I’ve been using EPIC since 2008. EPIC is sort of the benchmark for electronic medical records, and eventually most major hospital systems will be using it or one of a few competitors. We had it at University of Colorado Hospital, Denver Children’s, and Saint Joseph Exempla, where I did the majority of my rotations in med school. We have it at Hillcrest and Providence hospitals in Waco. Only larger hospitals and clinic systems can afford it, but Waco Family Health Center was a beta test site for them years and years ago, so we even have it in our clinic. I think being proficient in EPIC bolstered my chances of matching in Waco a good bit, and it was a huge help adapting to intern year, which is challenging enough without having to learn an entirely new system.
I was surprised to discover that we don’t have EPIC at Bet Eman His House of Hope Hospital in Yei, South Sudan. I’m sure they are probably planning to transition to it, but the GoLive can take a while to plan and prepare for… and they’ll probably need some computers first. The medical records system here is different. There are pre-printed lab slips, and official hospital forms for tracking vital signs, meds, and H&P’s. Pretty much everything else is recorded in small notebooks that the patients keep with them; in fact, they keep almost all the medical records, except for the carbon copies of the op reports and discharge summaries, which we retain in the office. This is a pretty common system throughout Africa, but let that sink in for a moment; can you imagine if we were expected to keep up with ALL our own medical records in the U.S.? My patients (and myself, if not for Katie) just wouldn’t have records; we’d start from scratch with each new visit. (I will say though, the yellow card system they use for tracking pregnancy is remarkably similar to the purple cards we use at FHC. Not sure what to make of that).
You get used to a new system quickly. The first day I couldn’t even find any of my patients, and not knowing anyone’s name I just had to ask someone with a hospital ID, “Could you show me the patient who was 34 weeks with the preterm contractions?” (silence). “She’s the one with the large spleen that we are treating for malaria and typhoid.” (silence). “I think she was wearing green…” and on like that until they figured out who I was talking about or I gave up and asked someone else. After 3 days, I know the system well enough to find patients on my own, and at the bedside I can just take their green notebook and read the most recent notes (the documentation is in English, but the handwritten notes are often illegible and don’t contain much helpful information. So it’s the same as in the U.S.).
After just 3 days, I’m having to fight my annoyance with the CO’s when they present patients by reading from the green notebook instead of actually knowing the information. If you’ve ever taught med students or interns, you might be thinking, “how is that different from presenting by reading the notes from your iphone instead of actually knowing the patients?” It’s not; I get annoyed when my interns do that too (and hypocritically pretend like that’s not exactly what I did all through med school and intern year).
His House of Hope was not founded as a ‘Westerners do everything’ mission hospital; they are all about training South Sudanese doctors, midwives and nurses, and the greatest hope is for the missionary doctors and nurses to one day be obsolete. My role this month is as a sort of senior resident, rounding with, supervising and teaching the CO’s, or Clinical Officers (residents in the U.S. used to be called House Officers). The CO’s are hard to characterize; they’ve finished medical school and are now fully able to practice, but in the context of the hospital they function like residents, and experience wise the newer ones are more like 3rd year med students, just now starting to gain clinical experience. Thinking of them in this context, they are really quite impressive. They are eager to learn and soak up knowledge. I left one of my OB/GYN reference books in the call room and returned to find my two CO’s, Kochoro and Moses, reading through and discussing it. What is this place?
I’m on OB this week. I’ll write again and share more about antenatal clinic, rounding on the maternity ward, deliveries and especially the OR. In the meantime, Katie had a big day yesterday and I’m looking forward to her writing about those experiences. Thank you for continuing to pray for us and our patients here in Yei.