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Recently, I saw a PBS Frontline documentary called The Released, which followed a group of poor, mentally ill men after they were released from jail. Each left with a bus ticket, $75 in cash, and two weeks' worth of medication. The men did badly in homeless shelters and group homes. They could not find work and did not take their medications; soon they were back in prison or dead. What reminded me of my time in Oakland was that none of the hospitals or clinics had records of which medicines had effectively treated the men's mental illnesses, and the men themselves wouldn't say or couldn't remember. They were ghosts. I was badly upset by The Released and wanted Technology Review to ask this question: Is there a technological solution to this small part of our larger health-care troubles?
David Talbot, our chief correspondent, found the answer. Boston Medical Center (BMC), which serves many of the city's poorer patients, has built a network of physician-based electronic records, linking the hospital with 10 community health centers (see "Prescription: Networking"). We were eager to learn if the network helped the people it was meant to help, so Talbot spent days in the emergency room of BMC. There, he met Vera Sinue, who had been admitted with unstoppable vomiting.
Talbot describes what happened next: "The attending physician, Aneesh Narang, was understandably worried. He asked if this had happened before; she muttered that it had happened only in childhood. A sudden and acute bout of vomiting might ... require speedy surgery. ... But Narang called up the electronic records ... [and] quickly saw that Sinue hadn't told the full story. In fact, vomiting was a chronic issue; it topped her list of medical problems. ... It's not clear why Sinue hadn't disclosed this information. (She later told me she might have forgotten.) ...
[S]uch miscommunication 'is not really that surprising--we get it all the time,' says Andrew Ulrich, an emergency room physician who is also vice-chair of BMC's emergency department. 'You'd be amazed what people don't remember.'"
BMC's network is not sophisticated technology. The electronic records have neither genomic data nor images. But those records saved Sinue from a CT scan and a dose of radiation. She was given antinausea drugs and intravenous fluids. "Once the crisis passed," Talbot writes, "a talk with a physician revealed that Sinue was distraught over a personal issue. When the subject came up, she was overcome with nausea. She got a referral for what she probably needed most: counseling."
Often, a technology is "emerging" only in context. But when the context is suffering, it can make a small but important difference. Write and tell me what you think at jason.pontin@technologyreview.com.
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