system data entry workload, and limited uptake by external offices and hospital-based clinicians.
• The new engagement with HCA Plano and the plan to deploy Vital Engine across more service lines could overcome prior adoption barriers if the implementation includes:
  • A robust EMR interface with eClinicalWorks (reducing or eliminating double data entry).
  • A targeted onboarding program for hospitals and hospitalists/ER physicians to start using Vital Engine for referrals.
  • Clear demonstration of the complete referral package workflow to ensure referrals are comprehensive and usable.
• The next concrete steps include: scheduling a 9:00 AM meeting on $18^{ ext{th}}$ with Randall Lowe, Sarah Utech, and Judy, to brief on updates and align on next actions; the goal is to finalize a plan for hospital-based adoption and scale across service lines.
• The interviewee committed to sharing the update with Randall and pushing for alignment across the organization to enable Vital Engine adoption, especially in the hospital referral stream.

Notes on related entities and context mentioned

• HCA Plano: Previously contracted with Vital Engine; there were issues that led to cessation, now returning with a larger contract intended to drive widespread usage across multiple service lines.
• Other platforms mentioned: LeadingReach (the client used this platform in addition to eClinicalWorks and Vital Engine); the lack of an integrated workflow across ClinicalWorks, Vital Engine, and LeadingReach was a key frustration.
• Medical City: The interview included a comment that Medical City had approved something related to the initiative, though this was not fully explained in context. It suggests broader regional engagement and potential alignment with other health systems beyond HCA.
• Current referral method: Predominantly faxes routed into eClinicalWorks; P2P exists but the Vital Engine integration never materialized; the marketing and onboarding approach did not achieve uptake.