By Karen Nitkin, For The Baltimore Sun
12:25 PM EST, December 2, 2012
In 2006, when Eugene Semenov was an undergraduate at Johns Hopkins University, he volunteered at the medical clinic of Baltimore Rescue Mission, which provides free medical attention to people who are homeless.
He couldn't help noticing that the record-keeping system was stuck in a pre-computer era, with volunteers tasked with taking vital signs and gathering information. The result was a lack of standardization, and a system of physical paper, which could not be transferred electronically to other doctors.
Now, the clinic has an electronic medical system that creates a standardized, searchable database for each patient, and provides prompts that assure the volunteers, who are Johns Hopkins undergraduates and medical students, are correctly gathering and recording information.
When a homeless person arrives at the clinic, a volunteer can easily access that patient's records, and follow a series of touch screens to collect vital signs and other information.
The system was created by Semenov, now 27 and a third-year Hopkins medical student, and Michael Morris, 26, a fourth-year medical student at the University of Maryland School of Medicine.
"We set it up so you can't finish the page until you finish collecting the vitals," explained Semenov.
"If you put in medications but not the dosages, you can't continue," added Morris.
The system, which is far simpler and less expensive than ones used at large institutions like Johns Hopkins, has been in place about a year. The students, who were undergraduates together at Johns Hopkins, both volunteered at the clinic during their first year of medical school. They spent several years developing the system, believed to be the first student-created electronic medical system for use by a free clinic.
They hope it will become a template for systems that can be used by other clinics treating underserved populations.
"Our goal is really to connect the local clinics to this system," said Semenov.
They also hope the information gathered by the electronic medical records system will help officials better document the needs and demographics of Baltimore's homeless population. Morris and Semenov said the need for such a system is clear.
"The beauty of electronic records is how easy it is to transition information from one clinic to the next," said Semenov. So doctors who treated a patient at an emergency room in a Baltimore hospital, for example, can access records showing if that patient has allergies to medications or a history of high blood pressure.
Morris noted the system also lets physicians see workflow and identify areas that could be improved.
Federal law requires that medical organizations establish electronic record-keeping systems, which can cost hundreds of millions of dollars. But Semenov and Morris estimate they spent less than $5,000 to develop the system, not counting their own hours of work. It was offered to the clinic at no charge, and future systems will be less expensive, said Morris.
They received some funding through an Albert Schweitzer Fellowship, and the rest from private donations to the nonprofit organization they created, Networking Health. They worked with two other Hopkins medical students, Mark Fisher and Roosevelt Offoha, and advisors including Hopkins computer science professor Avi Rubin.
"Michael basically sent me an email one day saying they were working on this system," said Rubin. "They were interested in looking at the security of their system, what they could do to make it more secure."
Design of the system began with considering what a medical clinic serving a homeless population need. Billing information is not included, because the clinic is free. All the coding related to insurance claims are not necessary.
"We don't need the extra functionality," said Semenov.
The clinic is staffed by a medical director, Dr. John Dalton, and is run primarily by volunteers. With a paper medical record, Dalton said, "You have a chart and you have to thumb around to different places and it's all there but it's kind of clunky." With the electronic records, "you see everything at a glance and it's a whole lot better."
Dalton said the system is particularly useful in documenting changes in treatment. For example, "if you're maintaining somebody who is complicated and they've got 10 different medications," a change in dosage of one medication can be accomplished with a click on a keyboard. "Whereas if you do it by hand you have to do the whole thing," he said.
"It's already a success," he said of the system.
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