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Technology without Borders

In just a fraction of the 5,100 square feet that used to swell with patient files at the GW Medical Faculty Associates (MFA), a digital x-ray machine, a nuclear reading room, and the Dr. Cyrus and Myrtle Katzen Cancer Research Center now stand — and those are only the physical gains of the MFA’s transition to electronic health records (EHRs) in 2004.

“All of that space has been built out to improve patient care,” said Steve Badger, CEO and treasurer of the MFA at the mHealth Speaker Series lecture, “Electronic Health Records: The Impact at Home and Abroad,” March 8.

The event, sponsored by GW’s Department of Emergency Medicine and the GW Collaborating Centers for Global Health and Development, featured Badger and Hiliary Critchley, vice president for strategy and policy at health care consulting firm Casscells and Associates. Using examples from both the U.S. and Haiti, the speakers detailed how EHRs and other technologies are being implemented in a variety of health care settings to improve quality and access to care, decrease costs, and better understand population health.

Badger first outlined the MFA’s successful implementation of EMRs, a move supported by its partnership with the health care software company AllScripts. By serving as a beta site to test Allscripts’ newest technologies and upgrades, the MFA has remained on the cutting edge of EHR capabilities and will likely become the first institution in the country to use iPads in integration with EHRs, Badger said.

In addition to the adoption of EHRs, the MFA has embraced other electronic capabilities such as “Patient Online,” a personal internet account used for appointment scheduling and cancellations, prescription refill requests, and patient–physician messaging. Once installed, Badger found that the system became a tool patients could not live without. “It’s crazy [because] no one would have ever thought it would be of value, let alone, become an integral part of communication in the practice,” he said. In the near future, the portal will likely be replaced with FollowMyHealth, a similar technology that also allows patients to access their personal health records.

The benefits of these and other technologies are manifold, said Badger. From significantly reducing health care costs to providing faster and better-coordinated services to reducing errors in prescriptions, technology has most importantly improved patient care.

“Technology is really the foundation of much of what we do,” said Badger. “It makes the practice of medicine better, it makes the business of medicine better, and it is something that we have clearly embraced. It has made us a better place.”

On a broader scale, health technologies are also making the world a better place, indicated Critchley, following Badger’s presentation. As a strategy and policy consultant for S. Ward Casscells, M.D., Distinguished Professor at the University of Texas Health Science Center at Houston and former assistant secretary of defense for health affairs, Critchley’s recent projects have engaged her in evaluations of health technology efforts in Haiti, where she conducted a needs assessment several months after the January 2010 earthquake.

“Just like here in the U.S., there is a real need and a real opportunity [abroad] for health IT systems that can aggregate information in order to assess population level data and research,” said Critchley. Because the earthquake in Haiti displaced so many people — cutting them off from any existent health care structure — “this surveillance type of work is certainly necessary,” she added.

Through her needs assessment, Critchley also found that post-earthquake Haiti suffers from a gap in mid-level care providers, since much of the country’s aid was only temporary. “After a couple of months, people can no longer provide free care, especially the domestic staff,” she said.

To help face these and other issues, Critchley and Casscells attended a symposium hosted by the American Medical Association in June. The conference — which brought together people from the Haitian Ministry of Health, academia, think tanks, NGOs, hospitals, government agencies, and more — sought to create technological solutions to the country’s health problems. The group decided that such resolutions must be part of a comprehensive public health program, designed for scale and sustainability, measurable, equitable, encouraging of country ownership, and interoperable.

“From our perspective, what better solution than ehealth when it comes to training world health care workers, monitoring diseases and epidemics, ensuring that new messages are pushed out, and having that electronic health record as really the gold standard?” said Critchley.

Though developing and disaster-stricken countries like Haiti face many more challenges to health technology implementation than countries like the United States, Critchley demonstrated that even Haiti — which used cell phones during and after the earthquake to alert patients of aftershocks and to establish an emergency text response system — can pave the way for new types of technologies. “There were so many different, innovative uses of cell phones post-disaster which we really think is going to change the face of disaster management, preparedness and response,” she said.

“Where we are today isn’t our destination, and I think that this is going to continue to push technology to really continue to transform health care,” concluded Badger. “It’s really exciting thinking about what’s in place today and what the possibilities are in the future.”

About the mHealth Speaker Series

The mHealth Speaker Series is a six-part seminar series that provides a forum for discussing mHealth evaluations, highlights mHealth research and practice at GW, and develops partnerships with the broader implementation community. It is sponsored by the Department of Emergency Medicine in the GW Medical Faculty Associates and the GW Collaborating Centers for Global Health and Development.