One by One, City Health Clinics Are Joining the Digital Age

Doctors at a Brooklyn health clinic will officially swap paper files in favor of electronic health records today amid a citywide effort to digitize community health centers.

Of the 29 participants in the Primary Care Information Project, a multimillion-dollar Department of Health and Mental Hygiene initiative that is bringing health information technology to clinics in the city's poorest communities, the Brownsville Multi-Service Family Health Center is the sixth community health center to switch over. City officials said they hope to convert the other centers to electronic systems by 2008, when computer terminals will be in each exam room.

Officials who support the initiative said it will improve the quality and efficiency of doctor visits, and will prompt clinicians with point-of-care reminders that can be advantageous in treating chronically ill patients. In the public health sphere, it will be possible to track epidemics like diabetes and obesity with an emphasis on prevention.

"We want to move from a culture that's focused on ‘fix' to a culture that's focused on ‘prevention,'" the director of the health department's Primary Care Information Project, Matt Kendall, said.

So far, the initiative has received portions of a $27 million mayoral commitment to bring electronic health records to at least 1,000 doctors in the next few years. It also has received $3 million in state funds, in addition to $2 million from the City Council. A $15 million city contract with eClinical-Works, a medical software provider, is pending, officials said.

Although it is costly, the initiative has garnered support from several local lawmakers. "If you're going to have high-quality care for patients in the future, you really can't do it without this technology," City Council Member Gale Brewer, a longtime technology advocate who represents Manhattan's West Side, said. Until now, she said, community health centers have not been able to afford to do so.

Administrators at the Brownsville health center, which treated 20,000 HIV/AIDS patients and 55,000 medical and dental patients last year, said they have high hopes for the project. In the past four years, they have put $500,000 of their own money into it. Although the program launches today, about 50 computer terminals have been operational since last month.

"We wanted to improve the quality of care that we bring our patients. This is a tool to do that," the health center's executive vice president and chief operating officer, Harvey Lawrence, said. In addition to streamlining the clinical process, Mr. Lawrence said, the electronic system will link lab reports and billing to patients' records.

Eventually, the electronic data could help the clinic obtain crucial government funding by way of documenting its services, he said.

Critics, however, said electronic health records could threaten patient privacy by making personal information — about mental illness or sexual history, for example — vulnerable to improper dissemination. "It's not without risk to have your sensitive information electronically stored and accessed," an attorney in New York who monitors health freedom, Robin Kaigh, said. "Does your dentist need to know what your gynecological history is?"

Ms. Kaigh said one of her main concerns is that it remains to be seen whether patients will have the freedom to choose whether they want to be added to an electronic health network. "Maybe you would like to have your information that way, but maybe I won't," she said.

Still, officials said security is a primary concern, and some suggested that the future of quality care depends on electronic records.

Chronic conditions are manageable, the executive director of the Primary Care Development Corporation, Ronda Kotelchuck, said, "but electronic health records are essential in doing that."