At the Duke Outpatient Clinic (DOC), one of the busiest clinics in the Duke University Health System, 75 residents care for 5,200 unique patients per year. That’s 1,200 to 1,400 visits per month.
The DOC’s diverse patient population presents with a host of complex medical problems and comorbidities, and each resident seeing patients there may only be at the clinic one half-day per week.
As the DOC prepares for the switch in July from the E-browser patient record system to Duke’s Maestro Care electronic health record, it’s especially important for the clinic to make sure all the medical staff is ready for the new system.
To see how Maestro Care might help streamline the complicated care delivery that has to take place each hour at the DOC, resident physician Adia Ross, MD, MHA, helped organized a DOC Maestro Care Preparedness Day in March.
“We wanted the chance to look under the hood of the EHR while analyzing the clinic’s workflow,” said Ross. “Maestro Care will change how the clinic operates, and we have to make sure that we don’t do a disservice to patient care in the transition.”
The March 30 event featured a multidisciplinary meeting involving nurses, managers, administrators, IT personnel, residents and the event’s project champions: Jessica Colquhoun, the DOC’s head clinic administrator, Alex Cho, MD, an attending physician and the incoming director of the Internal Medicine Program’s Ambulatory Curriculum, and the DOC’s medical director, Lynn Bowlby, MD.
“We had 30 people in a conference room and the main question was, ‘What were the gaps in our clinic?’” said Ross. The gap analysis, with input from housestaff, faculty and clinic staff, was helpful in identifying the areas where the DOC’s clinical workflow pathways could be improved, she said.
To prioritize the changes that need to occur at the DOC, the meeting utilized a dot voting system; participants were given six dot stickers and told to place them in the clinic areas they thought needed the most improvement.
“It was a totally democratic process,” said Bowlby. “All participants had an equal voice to identify areas of concern.”
The attendees of the meeting found three areas to focus on: medication reconciliation, the completion of resident administrative tasks and the general clinic workflow. Given the many competing priorities and the aggressive timeline for Duke’s Maestro Care implementation, the group decided to prioritize their efforts around medication reconciliation and resident task completion.
“Maestro Care will really help us, as doctors, communicate our needs to the nursing staff,” said Bowlby. “Instead of finding a nurse or using a flag system when we need something in the room, we can use a computer to communicate our needs for a test or lab result.”
Another major benefit the new EHR brings to the DOC is the ability to track patients over time and mine health data. Bowlby said many of the DOC’s patients have low health literacy and have a host of diseases they’re trying to manage at one time. Making sure patients are seen regularly can be a challenge.
“If we can capture the data of which of our patients we haven’t seen recently, we can really advocate for our patient’s needs,” said Bowlby.
Ross said she will be documenting and sharing the results of the DOC’s preparedness event and workflow analyses, and she hopes the information will help other Duke ambulatory clinics as they transition from E-Browser to Maestro Care. The clinic will begin simulating new Maestro Care nursing and physician workflow tasks beginning this month and until the switch to the new system. Clinic providers and staff will begin training in June.
To see how Maestro Care might help streamline the complicated care delivery that has to take place each hour at the DOC, resident physician Adia Ross, MD, MHA, helped organized a DOC Maestro Care Preparedness Day in March.
“We wanted the chance to look under the hood of the EHR while analyzing the clinic’s workflow,” said Ross. “Maestro Care will change how the clinic operates, and we have to make sure that we don’t do a disservice to patient care in the transition.”
The March 30 event featured a multidisciplinary meeting involving nurses, managers, administrators, IT personnel, residents and the event’s project champions: Jessica Colquhoun, the DOC’s head clinic administrator, Alex Cho, MD, an attending physician and the incoming director of the Internal Medicine Program’s Ambulatory Curriculum, and the DOC’s medical director, Lynn Bowlby, MD.
“We had 30 people in a conference room and the main question was, ‘What were the gaps in our clinic?’” said Ross. The gap analysis, with input from housestaff, faculty and clinic staff, was helpful in identifying the areas where the DOC’s clinical workflow pathways could be improved, she said.
To prioritize the changes that need to occur at the DOC, the meeting utilized a dot voting system; participants were given six dot stickers and told to place them in the clinic areas they thought needed the most improvement.
“It was a totally democratic process,” said Bowlby. “All participants had an equal voice to identify areas of concern.”
The attendees of the meeting found three areas to focus on: medication reconciliation, the completion of resident administrative tasks and the general clinic workflow. Given the many competing priorities and the aggressive timeline for Duke’s Maestro Care implementation, the group decided to prioritize their efforts around medication reconciliation and resident task completion.
“Maestro Care will really help us, as doctors, communicate our needs to the nursing staff,” said Bowlby. “Instead of finding a nurse or using a flag system when we need something in the room, we can use a computer to communicate our needs for a test or lab result.”
Another major benefit the new EHR brings to the DOC is the ability to track patients over time and mine health data. Bowlby said many of the DOC’s patients have low health literacy and have a host of diseases they’re trying to manage at one time. Making sure patients are seen regularly can be a challenge.
“If we can capture the data of which of our patients we haven’t seen recently, we can really advocate for our patient’s needs,” said Bowlby.
Ross said she will be documenting and sharing the results of the DOC’s preparedness event and workflow analyses, and she hopes the information will help other Duke ambulatory clinics as they transition from E-Browser to Maestro Care. The clinic will begin simulating new Maestro Care nursing and physician workflow tasks beginning this month and until the switch to the new system. Clinic providers and staff will begin training in June.