Record save: In the Boston Medical Center’s emergency department, Vera Sinue might have been subjected to a CT scan and other tests. But new electronic medical links with her community health center reassured doctors that her mysterious vomiting was not an acute issue.
A crow flying from Vera Sinue’s apartment in Boston’s Roxbury neighborhood to her job as an insurance representative near the Charles River in Brighton would skirt the edge of the Longwood Medical Area, a district of medical institutions including Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Children’s Hospital, the Dana-Farber Cancer Institute, and Harvard Medical School. These institutions are among the nation’s most respected. They supplied some of the experts now leading the Obama administration’s effort to reform the nation’s health-care system.
Yet it’s lucky for Sinue that when she began vomiting uncontrollably one day last August, she didn’t end up at any of the Longwood hospitals. Sinue, who is 35, gets her routine medical care at the Codman Square Health Center, in the heart of the low-income neighborhood of Dorchester. Her Codman Square records would not have been accessible to any of the Longwood emergency departments. While Boston’s medical institutions generally lead the nation in using advanced information technology for their own networks of physicians and satellite health centers (and the Longwood hospitals were early adopters), the networks don’t connect with one another to share data about patients’ medical histories and needs.
As it happened, Sinue went to Boston Medical Center, in the city’s South End, just a few weeks after Codman’s records became part of a network linking BMC with 10 community health centers. BMC, the teaching affiliate of the Boston University School of Medicine, runs New England’s largest trauma center and busiest free-care service. But it’s the links with the neighborhood health centers that are most remarkable. The health centers aren’t owned by BMC, so there were plenty of institutional barriers to their sharing patient data. And what this group of institutions has started doing to break down those barriers is an example of what the entire U.S. health-care system needs to do to make the best use of information technology. “In terms of a hospital taking the initiative to do what they have done–link together, using national standards, a set of individual physician-based medical records–it’s not all that common,” says John Halamka, CIO of Harvard Medical School and Beth Israel Deaconess Medical Center, who serves on regional and national bodies advancing health IT. “BMC is a leader in health-care information exchange.” The effort is especially significant because BMC serves so many low-income patients–who suffer disproportionately from chronic diseases and often have fragmented histories of care, making it all the more important for information to be shared among care providers.
Inside the BMC emergency room, Sinue’s vomiting did not stop. 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 indicate appendicitis or ischemic bowel disease (the death of intestinal tissue), either of which would require speedy surgery. In the absence of more information, most emergency-room doctors would order a CT scan (at least $2,100), and possibly an abdominal ultrasound (another $500), to see what was going on. But Narang called up the electronic records from Codman and found lab data and physicians’ notes that spelled out her allergies, medications, and history of medical problems.
These records were certainly not cutting-edge medical IT–no genomic data, not even any images. But they would make a big difference. Narang quickly saw that Sinue hadn’t told the full story. In fact, vomiting was a chronic issue; it topped her list of medical problems. At one point she’d even had an endoscopic procedure to examine her digestive tract for signs of ulcers or other abnormalities. It’s not clear why Sinue hadn’t disclosed this information. (She later told me she might have forgotten.) Whether caused by stress, cultural differences, or language barriers, such 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. But this reassured us that this was not an acute problem.” Doctors knew they could skip the CT scan and the ultrasound, thus saving time and money–and sparing Sinue a dose of radiation from the CT test. She was treated with antinausea medication and intravenous fluids. Once the crisis passed, 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.