TrialSite News recently covered UCSF’s configuration of Salesforce for a patient enrollment system.

TrialSite News staff interview Robert Krumm, an application developer for University of California, San Francisco. Robert, a software developer, was actively involved with the development of the Salesforce-based patient enrollment solution.

Mr. Krumm noted that in general many back-end transactional systems are highly mature and reliable—e.g. POS systems, etc. He included electronic medical records in that category.  However he emphasized that the next wave of software need—big data, analytics and artificial intelligence—are still in the early stages of true adoption. The developer reports that in many regards the back end, mature transactional system creators didn’t contemplate the way data would be required today. Hence, there is a lot more work than many think to truly capitalize on all of the technology in place—for example in a major academic medical center.

Academic Medical Centers—from the “As-is to the To-be”

Mr. Krumm described the reality that even with the advent of technology in the clinical or academic medical center context, the paradigm for the most part involves a physician looking through individual patient charts. So for example in the context of a clinical trial in most academic centers today this still involves a physician looking through each and every patient chart—whether paper-based or electronic—the result is still a lengthy and laborious process.  Moreover, in many institutions the common way to track information and collaborate among peers involves checklists in spreadsheets, emails, and generally manual list management. Physicians in major academic centers are incredibly busy.  If a clinical trial involves the recruitment of hundreds of patients the traditional approach to finding patients is no longer sustainable—the answer lies with integrated digital technologies.

Digitizing UCSF Urology Patient Enrollment

The UCSF researchers new that they required a digital information management and collaborative system that could introduce the efficiencies, productivity and scalability attributes required for transcending from “as-is to to-be.”

The UCSF Urology team identified Salesforce as a relevant cloud-based software application that could be used in clinical trials.  Afterall working with patients can be seen as clients and Salesforce, as a “CRM” vendor, made sense because the processes of client relationship management are similar and absolutely captured in Salesforce core capability.  Moreover, the UCSF team needed a cloud-based, centralized database that included client management and collaborative features so that different departments could easily access the relevant shared information.

UCSF Adopts Enterprise Electronic Medical Record: Epic

UCSF adopted electronic health record Epic back in 2011. In fact, Epic is one of the nation’s leading EHRs sharing market share leadership with Cerner.

UCSF deployed Epic enterprise wide—and UCSF is a big institution.  It was an ambitious project with the deal signed in March 2010 and the first pilot launched in April 2011. The role out was completed in 2012—actually an impressive delivery timeline given the size of UCSF and the complexity of EHR processes and systems.

The roll out included everything—from impatient clinical documentation and order entry by clinicians to the emergency department, the Intensive Care Units, the operating rooms and anesthesia, to hospital registration, admissions, scheduling and professional billing.

The state-of-the-art system was known as “Advancing Patient Centered Excellence” or “APeX” and created a single electronic health record for every outpatient and inpatient at UCSF. Moving forward, it would transform how UCSF providers and staff would exchange information across all care settings in addition to opening up heretofore not available ways for patients to engage with their personal medical records.

As with any enterprise software deployment challenges will always be present.  Electronic health records are fairly proscribed and rigid for obvious reasons including process adherence, compliance and policy purposes.   Moreover as Mr. Krumm considered earlier many transactional applications aren’t necessarily designed to liberate data for fluidity of use cases such as patient enrollment.  The reality was that UCSF made incredible strides for an enterprise EHR but for the very necessary need of a patient enrollment solution for clinical trials they still hadn’t arrived.

Epic Integration with Salesforce

Robert Krumm and team knew that to make clinical research easier they would need to access the transactional EHR backend system. After all, patients were managed in this tightly controlled, compliant system. The team would need a highly secure, mature software with flexibility, collaborative features and client relationship management capabilities that could integrate into the EHR. In this way they could benefit from the both worlds—that of the purpose-built, proscribed, enterprise electronic health record and that of a more flexible, cloud-based client relationship management system. They designed an integration with the EHR (Epic) which was relatively straightforward.

The Patient Enrollment Application

As mentioned previously, they selected Salesforce; in fact, Salesforce participated in the study that TrialSite News recently covered.

The UCSF team, Krumm included, configured a UCSF Urology-specific implementation of a patient enrollment system for UCSF clinical trials. They utilized agile methodologies and greatly benefits from Salesforce standard assurances. For example, Salesforce includes in its software-as-a-service offering various compliance support assurances.

With about 12 users and several trials the Urology team has been able to access patients in a far more rapid, qualitative and scalable manner via the integration to the EHR for prospective clinical trials. With the integrated Salesforce patient enrollment application, researchers can now rapidly search and determine the prospective patients that may benefit from a specific Urology-based clinical trial.  Moreover, they can include contacts and other relevant information that can be securely shared with other researchers in an efficient manner. As compared to the old way of looking up patient charts, one by one, now researchers can do rapid-fire, high quality, secure searchers that exponentially accelerates the clinical research patient enrollment process.

Robert Krumm reports that there has been growing interest in the patient enrollment application. From interest at the 2018 Salesforce user conference in San Francisco to other groups within UCSF, including Oncology, that have expressed interest in using the system—UCSF will benefit from this innovative work originating from Urology.

Krumm shared with TrialSite News he is open talking to others. UCSF is a State of California, public institution and embodies the mission of “caring, healing, teaching and discovering” with a vision of being “the best provider of health care services, the best place to work and the best environment for teaching and research.”

Robert Krumm can be reached at


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