Conversion to an EHR Messaging System

CASE STUDY – Case 8: Conversion to an EHR Messaging System

Goodwill Health Care Clinic is the clinical arm of Jefferson Health Sciences Center in a large Southern city. The clinic was founded in the early 1950s as a place for faculty physicians to engage in clinical practice. Over the years the clinic has grown to nine hundred faculty physicians and two thousand employees, with over one million patient visits per year. Clinic services are spread across eleven primary care and specialty care units. Each unit operates somewhat independently but shares a common medical record numbering system that enables consolidation of all documentation across units. Paper charts were used until two years ago, when the clinic adopted an EHR system.

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Goodwill Health Care Clinic uses a centralized call center to receive all patient calls. Patients call a central switchboard to schedule appointments, request medication refills, or speak to anyone in any of the eleven units. Call center staff members are responsible for tracking all calls to ensure that each is dealt with appropriately. Currently the call center uses a customized Lotus Notes system that can be accessed by anyone in the system who needs to process messages. Messages can be tracked and then closed when the appropriate action has been taken. Notes created from closed messages are printed and filed in the appropriate patients’ paper records. These notes cannot be accessed via the EHR.

Clinic staff members are very comfortable with the current Lotus Notes system, and it is used routinely by all units.

Information Systems Challenge

Goodwill Health Care Clinic requires all medication lists and refill information to be kept up-to-date in the EHR. Therefore, the existence of the current Lotus Notes system means that the same information must be documented in two locations—first in the call center note and then in the EHR. This leads to duplication of effort and documentation errors. The potential for serious error is present. Physicians and other health care providers look in the EHR for the most up-to-date medication information.

Although the adoption of the EHR has been fairly successful, not all units use all of the available components of the EHR. A companion paper record is needed for miscellaneous notes, messages, and so forth. All units are recording office visits into the EHR, but not all have activated the lab results or the prescription writing features. Several units have been experiencing physician resistance to adding more EHR functions.

The EHR system has a messaging component that works similar to a closed e-mail system. Messages can be sent, received, and stored by EHR-authenticated users. Pertinent patient care messages are automatically stored in the correct patient record. In addition, the EHR messaging system works seamlessly with the prescription writing module, which includes patient safety checks such as allergy checks and drug interactions.

The challenge for Goodwill Health Care Clinic is to implement the messaging feature and prescription writing component (where it is not currently being used) of their current EHR in the call center and the clinical units, replacing the existing Lotus Notes system and improving the quality of the documentation, not only of medication refills but also of all patient-related calls. The long-term goal is to add a patient portal feature where patients can schedule appointments, send messages to their providers, and refill prescriptions electronically.

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