TB-free: Colleen Clougherty needed a medical checkup in the Boston Medical Center emergency department before entering a detox facility. An electronic record made reference to a positive tuberculosis test 14 years ago but didn’t say whether she was now TB-free. Doctors were poised to order a chest x-ray until a nurse made telephone calls to confirm that she was healthy. Sharing electronic records more widely among providers could spare patients from needless tests and radiation–and save costs.
But those benefits are abstractions in relation to clinicians’ daily struggle to make sense of isolated scraps of data on individual patients. Consider the hot August night when it fell to Dona Petrozzi, a psychiatric nurse in BMC’s emergency department, to line up the proper care for a Dorchester narcotics addict named Colleen Clougherty, who’d called for an ambulance after suffering from hallucinations. Clougherty wound up in a special guarded wing reserved for psychiatric emergencies. Her room had no furnishings other than an examining table bolted to the floor. Clougherty sat on its edge, clutching a blue stuffed bunny she’d brought. Gaunt, with slicked-back blond hair, she wore gold hoop earrings and had a large tattoo of a leprechaun on her arm. “I had sensations. I could feel a lot of things–a lot of weird, creepy things,” she explained to me. “Like crabs were crawling on your toes, or like a slug was stuck to the side of your face, or like a spider was blowing on your head.”
Clougherty needed her medical condition checked before she could be sent to an inpatient psychiatric and detox facility. But that wasn’t easy to do. Although she gets her health care at the Neponset Health Center in Dorchester, some of her medical records were held in a special Boston-area computer system called BEST, for Boston Emergency Services Team, which was set up by BMC and mental-health agencies to keep track of psychiatric patients’ medications, hospitalizations, and histories. Petrozzi looked up Clougherty’s file. She saw a worrisome note from 14 years before: at the time, Clougherty had tested positive for tuberculosis. Since BEST is not integrated with the Neponset Health Center (and neither is BMC, though that’s in the works), Petrozzi had no easy way to see whether her patient might be sick and contagious. Without clarity in the record, doctors would have had to order a chest x-ray to rule out any signs of TB before releasing her.
Fortunately, Petrozzi and her colleagues were able to reach a Neponset staffer by telephone and confirm that Clougherty had had a clear x-ray within the previous year. But such improvisation is hardly a substitute for making electronic records readily available to the clinicians who need them. “Ideally, inpatient hospitalization admittance and discharge is supposed to provide a seamless transition from one milieu to the next,” Petrozzi said as we sat in her tiny, windowless office. On the wall hung a few reminders of other crises she deals with. A photocopied sheet of paper said, in bold letters: Please report all deaths to the New England Organ Bank–800-446-6362. She told me, “If you don’t have information–and it’s true of any level of care, but particularly in psychiatry–you are interfering in some way with the patient’s physical and mental well-being. You don’t want that to happen.”
The rancorous political debate over health-care reform tends to mask this kind of commonsense–and widely shared–understanding about the value of basic access to information. “The good thing about information is that most everyone can be in favor of it,” says Cutler, who recently coauthored a bipartisan report to Congress on the importance of properly deployed information technology in reforming health care. (It was also signed by a scholar at the conservative American Enterprise Institute.) “And if you look at the difference between the last time we looked at health-care reform, in the 1990s, and now, the single most important change is that the IT has changed. What everyone believes–not just left of center, not just right of center, but everyone–is that is now is the moment to seize that and really put it to work.”
David Talbot is Technology Review’s chief correspondent.