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Twenty-eight community health center networks serving some of New York City’s poorest areas are working to improve patient care and center-to-center interaction by converting paper-based patient records into electronic records.

The NYC Department of Health and Mental Hygiene (DOHMH) is supporting the health centers through a $27 million commitment from Mayor Bloomberg to bring electronic health records – which store health information and provide diagnostic support to doctors – to more than 1,000 doctors in the city.

This enterprise, called the Primary Care Information Project (PCIP), “seeks to improve health in New York City as a whole and particularly in underserved communities through the use of health information technology,” said Dr. Farzad Mostashari, assistant commissioner and chair of the DOHMH Primary Care Information Taskforce.

These community health centers operate among medically underserved populations and provide comprehensive primary care at fees adjusted according to the patient’s ability to pay. Participating centers matched the city’s support with $7.75 million of their own. These 28 networks care for over 500,000 New Yorkers at 150 sites in the city, such as the William F. Ryan Center with three sites in Manhattan, the Harlem United Community AIDS Center and the Brownsville Multi-Service Family Health Center.

Already fully integrated at five of these city centers, electronic health records allow doctors and nurses to more sufficiently care for patients by reducing the time it takes to pull up patients’ histories and communicate within the center. Doctors can easily reference a patient’s health history or access any data they have collected directly on their desktop computers.

Every examination room will have a computer, hopefully by 2008, so that providers can visually explain their health concerns to patients. Proponents believe this will reduce the language and cultural barriers many patients face.

City Council allocated an additional $2 million for the network and hardware infrastructure needed to run the systems for the project. Councilmembers visited one center last month, the Charles B. Wang Community Health Center in Chinatown, to see firsthand how the new technology improves patient care. Between its two sites in Chinatown and one in Flushing, Wang receives more than 160,000 visits by 35,000 patients each year.

Chief Medical Officer Thomas Tsang displayed the new technology recently to City Council Health Committee Chairman Joel Rivera and several other councilmembers and officials who have worked on the project.

Tsang quickly called up a patient’s health history. “Instead of a thick chart, everything is on here,” Tsang said. “It operates like Microsoft Outlook. Everything in my universe in patient care history is on my desktop.”

He displayed a chart of the patient’s health history: “I can graphically display values, for example, plot the patient’s blood pressure,” which makes it easier for the patient to grasp, Tsang said. “We used to have paper reports for blood tests, whereas all lab results are downloaded automatically with interface from lab computers in real time.”

While the councilmembers in attendance took in the benefits of the technology, they were more concerned with the costs of the program. At Charles B. Wang, it took $1.5 million to purchase the necessary software and hardware and train the staff. An additional $500,000 is needed annually to keep staff up to date on the system, Wang Chief Financial Officer Lynn D. Sherman said.

Although the system is only entirely implemented and operable in a handful of the designated centers, plans are proceeding as scheduled, said Barbara Hood, information officer for the Community Health Care Association of New York State.

It is important to focus efforts on community health centers and not hospitals because hospitals have so much more money, according to Denise Soffel, senior policy analyst for the Community Service Society. “The hospital lobby has been incredibly effective at getting money. There is a long overdue rebalancing to direct money community health centers … [New York City has] under-invested in this sector of care,” Soffel said.

“Generally some of the larger medical centers are farther along … It is going as planned, but a project like this has so many moving pieces. We need to make sure people are going to be successful at this by factoring in the planning and organizational issues. We give them the foundational work to guarantee their success,” Hood said.

According to Mostashari, paper systems used by healthcare providers are chaotic. “Very frequently, when patients go to see a doctor, records can’t be found,” he said.

“If a practice were to ask themselves ‘how many of our patients have diabetes? How many of our diabetic patients have their blood sugars controlled? How many of our diabetic patients without their blood sugar controlled are on insulin?’ They wouldn’t be able to know,” Mostashari said.

Electronic records provide a way to reference and cross-reference patient information. The system also sends reminders to providers. If a patient is overdue for preventative care, such as a mammogram or flu shot, the doctor is notified and he can see to it that his patient receives accurate care.

“The city is focusing on this … I think they realize community health centers who serve healthcare particularly in low-income communities are on the forefront to addressing those who need healthcare the most,” Hood said.

– Marisa Picker

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