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they su er disproportionately from chronic health problems such
as diabetes, heart disease, and asthma; and they often end up get-
ting primary care at emergency rooms. "Our patients, probably
more than other patients, are not as able to advocate for them-
selves," says Meg Aranow, the vice president and CIO of BMC.
"They may have language issues. And we have cultural barriers, such
that people are more or less comfortable talking to another gender
or someone who is perceived to be of a di erent class. There are a
ton of communication issues that burden our practice." Even when
such issues don't arise, doctors or nurses often need records from
other hospitals in order to give patients proper care. And today
that generally means phoning records clerks and waiting for faxes
to come through---a process that can take hours or days.
Nobody understands that problem better than Robert Gamble,
a nurse practitioner with Health Care for the Homeless, one of the
health centers now linked with BMC. His clients shuttle between
shelters, transitional lodging at motels, and the streets. Gamble
recalls a 28-year-old woman from Worcester, MA, obese and suf-
fering from high blood pressure, who had been assigned tempo-
rary housing with her two-year-old son at a motel in Marshfield,
50 kilometers south of Boston. Gamble was traveling back and
forth to see her, and trying to arrange medications for her---and
immunizations for her son---through phone calls to her doctor in
Worcester, 120 kilometers from the motel. "I'm used to working in
the dark, just working from the issues that are presented in front
of me," he says. "It will be great to get more history, medication
lists, and other background stu ."
It's easy to understand why BMC wanted better connections with
the community health centers, many of which serve poor and
minority neighborhoods. Their patients often come to BMC for
specialist visits or emergencies. But the hospital couldn't build
those connections until the smaller institutions computerized their
records, and community health centers---which number about 1,200
in the United States---are particularly hard-pressed to invest in IT on
their own, says Robert Miller, a health economist at the University
of California, San Francisco. The Boston project, which originally
targeted 15 health centers serving 206,000 patients, became possible
only when an anonymous donor contributed $5.5 million in 2001.
The first three years were consumed by the e ort to set up elec-
tronic records at the health centers and persuade sta to use them.
"For a long time during the transition, the doctors at the health
centers refused to let go of the paper record," says Francis Doyle,
executive director of Boston HealthNet, which runs the network.
Once that hurdle was overcome, the first links were forged. Begin-
ning in 2005, BMC doctors were able to log in and look up records
in the databases of the individual health centers, though a sepa-
rate password and user ID was still needed for each one. But the
... especially for low-income U.S. patients.
U.S. adoption of electronic medical records
is low ...
PERCENT OF PATIENTS PRIMARY-CARE PHYSICIANS USING
ELECTRONIC RECORDS, BY INSURANCE SOURCE
Doctor s offices
But where such systems are used, doctors see benefits.
... led them to order a genetic test
... led them to order a critical
... helped them provide
... helped them prevent a potentially
dangerous medication interaction
... prompted them to avoid
a drug-allergy problem
... alerted them to an important
DOCTORS WHO SAID ELECTRONIC RECORDS HAD ...
Fully functional system
Electronic records implemented 17%
Not implemented 83%
LIGHTLY USED BUT PROMISING
Sources: New England Journal of Medicine (adoption rates and physician survey);
Journal of Health Care for the Poor and Underserved
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