The Duke University Health System’s recent shift to using electronic medical records promises a future of streamlined health care, but the new system’s implementation has created several hurdles for patients and providers alike.
Over the past summer, the hospital completely revamped the organization of its online databases by introducing Maestro Care, a new medical records technology designed to unify the various branches of DUHS, consolidate records and improve the quality of patient communication. Many health care providers at the hospital have seen immediate beneficial results of the switch, made in response to federal requirements, but there are still some problems with switching over records and scheduling patients, particularly in Duke Student Health.
Maestro Care does not currently include an online scheduling system for Student Health, making it more difficult for students to make appointments, said Jean Hanson, associate director for clinical support services and outreach at Duke Student Health. The new system also has multiple steps for registration, which requires more paperwork. Moreover, Maestro Care does not have the ability to track immunization records for incoming students and volunteers, and it has been incapable so far of transferring all the old student health files into its new database. All of these problems have contributed to much longer waiting times in the clinic.
“With the [old] system we were using, about 60 percent of the appointments that were made each day were done online,” Hanson said. “Since the students can’t do that [now], they’re having to call in and we can’t answer the phones fast enough.”
Maestro Care is an interactive program which can process suggestions from its users to improve efficiency. The new system also uses the Duke MyChart—a more effective way for patients to view healthcare documents and communicate with doctors online. Maestro Care was introduced in response to the Health Information Technology for Economic and Clinical Health Act, which will start penalizing hospitals who do not switch to digital records by 2015.
Director of Student Health Dr. John Vaughn said he hopes that by the end of the semester, students will once again be able to make appointments online and have access to MyChart. For the time being, Vaughn is urging students to bear with the changes being made.
Vaughn noted that because the changes to Student Health came at the end of DUHS’ switch to Maestro, many of their services have been slowed down.
“It’s definitely frustrating for us but it could also be frustrating for students,” Vaughn said. “I would just ask students to be patient with us for now and realize in the long run that it’s going to be a good thing.”
Outside of Student Health, DUHS is seeing other issues with Maestro.
As with any software overhaul, there are still some issues with adjustment, wrote Dr. Lisa Nadler, a family medicine physician who was involved in the implementation of Maestro Care at Duke, in an email. Maestro Care has yet to go live in Duke Regional Hospital and Duke Raleigh Hospital, meaning many resources for implementation have been concentrated at those locations. Due to limited funding and time, it has been a struggle to answer requests for changes in the system.
“There are currently 3,300 tickets in the queue of things that people want and need optimized,” Nadler said. “We are in the process of prioritizing these and will chip [these] away over time with the resources available.”
Despite current shortcomings, high prospects remain for Maestro Care once it surpasses the transition phase of implementation. Employees were trained for eight hours or more on the new system based on their levels of responsibilities, but Hanson believes that with more training and experience, hospital providers will be able to fully utilize the system to improve both student and patient care.
Nadler agrees that the change has been a difficult process but is convinced that the transformation will be worth it in the long term for patient care and safety.
“Before, I had my problem list, orthopedist[s] had theirs, cardiologist[s] had theirs,” Nadler said. “Now, we share one list so we’re all looking at the same information… Lots of things are triggered automatically, warnings about drug interactions, health maintenance things that have not been done, reminders.”
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