Diane S. Bauguess, BS RN,
CD/TB/STD/Rabies Program Coordinator, Wilkes County Health Department
Diane talks about why the mental struggles to convert to an EHR are well worth it. Here is her story.
I started in the health department in 1983 in home health and then the home health agency went to the hospital. So I stayed with a hospital based agency doing home health until I returned to Public health in 2012.
I had already been using electronic medical records since 1997. I had experience with three different electronic medical record systems. When I returned to the health department, and realized we were still on paper, it was quite a shock for me, because I was used to taking a phone call, having the patient ask a question and just turned around to my computer and pulled it up. So, I had to get used to saying “ah could I have a number where I can call you back. I’ll have to go find your medical record”. And then the hunt started. And that’s just the way it was because, the file may have been checked out of medical records and sometime you’re ten or fifteen minutes trying to track down that paper record so you could finally call the patient back. So that was quite a backward step for me, and something that made me say “Do I really want to do this?” But I did. I love what I’m doing, and luckily for me, I came to the health department at a time when they were looking at transitioning to electronic medical records.
We started training with Patagonia Health in May of 2013 and when they first started talking to us about going to an EHR we asked “how long is the training, and when is the go-live date?” What we were told by our transition team was “we train this week, and then we go-live on Monday.” And I thought “Oh yeah, that’s going to happen.” But Patagonia Health’s team told us what we needed to do, they gave us some liberty in our training to talk about how we wanted things to function.
Of course there are always things that have to be worked out. We found out very quickly that keeping a notebook was key. The way we talked about doing things one day might not be the way we were doing things the next; we had to work out what was best for us. While Patagonia Health gave us the training, and it was very good training, we still had the ability to tweak the system the way we wanted it for our own department, and that’s what we did. And nobody quit. Everybody showed up for work and it went well.
In my previous experience, when we first went live with electronic medical records, we had some nurses that had never used a keyboard, didn’t know how to type, and retirement suddenly looked really good for them. I know how that is. I went through that with some staff, and they did retire.
The thing that I like about Patagonia Health is that now when I am stepping outside my box, for example I might get pulled to do triage, I can say “Hold on just a minute, let me pull you up on the computer and I’ll tell you what you need to know.” And most of the time, because of the way Patagonia Health’s system is organized, you can easily find the information, because it’s right there.
Here again, if I had had a paper record, I would have had to go pull their record and call them back. Then you’ve got people complaining because they’re not getting a timely response.
Another reason I love the system is the ease of reporting. One of my tasks is to report STDs. Now, I can be in my office, at my desk on NC EDSS and see that I’ve got a positive chlamydia with a lab report, see that it came through our health department and I can go right to Patagonia Health. I can pull up that visit note, or encounter note. I can see what that patient’s symptoms were, I can see if they were treated in clinic. I can be done with that, closed out, and sent to State in less than 5 minutes. It was taking me that long before just to hunt down the chart.
So there are some great things about electronic health records that makes it well worth the transition.
Wilkes County Reaps the benefits of the TB App
When we were first asked if we wanted to work with Patagonia Health to develop a TB App, my response was, if a vendor gives you a chance to work on something, take it! They’re soliciting feedback for what works and what doesn’t work.
I had been using an electronic system from a national vendor who catered mainly to hospital-based agencies and were kind of doing home health on the side. There were only two home health agencies that used it. So whenever we had any major changes that came up, specific to NC, for example there was a Medicaid change, we were not a priority to get that done. With Patagonia Health this has all changed. They are primarily in NC, and they seem to cater to us North Carolina health departments. Now, when we have something new coming up, like state forms changing, they’re right there listening. They’re asking what can we do, how can we make this work for you? They’re helping us meet our deadlines, and I think that is a key thing with any software vendor. Patagonia Health hears us, they tell us what they plan on doing and they solicit feedback from us about it.
When we had the offer to do the TB App, I’m like, OK Yeah! I’ll be a guinea pig. It gave us an opportunity to sit down with the Patagonia Health team. They had meetings with us at a central location. They showed us what they thought about doing and what the app might look like and we made suggestions. We even included a TB state consultant who provided feedback and guidance on how we ought to be responding to some details. And it went really well.
The thing that I like about the TB app is that it’s right there on the computer. If I’m out when one of my LTBI patients comes in, any of the staff can pick up that patient in the computer. They’re not having to find where I left my black notebook (because I might have left it in an area I was working the day before). So it really works. They can pull up that patient, they can see any notes I made from their last visit and know what to follow up on this time. They can see if I did labs on that patient, how those labs turned out and if there is anything to be concerned about, and then document it.
I don’t know if any of you have had any requests from the prison systems, or another health department for TB records on patients that were seen before, and you’re going to try and fax it, and of course you know the form has been written on by several people, it’s paper and every little spec picks up on it when you fax that copy and I’m looking at it and thinking “Honey, I’m going to fax this to you but good luck reading it.” Especially when it is someone you were seeing daily for medications. So with the TB App, when you get finished with it, or at any point in time, you can print out anything that is in that TB Application that you documented on that patient. This nice pretty form that you can send, it’s very legible, and has all your documentation there. It covers everything that is in the paper forms, but better. We’re continuing to work on it, but so far I have been really pleased with it. Pleased with the roll out. Pleased with the way that it is working for us.