The BMC network went live just this summer, so the hospital has not yet formally analyzed its impact. But anecdotes like the one about Vera Sinue have been trickling in. And after just two weeks, Dan Newman, BMC’s chief medical-information officer, stumbled across one of the system’s ancillary benefits. Newman had been treating a man in his 60s for chronic back pain. “I had had problems with this patient in the past,” he says. “He would show up every single month for his medication but wouldn’t go for any tests to work up the cause of his pain.” Sure enough, the system showed that the patient had visited several of the health centers: he was doctor-shopping to obtain prescriptions for painkillers. “They had Percocet on the medication list and were writing him for other drugs, too,” Newman says. He adds that the system has unmasked other patients doing the same thing. And data mining from eight of the connected health centers has already begun in an effort to improve patient care. A particular focus is on the chronic health problems afflicting the network’s patients. (To pick just one of many sad national statistics, African-American diabetics are 2.3 times as likely as white diabetics to suffer preventable complications that require amputation of a foot.) The eight health centers serve more than 70,000 adult patients and have begun tracking seven indicators of diabetes or heart disease–which affect more than 5,000 of them–while working on outreach strategies to help them manage their health. (More than half the patients in the network receive care at more than one of its facilities, so sharing the data is crucial.) The neighborhood health centers have also overhauled their notoriously inefficient process for managing referrals to BMC specialists. Previously, this process relied on the patients themselves, with uneven results. “We’d end up with patients sitting in the cardiologist’s office, and the cardiologist would ask, ‘Why are you here?’ and the patient would respond, ‘I have no idea,’” Newman says. “Some of them would say, ‘I don’t even know what my doctor’s name is.’” Now the specialists can call up the complete record. And with fewer repeated appointments, everybody is wasting less time.
Despite all this, a visit to BMC’s emergency room provides a reminder that electronic records, even those shared within an innovative hospital network, are of limited use unless the data is shared more widely across the health-care system. On the August day when Sinue came to BMC, only 164 of the 366 patients seen in its emergency room had previously visited that hospital or any of the 10 health centers. The rest had no records in the system: 77 said they had primary-care physicians outside the network, and 125 said they had no such provider at all. This latter group included Joycelyn Jobson, a 60-year-old woman who arrived complaining of pain in the left side of her abdomen. The doctors performed an electrocardiogram (EKG) and noted a slight abnormality in her heart rhythm. This was a red flag: it could have meant she was in the early stages of a heart attack. Or it could have been nothing–perhaps the vestiges of a cardiac event years earlier.
I went up to Jobson’s room. There, a resident, Jessica Eng, was trying to tease out more information.
“What’s wrong?” Eng wanted to know.
“This pain … bad feeling,” Jobson replied. “Won’t leave me alone.”
“Long time. Long time now.”
“What kind of treatment have you had for this?”
“Have they looked at it with scans or ultrasound?”
“Have they ever had a camera inside?”
It wasn’t clear whether real communication was actually happening, or whether Jobson even had an emergency; at one point, she told me she’d had the pain for 20 years. Doctors were hopeful when she said she’d previously been to the Codman Square Health Center. (She lives in Jamaica, where she and her husband raise yams and pigs on a small farm, but regularly visits her son and grandchildren in Boston’s Mattapan neighborhood.) Yet the database revealed no hits. And so an expensive medical odyssey began. She was admitted for observation and hooked up to machines that monitored her vital signs. Nurses checked blood pressure in both arms; a difference was noted. This can be harmless, or it can signify a life-threatening tear in the thoracic aorta. So the nurses wheeled Jobson in for a CT scan. No tear was found. But a radiologist examining the scan saw nodules in Jobson’s lungs. Though the nodules probably indicated infection rather than cancer, the discovery meant ordering another CT scan in three to six months to rule out a malignancy.