ClinicStation was developed by The University of Texas M.D. Anderson Cancer Center in response to internal needs for an Electronic Medical Record (EMR) and several previous failed EMR deployments. It was developed by Kevin McEnery, M.D. and Charles Suitor as an expansion of a successful radiology PACS initiative.  It was first deployed as a web application in 1999 with about 30 clinical applications. It was rewritten as an n-tier  (SOA) back-end coupled with a desktop application in 2007 and today has about 70 clinical applications.  The SOA enables ClinicStation to expose more than 40 different data sources (internally developed and commercial software) to clinicians within a single interface.  It also enables other M.D. Anderson applications to draw on ClinicStation data, such as:
- The RadStation (for radiology)
- PathStation (for pathology)
- ResearchStation (for research)
- ClinicStation Outbound (a web portal for patients and outside physicians) - ClinicStation has scaled from around 1,500 users in its early stages to over 8,000 today.
In June 2013, M.D. Anderson announced that ClinicStation would be replaced by Epic Systems in 2016 . This new system is expected to improve patient care. Patients will experience more convenience and providers will be able to implement best practices in a more standardized way.
The University of Texas M. D. Anderson Cancer Center, a world-renowned cancer center, needed to get complete, up-to-date patient data to medical professionals in a useful and timely manner. Commercial electronic medical record (EMR) systems could not accommodate their complex workflows. Using Service-Oriented Architecture (SOA), Avanade helped MD Anderson build an EMR system that aggregates both clinical and research data from more than 40 disparate applications, providing physicians, mid-level providers, and nurses a complete, current view of the data associated with each patient. With the system’s flexibility, the center can allow departments to pursue whatever software applications best suit their needs, presenting the data from those applications in a single comprehensive tool. With its scalability, the center can grow in its ability to serve more patients and incorporate new types of data into each patient’s record.
The system, called ClinicStation, redefines healthcare record keeping and represents a major advance in the healthcare industry. The new system is pioneering in seven important ways:
- It is the first EMR system to provide an interoperability foundation between clinical and research information, a capability that will significantly improve both patient care and research. The best decisions can be made about a patient’s treatment utilizing the latest cancer research.
- The cancer center is the first hospital to fully deploy custom-built EMR technology from scratch on such a large scale: it involved 100 developers, encompasses 70 modules and now processes up to 4,000 service calls per second during peak periods, and approximately 325 million calls per month.
- The system uses a full Service Oriented Architecture (SOA) and the Microsoft .NET Framework, and is one of the most fully implemented SOAs in the healthcare industry.
- ClinicStation provides an integrated view of each patient that’s available to authorized participants in the clinical and research chain. Most hospitals keep medical images and data in separate systems; at M.D. Anderson, separate systems are presented through SOA as an integrated working environment.
- The new system is flexible, growing and changing to meet M.D. Anderson’s needs without hampering daily operations. Uniquely, physicians and others in the healthcare chain provide the leadership when it comes to introducing new capabilities.
- It demonstrates that the interoperability and flexibility made possible by SOA have the potential to improve any industry challenged by information maintained in disparate systems.
- Already ClinicStation is serving as a model. M.D. Anderson allows other institutions to view and learn from the system, promoting M.D. Anderson’s role as a leading teaching institution.
The University of Texas M.D. Anderson Cancer Center seeks to eliminate cancer through programs that integrate patient care, research, prevention and education. Patient data includes routine care, lab tests, radiology images, perioperative records, and data derived from their participation in clinical and research protocols. As such, medical professionals’ productivity has been hampered by the effort required to find both physical records and particular pieces of data within a patient’s medical record. In 1999, MD Anderson created ClinicStation to integrate the presentation of radiology images with clinical data stored in a variety of IT systems.
ClinicStation was improved upon in the coming six years including novel features and resulting in a more sophisticated system. 
This innovative application ultimately became the cornerstone for the Institution’s Electronic Medical Record (EMR) system. MD Anderson decided to re-architect ClinicStation in 2005 using Microsoft .NET and Service Oriented Architecture (SOA) for enterprise-scale use.  This allows them to utilize other software applications. Over a 15-month period, MD Anderson and Avanade worked on iterative feature development with rigorous qualityassurance. MD Anderson was concerned that critical protected health information (PHI) in other secure information was protected and auditable at every step in the process, thus ClinicStation’s security infrastructure involves a shared token server to authenticate a user and client application and takes advantage of WSE 3.0 for Microsoft .NET.
Avanade re-architected ClinicStation through a full use case definition effort to develop functionality requirements and provide documentation necessary for future system maintainability. Avanade helped re-tool the MD Anderson software development staff from VB 6.0 to C# and developed a detailed curriculum and training on the ACA.NET SOA framework, which is built on C#. Avanade then developed an EMR “training sandbox” that demonstrates how to develop new EMR functionality with coding standards and best practice guidelines. ClinicStation has set a new standard for enterprise-class interoperability in the healthcare industry. The majority of major healthcare institutions in the U.S. have elected to implement commercial EMR systems from enterprise-scale software vendors.
It is estimated that less than six major healthcare providers in the United States have attempted a custom-developed EMR, regardless of underlying technology platform, and even fewer have succeeded. MD Anderson’s custom EMR implementation is an unparalleled example of Microsoft .NET and SOA-based technologies successfully deployed at scale within the healthcare industry.
ClinicStation serves 7,000-8,000 users and stores medical data for nearly 80,000 patients. The system serves about 13,000 unique users per month and up to 4,500 users simultaneously. The users include staff, referring physicians, consulting physicians and even patients, who have their own portals to relevant data. End-users gain access to patient data from more than 60 back-end systems operating on a variety of disparate platforms through the SOA framework. ClinicStation automatically detects and upgrades to the latest version after a system upgrade. The most current version 4.0.11 build 1 (as of 07/25/2014).
The system has delivered many important benefits. Among them:
- Data accuracy. When a physician looks at image data or clinical data in ClinicStation, he or she is looking at the most up-to-date data, in the originating system.
- Flexibility. Adding new systems and data sources is extremely easy. That flexibility is facilitated by the SOA framework, because it is not necessary to move data around.
- Increased performance. A single server on the new architecture can easily handle the load of the entire 11-server Web farm in the old architecture.
- Stability. A custom monitoring solution helps the IT department see developing problems and resolve them before they affect users.
- Increased productivity. The flow between the hospital and all of the clinics is much faster.
- Reduced costs. By some internal estimates, every physician who uses ClinicStation saves a half-hour a day, every day.
Offers 75 services, reflecting various types of data. Its use is intensive: 325 million service calls a month, with peak utilization topping 4,000 service calls a second providing access to more than 80,000 patient visits every year.
ClinicStation was internally developed with a core development team of just three individuals at an estimated cost of $200,000. The system architecture is scalable, with economical, non-mainframe servers deployed in the rules-tier. The application is efficient to maintain with automated monitoring tools observing system performance and notifying personnel when problems arise.
As many as 8,000 users rely on the system at any given time. System performance provides access to any requested document usually in less than 1 second. Enterprise training costs are negligible largely due to what users acknowledge is a very intuitive user interface. A recent upgrade was successfully accomplished with five email messages informing users of new features. No formal training sessions were scheduled, allowing personnel to focus on their primary responsibility of patient care . Electronic prescriptions (ePrescribing) was added in a pilot format in 2011, with rollout institution wide in 2012 . Since the ePrescription rollout there have been various changes to clinic workflows and upgrades to ClinicStation that require staff education to maintain best practices. Staff have access to pdf documents, videos, training webinars, and computer-based training courses for updates.
The last major deployment for ClinicStation was completed December 2013. Although ClinicStation will be replaced by Epic Systems in 2016 it is still fully supported by the ClinicStation team as they continue to streamline and digitize clinical processes .
ClinicStation Integration with Other EMRs
Despite its various modules, ClinicStation does not meet all the electronic documentation needs of the institution. MD Anderson is also currently utilizing PICIS (now Optum applications which are integrated with ClinicStation, such as:
- Anesthesia Manager - documentation by the anesthesia staff during the perioperative period
- OR Manager - nursing care documentation in the operating room
- PreOp Manager - nursing documentation in the preoperative area
- PACU Manager for nursing documentation in the postoperative areas
- Critical Manager for nursing documentation by intensive care unit 
In 2002, the ClinicStation project was the recipient of the 2002 NASCIO Recognition Award under the category of "Innovative Use of Technology" . This award recognized ClinicStation's effective utilisation of a web services data access model to leverage existing clinical databases into an integrated clinical display.
Also in 2002, ClinicStation received the Texas Association of State Systems for Computer and Communications (TASSCC) award of excellence. 
In 2003, the legacy ClinicStation was recognized by a ComputerworldHonors Laureate award. 
In 2009, ClinicStation also received the 2009 21st Century Achievement Award for Healthcare presented by the Computerworld Honors Program. 
ClinicStation Outbound (CSO)
In 2009, a modified variant of ClinicStation was released to allow patients to gain access and view their medical and laboratory reports.  This version, called ClinicStation Outbound (CSO), made M.D. Anderson the first Comprehensive Cancer Center in the nation to offer protected web-based access to medical information; thus allowing patients to be more involved in their treatment beyond the treatment facility. It also enables authorized referring physicians to obtain patient records and follow-up on the treatment protocol, thereby eliminating time delays involved with mailing and/or faxing patient records. For this project, M.D. Anderson's EMR team linked up with Avanade once again to create this external portal which is a subset of the parent ClinicStation application. HIPPA compliant health record personal information via CSO and appointment schedule via the web . Just one year after CSO was launched, more than 28.000 patients (57%) logged into their personalized M.D. Anderson accounts and accessed their personal medical information, records, and test results.  Patients can access ClinicStation Outbound by logging into their myMDAnderson account. 
Clinic Station version 4.0.11 was certified for meaningful use by the Certification Commission for Health Information Technology (CCHIT) in August 2011.  Meaningful use specified electronic health record requirements that had to be met and utilized in order for hospitals and eligible providers to qualify for incentive payments as mandated by the Centers for Medicare and Medicaid under the HITECH Act of 2009. 
At the time, Clinic Station did not have the capability for electronic prescription, provision of clinical summaries to each patient after each visit, and electronic patient needs assessment . Modules that were added to ClinicStation in 2012 to meet these requirements were ePrescribe for electronic prescription, and ePNA for electronic patient needs assessment. The functionality for the release of unauthenticated dictated provider notes to myMDAnderson, the patient’s portal, allowed ClinicStation to meet the requirement for the provision of discharge summaries to patients within 72 hours of visit. 
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