On a recent Wednesday evening, a man complaining of knee pain showed up at the Baltimore Rescue Mission’s medical clinic, which provides free care to the city’s homeless. His case was assigned to volunteer Asad Durrani, one of the undergrads from Johns Hopkins University who staff the clinic.
The man told Durrani that he’d walked 20 miles the day before, providing a reasonable explanation for his pain. But when Durrani pulled up the patient’s electronic medical record, he saw there was more to the story. “He said he walked 20 miles yesterday,” Durrani recalled. “He left out that he does it five days a week.”
The patient left with a prescription for naproxen, an anti-inflammatory drug, and instructions to return the following month. Thanks to the EMR, Durrani learned that the man regularly came to the clinic for what was a chronic problem rather than a temporary condition. “A lot of times they don’t mention these details,” Durrani said, referring to the homeless and uninsured patients who frequent the clinic.
Back when Eugene Semenov was an undergraduate volunteer at the Baltimore Rescue Mission, it had paper charts instead of electronic records. “The process of collecting their data often was redundant because the charts were not very well organized,” said Semenov, who is now in his last year of medical school. “It was hard to understand what was going on with the patient in a time-efficient manner.”
Semenov remembered accompanying a longtime patient, who appeared to be in an altered mental state, to a local emergency room. The hospital had no record of the disoriented man, and there was no electronic file from the clinic. “The patient was a blank slate for everyone, and that’s a very dangerous situation for anyone to be in.”
Semenov and fellow Johns Hopkins undergrad Michael Morris decided to devise a better system. Sharing an avid interest in health IT, they thought the clinic’s patients and volunteers could benefit from the type of EMR used by hospitals and private practices. But when they tried to identify other free clinics that had successfully gone digital, they found no examples.
“A lot of people in healthcare are resistant to new technology because there is a learning curve,” Semenov said. “The second problem is the cost. When you combine those two, the adoption of an EMR by a free clinic becomes virtually impossible.”
While attending medical school, Semenov and Morris spent several years developing a low-cost, secure solution based on open-source EMR software and hosted on a server controlled by the mission. They formed a nonprofit organization, Networking Health, and received funding from an Albert Schweitzer Fellowship and private donors. After implementing their system at the clinic in November 2011, Semenov and Morris continued to fine-tune it by seeking feedback from volunteers.
Kevin Jang, a Johns Hopkins senior and mission volunteer, said electronic medical records streamline the intake process and provide a broader view of the patient’s overall health. “It’s easier to follow up on progress on things like blood glucose level or blood pressure,” he said. “It’s nice not to have to ask the patient about their family history every time.”
Jang also praised the system’s integration of online reference materials. “Whenever we don’t know something, there’s a link to the medical dictionary so we can look up medications or conditions,” he said. The electronic medical records have particular value for students, added Durrani, training them to take thorough medical histories. “It forces you to ask all the right questions,” he explained.
For Dr. John Dalton, who has overseen the Baltimore Rescue Mission’s clinic for more than two decades, the new computer system has transformed the way he and his volunteers practice medicine. “If you are running a primary care clinic like we did before, what you do is you field somebody’s chief complaint and you shoot at it much like a guy in the westerns will shoot his pistol at a target and hit it or not,” he said. “If you’ve got an EMR, you’ve got a whole display in front of you of the information gathered over his previous visits. You can do the next step, which is comprehensive work. Rather than just shoot for the problem of the moment, you can address all of the problems.”
The Road Ahead for Continuity in Care
Last April, Networking Health was recognized at the Clinton Global Initiative University conference, an event created by former president Bill Clinton to showcase innovative ideas. But Semenov said that developing the software, which is in its third version, was only a first step. Homeless individuals in particular stand to gain from the sharing of information across institutions, he explained. “They tend to be more migrant than the average individual,” he said. “There is no continuity in care.”
For this reason, he and his colleagues hope to implement their system at other local clinics and integrate it with the Chesapeake Regional Information System for Our Patients (CRISP), a Maryland nonprofit devoted to the exchange of patient data among healthcare providers. “There was obviously a value to introducing this to one clinic, but the greater value to the homeless population is making it available throughout the area,” Semenov said.
Networking Health also aims to use data gathered by the Baltimore Rescue Mission to identify epidemiological trends and common health problems among Baltimore’s homeless. The clinic caters to 30 to 40 percent of the city’s homeless population, which comprises roughly 5,000 individuals at any given time, according to Semenov.
Whether or not the Networking Health system expands beyond the Baltimore Rescue Mission, it proves that free clinics with limited resources can still reap the benefits of electronic medical records, Semenov said. “Our goal is to be able to show that this is very easily achieved,” he explained. “This was done by two medical students who are not professional programmers. We used a massively available technology that is free to use.”