Modernizing Health Records for the Most Vulnerable

Over a decade ago, an NJIT health care startup took up a daunting challenge: to train 5,000 primary care providers in the state to adopt electronic health record systems that would allow them to better track their patients, improve their quality of care and securely share information.

The federal government, which funded the $50 million effort, had identified cumbersome and sometimes illegible paper records as one of the health care system's principal vulnerabilities. The group, NJ-HITEC, ultimately trained 6,500 providers.

Years later, at the request of the state, a successor organization at NJIT is plugging a gap in that initiative: modernizing record-keeping systems for one of the most complex and vulnerable segments of the patient population - people with substance use disorders.

"This is a severely siloed system. The aim is to integrate it and enable interoperability so that facilities can share information," notes Renu Tadepalli, who runs the program for the health care division of the university's New Jersey Innovation Institute (NJII). A primary goal is to reduce opioid abuse, but treatment centers say their new systems also allow them to keep better track of patients' overall health and to respond quickly to crises.

By connecting with the New Jersey Health Information Network, an electronic exchange of patient health information run by NJII, treatment centers receive alerts, for example, when a patient checks into a facility or a doctor orders a new prescription.

"We're able to see when a patient is in and out of the hospital and what they were admitted for," says Katy Linton, CEO and facility administrator of Greater Essex Counseling Services in downtown Newark. "Some of our clients have a number of problems, such as schizophrenic disorder, hypertension and diabetes, and we can find out if they're in touch with a family member or whether they need us to act on their behalf. Finding out where they are and what they need will help with more accurate diagnoses."

She adds, "In general, we want to focus on helping patients maintain a happy, healthy and whole lifestyle. You can't work hard on substance use issues if you're not feeling good."

Patricia Ackermann-Blanco, the center's clinical director, recalls the time a patient was losing weight, seemed disoriented and then dropped off the radar. Then she got an alert from a hospital apprising her of a dementia diagnosis for that patient. "We're able to follow up with clients that would otherwise get lost in a very cumbersome health system," she says.

Managing 250 clients with substance use and other problems is complicated, and the new system can help in multiple ways. In just one small part of the operation, the center processes between 170-200 urine tests a week.
Tracking that is now easier.

Critically, they also receive alerts when a doctor orders a prescription, so staffers can monitor what's called "pharmacy shopping," helping them to "prevent overdose or death and to see when a patient is struggling with sobriety," Ackermann-Blanco says.

Greater Essex first talked about adopting electronic records a decade ago.

"But the cost, at $50,000 to $70,000, was prohibitive," recounts Chris Vadas, the facility's co-owner and COO.

With funding from the New Jersey Department of Health and the New Jersey Department of Human Services for both the systems and the training, NJII has so far enrolled 110 facilities in the program.