Inside Duke Medicine

Cardiology’s Legacy as Technology Leader Paves the Way for Duke Maestro Care Transition

Even with cardiology facing a double challenge – one imminent and one less than a year away – in its preparations for the Duke Maestro Care go-live, inpatient physician champion Cary Ward, M.D., exudes confidence in the division’s ability to rise to the occasion. She simply points to history.

“Cardiology at Duke long has been at the forefront of information technology, and historically has been one of the first divisions at Duke to develop and implement technology in the realm of patient care,” Ward said. “I have complete faith that cardiology will do a great job with this Maestro Care transition and be one of the major supporters of Maestro Care.”  

Cardiology is keenly aware of the important role a good IT system can play in patient care and is dedicated to ensuring that the Maestro Care implementation not only serves cardiology’s purposes but also makes the division even better, she said.

Cardiology’s first ambulatory phase goes live on Oct. 10 when Maestro Care Wave 2 arrives. The inpatient phase comes in July 2013.

Work on the former is winding down with the completion of documentation templates. Now attention is beginning to turn to the latter with a focus on capturing the best of the current electronic health record systems for inclusion in the Maestro Care system, designing documentation and notes, and integrating current clinical technologies with Maestro Care. As has been typical as go-lives approach, excitement mingles with anxiety.

“The cardiology clinics are very busy and care for a lot of complicated patients,” Ward said. “Combined, those two factors pose additional challenges for an automated notes system that works well for patients with five or six medical problems who may have seen two or three physicians before coming to Duke, and may have undergone multiple surgeries. That makes providers in cardiology a little nervous.”

But as preparation progresses from building the system toward embracing the demonstrated value of specialty-specific training and practice, enthusiasm and confidence are mounting about Maestro Care’s capacity to handle the job both in cardiology and in fulfilling its mission to effectively share patient information across Duke University Health System.

“Maestro Care will be an excellent system,” she said. “It has lots of interesting query features that our research-minded cardiologists will find appealing and very useful, especially its ability to quickly put important information at their fingertips – such as how many of their patients are meeting their cholesterol goal, if their diabetes is under control, and whether the physician is meeting his or her own goals for a patient’s care. Our clinicians are exceptionally smart people who do a lot of complicated things every day. Adapting to Maestro Care will be just one more challenge.”

While not directly involved in Wave 1, the people in cardiology know that the July 18 implementation went very well. And with preparation ramping up as they take advantage of online training, classes and using the playground, they increasingly are invested in learning the Maestro Care system and focusing on how they can adapt it to work best for them in Wave 2 and the inpatient phase next July.

Ward said cardiology is meeting with super users, practicing creating and entering records for mock patients, and encouraging people to go to personalization labs to customize features and preference lists. In addition, grand rounds will be held the week before go-live to help make sure people are familiar with the basics of Maestro Care.

“It’s going to go fine,” she said. “In the 10 years I’ve been at Duke, we’ve learned five new computer systems. This is just one more transition. Everyone will be constructive and help make the system better in the end.”