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DUHS digitizes records with Maestro Care

By summer 2014, Duke University Health System will convert to a single, standardized electronic health records system, revolutionizing access to patient history.

DUHS will convert to a paper-free electronic system that facilitates the exchange of medical records with other health care organizations across the country, said Dr. Jeffrey Ferranti, chief medical information officer, vice president for clinical informatics and associate director of the Duke Center for Health Informatics. The initiative, required by federal legislation, will fully digitize all past, present and future patient records in one database. Benefits include greater patient access to their own records and the ability to share the information across health systems.

“It’s a single system that covers really all aspects of clinical care,” Ferranti said. “That means that patient [information] is consistent across the enterprise.”

Duke is using Epic Systems Corporation’s Epic software—the leading electronic medical health records system—to implement the new system DUHS has renamed Maestro Care. The overhaul will cost $700 million over seven years, Dr. Victor Dzau, chancellor for health affairs and president and CEO of DUHS, said in September.

“The Maestro Care electronic health record implementation will transform our ability to deliver the very best in quality health care services to patients throughout the Duke Medicine network and is aligned with our core value of ‘caring for our patients, their loved ones and each other,’” Dzau wrote in an email Thursday. “A system-wide EHR will be essential in supporting future strategic efforts related to care redesign and population health management.”

The EHR system implementation follows the American Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Health Act, Ferranti said. The acts mandate that health care providers and hospitals adopt certified electronic health records.

Several health systems in the region, including Wake Forest Baptist Health and University of Virginia Health System, have either installed Epic or are in the process of doing so, said Heidi Cozart, clinical director of Computerized Provider Order Entry and Health Analytics/IT Patient Safety.

Within DUHS, Maestro Care will go live first in outpatient ambulatory clinics, with 45 different clinics going live by July 2012, Karen Rourk, director of the Maestro Care Ambulatory Project, wrote in an email Thursday.

Duke Hospital, the new Duke Medicine Pavilion and Cancer Center and all revenue cycle systems are set to go live July 2013, Ferranti said, adding that Duke Health Raleigh Hospital and Durham Regional Hospital will follow in 2014.

Increasing access

In all of its hospitals, DUHS currently utilizes a homegrown electronic records program—eBrowser—that contains patient labs, pathology and radiology reports and other pertinent patient information, Ferranti said. All of the information on eBrowser will be converted as a part of the project. One limitation of eBrowser is that it does not accommodate the flow of information and patient records between hospitals. Maestro Care will eliminate those issues.

“All of the information from Durham Regional [will be] ready and available for the providers and clinicians, so you really get the picture across Duke Medicine of the patient and all of the encounters that they’ve had,” Cozart said.

Maestro Care will enable patients to access their records online, Ferranti said.

There are also ways to exchange data with non-Epic health systems. Currently, patients who receive care at Duke Medicine can sign a document releasing information from their visit to their primary care physicians. This document, Cozart said, could be adjusted in order to release their information legally to other hospitals in the Epic records system.

“It’s not all inclusive, but it certainly lays the foundation for beginning to share information… beginning to break down the walls beyond Duke,” she said.

Cozart added that there are numerous measures to protect patient privacy in the new electronic system, including Duke’s own strict security guidelines.

‘A win-win’

Prior to launching Maestro Care, all Duke Medicine employees will be trained in the Epic software.

“All of the [software] analysts are certified in using Epic,” Rourk said. “We have selected six physician champions that were also trained on the system and will lead content design in the specialty clinic areas.”

The core team that is leading the transition to Maestro Care must undergo a regimented certification process at the Epic center, including in-classroom lessons, project work and exam work, Cozart said. This training—mostly for those involved with inpatient clinics—is already underway and should be completed in December.

DUHS will not start training other users until April or May of 2012, Rourk added.

Ferranti also noted concerns about introducing technology into physician-patient relations.

“There’s always that fear that if you put a computer in a room with a doctor and a patient, it will negatively affect the interaction,” he said.

Providers are largely in control of how they want to incorporate the technology into their care, Cozart said.

“There are risks, but not cons,” Cozart said. “[Having] one [health care] record across the entire system is a win-win.”

EHR used in a ‘meaningful way’

Under federal law, physicians are required to use EHR technology in a “meaningful way,” Ferranti said. Meaningful use includes reporting statistics that describe the quality of care a health system is providing. This includes documenting efforts to encourage patients to quit smoking and recording up-to-date allergy and prescription lists for at least 80 percent of patients.

The federal government incentivizes doctors to report such data, he noted.

“[Meaningful use] is really emphasizing that providers should have a tool to help facilitate what they naturally should be doing as health care providers,” Cozart said. “When it is all electronic and it’s all in one place, it does become more meaningful because there’s a way to know that health care providers are actually using EHR in an appropriate way.”

Cozart added that Epic will help achieve meaningful use by organizing and standardizing the system. With many patients moving between hospitals, a major goal will be assuring continuity in the way patients are treated at each institution.

“Maestro Care provides an opportunity for us to have a single, seamless EHR across Duke Medicine,” Ferranti said. “One patient, one record, one health system.”

Julian Spector contributed reporting.

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