Experience with an electronic health record for a homeless population

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This is a review of the article titled; Experience with an electronic health record for a homeless population.

Dyan R. Blewett, MS, G. Octo Barnett, M.D., Henry C. Chueh, M.D. M.S., Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA

American Medical Informatics Association 99 (1999) 481-485


According to Dyan et al, in their article, the health care needs of the homeless population are unique. People who are homeless are less likely to seek ambulatory medical care with their multiple medical problems until their conditions have worsened. There is a high prevalence of mental-health illness and substance abuse among this population. Certain medical conditions like diseases and disorders of the skin , human immunodeficiency virus infection, tuberculosis and gynecologic problems are more prevalent in the homeless.Homeless children have a higher incidence of injuries related to trauma and chronic diseases. Obesity is the major nutritional problem in the homeless children due to high content of carbohydrates and fat in their food sources.Perceived efficiency impacts following electronic health record implementation: an exploratory study of an urban community health center network

An electronic medical record system was designed by the laboratory of computer science Massachusetts general hospital to try to meet the particular needs of the Boston Health Care for the Homeless Program (BHCHP) which was established in 1985.

A central server running Windows NT and Shiva remote access technology are located at the BHCHP respite.Using portable computers and work stations and regular telephone lines, provider dial via modems int to this server from various remote sites in the Boston area where medical care is being delivered.


The system was implemented in a client-server, distributed database architecture. The EMR currently includes the following sections; demographic, Summary, Medical History, Physical Exam and Procedures, Labs, Guidelines, Case Management and Visit Notes. The fields included in these sections are the usual fields expected in the medical record (problem and medication lists, etc.) with additional fields vital for providing care for homeless population. These include ; alias, benefits, substance abuse, preveious address, homeless status,case management and guidlines for the 20 health maintenance concepts that are monitored. Controlled vocabularies are used to validate data entry where ever possible. Acess to data entered in the sytem for analysis is provided via an ODBC connection from Microsoft Access to the ORACLE data base. Queries are run on the database to scan for duplicate records, misclassification of encounter types and other possible data entry errors. Retrospective analysis studies can also be conducted using the EMR for assessing quality assurance and outcome.


The system has been used by over two hundred providers from various health care specialities( Table 1). There are, on average, twenty providers logged into the system at any given time.


The article discussed in detail how BHCHP the largest healthcare system for the homelss in the country integrated information technology to better serve this difficult to reach population.


The article was informative and interesting.

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