Health Records for the Homeless

Date: February 1, 2013

Johns Hopkins medical student Mark Fisher documents symptoms described by patient José Ortíz-Cepeda.

In a tiny exam room with bare white walls, Hopkins medical student Mark Fisher listens as José Ortíz-Cepeda, 29, describes his struggles with anxiety since running out of his antipsychotic prescription. Tapping the touch screen of his iPad, Fisher calls up a note to see what medication and dosage the homeless man received during a previous visit to the Baltimore Rescue Mission. He also reviews other information critical to developing an effective treatment plan.

This simple but important treatment step is made possible by a new electronic medical record (EMR) system developed by Fisher and his classmates to improve the health of patients who, like Ortíz-Cepeda, are homeless and uninsured. It is believed to be the first of its kind designed by students for free health clinics that cannot afford a commercial EMR system.

One of the system’s creators, fellow medical student Eugene Semenov, recognized the need for one when he was a Hopkins undergraduate volunteering at the mission’s free clinic for uninsured and homeless East Baltimore residents. Although many of the same patients returned over weeks or months, there was no organized medical records system to provide them with thorough and efficient care.

“Clinic volunteers didn’t have an easily accessible record to see which medicines the patient had been prescribed, the previous exam findings and diagnosis, the patient’s allergies, or whether the patient had been referred for specialty care,” says Semenov.

Providing effective care to the homeless is fraught with challenges, he notes, given that many have chronic diseases; lack nutrition, shelter, and safety; have mental health and substance abuse problems; and are less likely to seek regular care. They often come to emergency departments without an accessible medical record to assist physicians in treating them.

So Semenov teamed up with fellow Hopkins undergraduate Michael Morris, and later, Fisher and Hopkins medical student Roosevelt Offaha, to develop a secure electronic medical records system for the clinic. They used open-source software, customized it with specific functionality, and put it on a secure server.

More than 250 of East Baltimore’s underserved residents now have an electronic medical record at the Baltimore Rescue Mission clinic. The system has been used in more than 750 patient visits. “This is an exceptional initiative on the part of our medical students to help some of the most vulnerable patients in Baltimore who too often fall into the cracks in our health care system,” says project adviser Peter Greene, chief medical information officer for Johns Hopkins Medicine. “The students’ dedication to this project is very impressive. They had to work through many logistical challenges but were determined to see this through.”

The system took several years to develop. Last year, the students formed Networking Health, a nonprofit corporation, and applied for federal nonprofit status that will enable them to raise funds to build and support the EMR platform. Their work was recognized this past spring at the Clinton Global Initiative University conference, an event created by former President Bill Clinton to showcase innovative ideas to benefit humanity. —Ellen Beth Levitt and Shannon Swiger