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Dome - More Consistent Care for Baltimore's Homeless

Dome January 2013

More Consistent Care for Baltimore's Homeless

Date: January 4, 2013

Third-year Johns Hopkins medical student Mark Fisher documents symptoms described by patient José OrtÍz-Cepeda. Fisher helped create an electronic medical record system to improve care for patients served by free medical clinics
Third-year Johns Hopkins medical student Mark Fisher documents symptoms described by patient José OrtÍz-Cepeda. Fisher helped create an electronic medical record system to improve care for patients served by free medical clinics

In a tiny exam room with bare white walls, Johns Hopkins medical student Mark Fisher listens to José Ortíz-Cepeda describe 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 29-year-old 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 Ortiz-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, Johns Hopkins medical student Eugene Semenov, recognized the need 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. “There was no standardized tool at the clinic to collect and store that information.”

He explains that providing effective care to the homeless is fraught with challenges, 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 Johns Hopkins undergraduate student Michael Morris, and later, with Fisher and Hopkins medical student, Roosevelt Offaha, to develop a secure EMR system for the clinic. They used open-source software, customized it with specific functionality and then put it on a secure server.

Modeled after hospital electronic medical records, the clinic’s system documents what is recorded during a typical patient encounter, such as history of present illness; past medical, social, and family history; results of the physical exam; and allergy and medication information. When meeting with patients, trained student volunteers use a netbook, tablet or smartphone to mark symptoms and record notes. The EMR also includes the physician’s assessment and a plan to aid in patient follow-up.

More than 250 of East Baltimore’s underserved residents now have an EMR 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.

“Our next priority,” says Semenov, “is to expand the system to other free clinics in Baltimore and connect the records through the Maryland CRISP project—an initiative to create a health information exchange to enable all medical providers throughout the state to share electronic medical records so that patients can receive quality care no matter where they go for treatment.”

Networking Health also plans to develop an online portal so that patients and their family members can remotely access their medical records. Another project will analyze all collected records to identify where further health resources are needed for homeless and uninsured community members.

—Ellen Beth Levitt and Shannon Swiger