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 suffering from high blood pressure, who had been assigned temporary 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 stuff.”
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 effort to set up electronic records at the health centers and persuade staff 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. Beginning in 2005, BMC doctors were able to log in and look up records in the databases of the individual health centers, though a separate password and user ID was still needed for each one. But the doctors and nurses at the health centers came to realize that these new links were of limited use unless all the centers and BMC networked their data to create a single patient record available to any clinician anywhere in the network. It would take $1.25 million in two grants from the U.S. Health Resources and Services Administration to create this truly integrated network–one that so far covers 10 health centers, not all 15 originally envisioned. (The other five will be added in the next year or two.)
To create a single, searchable system, BMC and the health centers needed to reliably match records for the patients in their respective databases. They did it with software from GE, one of several major health-IT vendors. The technology looks at birth dates, addresses, race, and other identifiers to distinguish patients with similar names and, conversely, to determine when records containing different addresses or differently spelled names actually refer to the same person. It creates a master index, but the actual patient data stays at the individual health centers. When a doctor logs in at BMC, the software pulls out the latest information from all sources. And a doctor needs to remember only one user ID and password.