Inside Duke Medicine

Envisioning a truly integrated health system

Duke Maestro Care’s seamless and comprehensive electronic health record will provide hospital nurses such as Beatriz Asrafuddin and Sevda Mirza, seen here working in Unit 5-1 at Durham Regional, the complete story of each patient for whom they care.

Patients and families who are treated at any of the three Duke University Health System hospitals get the same kind of excellent care, whether it is a surgical procedure, or cancer treatment or physical therapy.

But in a lot of ways, Durham Regional Hospital, Duke Raleigh Hospital and Duke University Hospital operate like three different entities, instead of as a single inpatient effort that is part of a systemwide continuum of patient care.

As work for Duke's Maestro Care implementation moves forward in the inpatient areas, a large, multidisciplinary team is critically examining processes, procedures and workflows to improve care for patients and their families through the standardization and integration the new electronic health record (EHR) system can provide.

“Maestro Care implementation presents us with a really rare opportunity, to not only bring a widely respected EHR system to Duke, but to look at what we do best, and spread that across our three hospitals,” said Clay Musser, M.D., a Maestro Care provider champion who works at DUH. “It’s more than just an IT upgrade. It’s about making positive changes that really improve the care we provide to our patients and their families.”

Janet Apter, RN, DNP, nursing and ancillary champion for the inpatient and ambulatory Maestro Care projects, is leading multiple teams looking at how clinical documentation and practice can be improved and standardized across the health system.

“Standardization is connected to efficiency, that’s true, but it’s also about other important goals, such as safety and quality,” she said. “Maestro Care will provide us with a great tool that helps us make sure that we provide consistent and safe practices across the health system. This is an opportunity to collaborate within and across the disciplines for the care of our patients and families.”

Maestro Care, constantly updated with standardized documentation of critical data points like blood pressure and pain assessment, will “tell each patient’s complete story, in full and in one system,” said Charles M. Hodges, M.D., chief medical information officer at Duke Raleigh and a provider champion. “And each member of the care team will build on that story as they enter their documentation into Maestro Care.”

Even so, Maestro Care is about more than just getting three hospitals to do that same thing the same way, said Robert Lineberger, M.D., chief medical information officer at DRH.

“The process of implementing Maestro Care will help us truly act like a health system, not just clinics and hospitals called Duke.”