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School of Medicine
Dome - Patient-Centered Technology
Dome January/February 2014
Date: January 1, 2014
The phone call is from an older woman with limited ability to travel. Though she hadn’t been hospitalized, she fears she has developed a bedsore. She can’t twist around to see the ulceration, the woman tells Sarah Clever, an internist at The Johns Hopkins Hospital’s outpatient center, and her sister doesn’t know how to describe it. What should she do?
Instead of asking the woman to make the difficult trip to Baltimore for an exam, Clever suggests she find somebody to take a photograph of the sore and then email the image to her. When the physician opens the attachment from the patient’s niece, she sees “definitely a bedsore, but at a treatable stage,” she recalls.
Using the Epic electronic medical record system, Clever attaches the photograph to the woman’s digital chart and sends a referral to the Center for Wound Healing at Howard County General Hospital, a more convenient destination for the woman. She is treated there three days later.
“Something that could have taken hours and a lot of extra effort, and frankly lots of pain for her, was made easier because of Epic,” says Clever, who notes she would have spent considerable time figuring out whom to contact at Howard County General and how to securely send the patient’s information.
As Epic continues its rollout across Johns Hopkins Medicine, users praise its ability to collect, merge and organize patient information across the health system, creating a more complete and up-to-date medical record that includes doctors’ notes, lab reports, referrals, prescriptions and images.
Not so long ago, lab results were sent by fax and scanned into the patient record, referrals were written by hand and doctors jotted notes on sheets of paper. “There was no system for tracking all that,” says John Flynn, internist, rheumatologist and medical director of Epic.
Clever, for example, used to write out notes during patient visits, then dictate them a day or two later; a system, she says, that was bound to result in lost details. Now, she types in information from a desktop computer in the exam room.
Amy Knight, a hospitalist at Johns Hopkins Bayview Medical Center, says she sees many patients with chronic conditions, including diabetes, congestive heart failure and high blood pressure. Often, they receive care at several locations within the health system, which used to mean Knight had to toggle between different electronic systems. “It might not have occurred to me to even look for their records, but now it’s right there in front of me,” she says. “I love having access to all my patients’ records in one place.”
Patient files in Epic include information as far back as April 2003. This enhances patient safety, because doctors now have ready access to complete information including prescriptions and test results, notes Flynn, who sees rheumatology patients at Johns Hopkins Bayview and The Johns Hopkins Hospital.
Thanks to Epic, he can now easily “share patients” who live in the D.C. area with Sabiha Kahn, a rheumatologist with the Johns Hopkins Community Physicians practice in Bethesda, Md. because all information becomes part of a single digital chart.