Neil Calman, M.D co-founded and runs a 25 year old community health center network in the Bronx, Manhattan, and the Mid Hudson Valley of New York State. The Institute for Family Health network is comprised of 26 separate practice locations including 16 full-time health centers, three dental practices, two school health programs, and nine sites which serve New York City’s homeless population.
Dr. Calman explained how active the network is in the communities. The health center network is involved in recruiting underrepresented minority students into the health professions by serving as the New York City Regional Office of the Statewide AHEC. All of the sites train dozens of social workers, medical students, family practice residents, the faculty, and administration programs in the area.
The Institute’s research arm is supported by grants from NIH, CDC, and many other public and private entities to study health disparities. Importantly, the researchers are studying how health information technology can help to reduce and even eliminate those disparities in health outcomes.
According to Dr. Calman, seven years ago the Institute implemented the EPIC System, a sophisticated EMR and practice management system used across the network. The system cost $2 million to purchase and to implement. The purchase and implementation of the system has resulted in saving many lives.
Dr. Calman is actively overseeing that the elderly over 65 receive the vaccination against pneumonia. The system enabled the network to run a report on their patients and by doing the search found that they were giving only 19 pneumonia vaccines per month which seemed very low for the size of the population of patients.
So the computer was programmed to put out an alert whenever a patient over 65 or a patient with a high risk chronic disease had not been vaccinated against pneumonia. As a result, in the first month, 396 doses of the vaccine were given to patients.
As Dr. Calman reports, they have searched the system for patients who have creatinine levels in their blood of over 1.8 and have not been to a nephrologist. The computer search yielded 32 patients and as a result, 32 patients and messages were sent through the system to the providers to prompt them to send their patients for a consultation. The last time, the computer yielded a report to see how many patients with creatinine levels over 1.8 had not been sent to the nephrologist was three.
In another example, two years ago, a report came out that showed women taking Ace-inhibitors to treat high blood pressure could have serious heart and lung birth defects in 7% of all women taking the medication in the first trimester of pregnancy.
A search was done and revealed that 232 women of child-bearing age in the practices were on this medication. The next step was to send a list to each of the primary care providers, to tell them that their patients were at risk and to let them know of the new research data. Letters went out to all 232 patients that they should speak to their provider about taking the medication.
Dr Calman further described how a patient with diabetes who was homeless called him needing medical care late at night. Fortunately, she called his cell phone before leaving to go to the emergency room. Dr. Calman thought maybe the problem was due to an imbalance in her metabolism.
Before she left for the emergency room, he used his home computer to access her list of chronic problems, medications, results of her last EKG and other diagnostic tests, and immediately faxed them to the emergency room. At that point, the information was available to the ER doctors before the patient arrived, and they were able to make the correct diagnosis and treat her appropriately without hospitalizing the patient.
Three months ago, a patient portal was opened up to go into the EHR system. This enables patients to have access themselves to their records plus a hospital or specialist can have access to view major parts of medical their records online—24/7. Over 1600 of the patients served via the network have signed on to this service and over 1200 are already active users.
In summary, the EHR system allows the network to truly mange the 72,000 patients cared for in ways that would otherwise be unachievable.