Students create electronic records for homeless

A free medical clinic serving Baltimore's homeless and uninsured residents now has its first electronic medical records system for patients, a project conceived and implemented by medical students at Johns Hopkins and the University of Maryland. It is the first electronic medical records system developed by students for use by free clinics that cannot afford a commercial one.

The need was recognized by Eugene Semenov while he was an undergraduate at Johns Hopkins and a volunteer at the Baltimore Rescue Mission's free clinic for uninsured and homeless East Baltimore residents. Semenov saw many of the same patients returning with complex problems over weeks or months, but there was no organized medical records system to enable them to receive the most thorough and efficient care.

"[The staff] 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," Semenov says. "There was no standardized tool at the clinic to collect and store that information."

So Semenov teamed up with fellow Johns Hopkins undergraduate Michael Morris on an ambitious project to develop a secure electronic medical records system for the clinic. They used open-source software and customized it with specific functionality, and then put it on a secure server.

The system, Semenov says, is modeled after hospital electronic medical records—what would be noted in 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. It also includes the physician's assessment and a plan to aid in patient follow-up.

As a result, more than 250 of Baltimore's underserved residents now have an electronic medical record to provide more consistency in their care. So far, the system has been used in more than 750 patient visits to the clinic.

"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 Peter Greene, chief medical information officer for Johns Hopkins Medicine, who served as an adviser on the project. "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. Semenov and Morris pursued it after they graduated from college and went on to medical school, Semenov at Johns Hopkins and Morris at the University of Maryland. Semenov has also earned a master's degree in economics, focusing his research on ways to improve the health care system. Before medical school—and after he'd earned a master's degree in molecular and cellular biology—Morris worked for a startup medical device company, focusing his research on diagnostic technology and informatics.

As they worked on the project, the pair enlisted the help of two other Johns Hopkins medical students, Mark Fisher and Roosevelt Offoha. In September 2011 they formed a nonprofit corporation called Networking Health and applied for federal nonprofit status, enabling them to raise funds to build and support the system. The students also secured an Albert Schweitzer Fellowship. 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," Semenov says, "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."

Greene says that linking the Baltimore Rescue Mission's patient records to CRISP would make the Networking Health program even more valuable. That way, when patients came to a hospital emergency department, physicians could look up their medical records in CRISP, and the clinic staff could find out about the patients' diagnosis and treatment at area hospitals.

"It would provide continuity of care to the most vulnerable patients," Greene says.

Expanding, refining, and maintaining the electronic medical records system will require funding, and Semenov says that the students hope to initially raise $250,000. Some of the funds will be used to hire a few people to keep the system operating.

Providing effective care to the homeless population 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 for treatment of serious health problems without an accessible medical record to assist physicians in providing care. Now, however, at least for patients from the Baltimore Rescue Mission who arrive in an emergency department, the staff can call the clinic to obtain the patient's medical history.

Posted in Health, Student Life