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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 E3, 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. E3 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 Giuse, Ph.D., associate professor of Biomedical