Baltimore Medical Students Create Secure Open Source EMR for Homeless Patients

A free medical clinic serving Baltimore's homeless and uninsured residents now has its first electronic medical record system for patients—a project conceived and implemented by medical students at the Johns Hopkins University and the University of Maryland. It is the first electronic medical record (EMR) system developed by students for use by free clinics that cannot afford a commercial EMR system.

The need was recognized by Eugene Semenov while he was an undergraduate student at Johns Hopkins University and a volunteer at the Baltimore Rescue Mission's local free clinic for uninsured and homeless East Baltimore residents. Semenov saw many of the same patients returning over weeks or months with complex problems, but there was no organized medical records system to provide the most thorough and efficient care.

"They didn't have an easily accessible record to see which medicines the patient had been prescribed, the previous exam findings and diagnosis, the patient's allergies or whether the patient had been referred for specialty care," says Semenov. "There was no standardized tool at the clinic to collect and store that information."

So Semenov teamed up with fellow Johns Hopkins undergraduate student Michael Morris on an ambitious project to develop a secure electronic medical records system for the free clinic at the Baltimore Rescue Mission. They used open-source software, customized it with specific functionality, and then put it on a secure server.

The system is modeled after hospital electronic medical records—what would be noted in a typical patient encounter, such as history of present illness; past medical, social, and family history; results of the physical exam; and allergy and medication information, says Semenov. It also includes the physician's assessment and a plan to aid in patient follow-up.

As a result, more than 250 of Baltimore's underserved residents now have an electronic medical record to provide more consistency in their care. So far, the system has been used in more than 750 patient visits to the clinic.

"This is an exceptional initiative on the part of our medical students to help some of the most vulnerable patients in Baltimore who too often fall into the cracks in our health care system," says Peter Greene, M.D., chief medical information officer for Johns Hopkins Medicine. "The students' dedication to this project is very impressive. They had to work through many logistical challenges but were determined to see this through," adds Greene, who served as an adviser on the project.

The system took several years to develop. Semenov and Morris pursued it after they graduated from college and went on to medical school; Semenov at Johns Hopkins and Morris at University of Maryland. Semenov has also earned a master's degree in economics. His research focused on ways to improve the health care system. Before medical school, Morris worked for a start-up medical device company after he'd earned a master's degree in molecular and cellular biology. His research focused on diagnostic technology and informatics.

As they worked on the project, the pair enlisted the help of two other Hopkins medical students, Mark Fisher and Roosevelt Offoha. They formed a nonprofit corporation in September 2011 called Networking Health, and applied for federal nonprofit status, enabling them to raise funds to build and support the system. The students also secured an Albert Schweitzer Fellowship. Their work was recognized this past spring at the Clinton Global Initiative University conference, an event created by former president Bill Clinton to showcase innovative ideas to benefit humanity.

"Our next priority," says Semenov, "is to expand the system to other free clinics in Baltimore and connect the records through the Maryland CRISP project—an initiative to create a health information exchange to enable all medical providers throughout the state to share electronic medical records so that patients can receive quality care no matter where they go for treatment."

Greene says linking the Baltimore Rescue Mission's patient records to CRISP would make the Networking Health program even more valuable. That way, when patients came to a hospital emergency department, physicians could look up their medical records in CRISP, and the clinic staff could find out about the patients' diagnosis and treatment at area hospitals. "It would provide continuity of care to the most vulnerable patients," says Greene.

Expanding, refining and maintaining the electronic medical records system will require funding. Semenov says they initially hope to raise $250,000, which would include hiring a few people to keep the system operating.

Providing effective care to the homeless population is fraught with challenges, given that many have chronic diseases, lack nutrition, shelter and safety, have mental health and substance abuse problems and are less likely to seek regular care. They often come to emergency departments for treatment of serious health problems without an accessible medical record to assist physicians in providing care. Now, however, at least for patients from the Baltimore Rescue Mission who arrive in an emergency department, the ED staff can call the clinic to obtain the patient's medical history.