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The Big Switch to Electronic Medical Records—Oh, Yeah

It was an exciting day at the Miracle Campus. You could feel it, almost like the very air was sizzling. You could hear it at prayer circle, when songs of praises were lifted higher and higher. You could see it on the faces of patients, smiling in wonder and wondering…

It was switchover day. Moving day. Learning day for the staff. Culmination of 12 months of work and continuous improvement.

The Luke Commission brought all campus patients under one roof. And, even more pioneering, TLC initiated its own comprehensive electronic medical records (EMR) system.

“Patients are flowing through the new system,” said Tiffany Riggleman, one of the team leaders in the EMR project. “Staff is getting trained. This is user-friendly, making things simpler.”

Sam Riggleman, working alongside a team of developers, realized an in-house EMR system was needed and on the exciting switchover day laughed when he said: “It’s a bit like playing ping-pong on the first day. We get the system to a point where we’re confident all core elements are stable and then try to solve issues as they arise and clear them before the next one comes. We’re making all changes on the live server in real-time, so it’s intense, but you expedite the development process significantly.”

Sam and Tiffany Riggleman head up the TLC team for the major shift from paper medical records to digital records. It’s a 12-month project coming to fruition.

Encouraged another TLC leader Winile Simelane to staff: “We would love for you all to be shining examples of how to be the friendly face of TLC when every patient arrives. This will be a big day for us as we are combining V1 (a vehicle warehouse where chronic patients were treated) and SCSC (the new under-construction specialized care and surgical center where a daily campus outreach was hosted) under one SCSC roof, and also launching the EMR the same day.”

What do patients say? “Thank you for finding better ways to help us.”

“Now I know you have my right telephone number.” Contact information, so vital to followup with patients, was previously confirmed over phone calls. Now, as soon as a patient gives his or her contact number, an SMS is sent to that number to verify the information.

Engineers Sam Riggleman and Danielle Little work on adjustments on the big switchover day.

“At first those machines scared me,” admitted another patient. “Then it took my photo, and I thought ‘That is me.’”

Sam nodded his head, pleased, when he heard this. “Facial recognition is incredibly low-cost and easy to implement in rural areas where mobile devices are already utilized. And as for fingerprints, after testing several scanners, we believe we’ve got a strong platform to utilize fingerprints in high-volume check-in locations.”

“With facial recognition and fingerprints, we will know who each patient is and how he or she has been treated,” Sam noted.

Treating patients with repeated accuracy and courtesy is a goal of all TLC staff.

Meanwhile outside the SCSC building where patients are being treated inside, the TLC assets crew continues building. It’s a busy place, for sure.

Leader Mbongiseni Tsela circulated throughout the 200 patients on switchover day, making sure they felt welcome and understood any temporary confusion.

“As I introduced patients to the new electronic system today, I apologized for any delay. They understood. Most said they are so thankful that they felt loved,” said Mbongiseni. “In the morning, they asked for water because it was a hot day. We responded quickly. I felt no negativity. Patients were very cooperative.”

TLC needed to build its own EMR system to integrate the prevalence of HIV and TB treatment with a full range of comprehensive services offered.

”It’s designed for Eswatini and what we do,” noted Sam. “If it’s not designed for what we do, then at best we’re storing records but missing out on adding efficiencies in the process. At the end of the day, we want to improve speed, quality, and follow-up care.”

Before the new EMR, everything had to be written down or entered on computers, often many times, passing through many hands, so patients could be treated with care and consistency.

Teaching and learning are TLC staff members.

Now no papers will be used or pass hands. TLC has over 100 iPads checked in and out each day for patient care. Staff leaders trained other staff members who, in turn, trained newer staff members throughout the day.

“It does not compromise speed to do everything electronically,” explained Tiffany. “It makes us as efficient as possible, which is our goal.”

A doctor can see from another room what he needs to see to diagnose and treat a patient. The medical team can see everything from check-in to registration to triage to labs to x-rays to pharmacy to doctors’ and nurses’ notes.

“Electronic medical records speed up visits. Patients can get in and out faster, without compromising care,” said Sam. “It allows us to invest more energy in the things we want to do and less in the things we have to do.”

Patients are still #1 and are called VIPs, Very Important Patients.

Indeed, optimizing the use of the TLC team is what it’s all about. That and, of course, patient care. “The team can spend less time on administrative duties and more time on the patients themselves,” said Sam.

“Just having all medical patients in one place helps,” Tiffany observed. “I’m glad we started both on same day.”

Looking around, Sam explained, “We changed documentation and work flow all at same time.”

Another advantage to electronic medical records is keeping track of patient medical history. “We are centralizing medical documents,” Sam said. “We used to have different databases for different services. Keeping accurate records, present and past, of each patient and the services received has been a challenge for us in the past since the patient’s care was interconnected but the database structure was not.”

Sam and Tiffany worked with a whole team at the Miracle Campus and abroad to get TLC’s EMR system up and running. When asked about the pressures of such an endeavor, Sam simply laughed and Tiffany smiled.

The new EMR system takes thousands of paper records and imports them to a central digital system for improved accuracy and speed.

“We put in some later nights,” conceded Sam, over many months and through many obstacles. “Most of strategy has been driven by the TLC team. I’m excited. It’s nice to have made it through the initial rollout phase.”
Tiffany noted, “The deadline has come, we are up and running, and now we can just be tweaking the system.”

The TLC team has now completed the migration and consolidated over 100,000 patient files from three databases into the centralized platform.

They will continue to work alongside Eswatini’s Ministry of Health and National Healthcare System, “to exchange ideas and come up with solutions,” Sam added.

Switchover day is over, but there’s still an air of excitement on campus. And as one patient said, “You never know when you come to the Miracle Campus what miracle you will see next. I just saw another one today.”

(by Janet Tuinstra)  

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