Baltimore Clinic Develops E-Records For Homeless Patients

Raymond Banks is one of the patients at Baltimore Rescue Mission, a free clinic for poor and homeless residents in East Baltimore. His 59 years have been rough on him. He's spent the past eight in various shelters. Half his teeth are missing. He suffers from hypertension and chronic leg pain. On a chilly Wednesday night, Johns Hopkins medical student Eugene Semenov is examining him.

Banks says he caught a cold from Hurricane Sandy.

"At night time when I try to go to sleep, I be coughin' like in the middle of the night," says Banks.

He mentions all of the different clinics and emergency rooms he's been to: "Union, Memorial, Sinai, and Mercy, but my main medical center is Jai Medical."

He's come to the Baltimore Rescue Mission to get a refill on his hypertension pills, which he doesn't take regularly.

"It's as-necessary," he tells Semenov.

For homeless, medical treatments often redundant

Semenov and other students and physicians volunteer at this free clinic. He says Banks is pretty typical of the homeless patients they see at the Mission.

"Over the last year he's been seen at a number of other emergency rooms... every time he goes to a new place they need to start from fresh," explains Semenov.

Because Banks is somewhat of an itinerant, his various medical providers do similar procedures with similar results.

"They do the same thing at Sinai, the same thing they've done at Mercy, without a different result," says Semenov. "So there's redundancy of medical care, a waste of medical resources, and he's not getting what he needs. He hasn't been entirely well-followed. There's an issue of health literacy here. He says he takes his pills only when he needs to. He takes them when he has hypertensive crises — he should be taking them the entire time."

Semenov and several friends saw this problem happen again and again at the mission. They also noticed that volunteers who didn't have medical training were writing records on paper, and there was a lack of consistency in the notes. There was duplication and inefficiency.

"So we thought an electronic record would help them organize a little bit better," says Michael Morris, a medical student at the University of Maryland. "We thought we could use it as a teaching tool to help teach the volunteers how to take a medical history."

An e-record would be easy to share across clinics, too. So Morris, Semenov, and two friends wrote their own program for it.

Open source medical record system keeps things consistent

As volunteers and doctors consult, everyone has a laptop or an iPad with the same screen full of checkboxes.

"We created a lot of checkboxes to make sure the right questions are asked," says Marc Fisher, another one of the program creators. "Are you having chest pain, feet been swelling lately, things that can uncover underlying conditions."

The idea, says Michael Morris, is that one day — one day soon — free clinics all over the region might use a similar platform and share information. Not just to help a clinic run smoothly, but to let different clinics track the same itinerant patient.

"This is a very new idea — it sounds obvious right? But the reality is in that medicine, everything takes a little more time," says Morris.

One reason it takes so long is the cost. An electronic medical record system can run anywhere from $50,000 to millions of dollars for a big hospital. Plus, programmers aren't doctors, so doctors have to end up changing the software all around to get it to suit their needs. This open source medical record cost about $10,000.

Its creators say they're hopeful it could save much more than that over time, and help particularly vulnerable patients get much better care.

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