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Health Information Technology in Underserved Communities

Seven years ago, Carmen Aranibar, 67, a native of Peru, moved to Montgomery County, Maryland. Her daughter was concerned and knew her mother needed permanent health care because she suffers chronic ischemic heart disease and doesn’t have health insurance.

In this article...
By Isaac Itman

Seven years ago, Carmen Aranibar, 67, a native of Peru, moved to Montgomery County, Maryland. Her daughter was concerned and knew her mother needed permanent health care because she suffers chronic ischemic heart disease and doesn’t have health insurance.

Aranibar takes so many medications she can hardly remember them all. She also visits specialists regularly and has routine checkups to keep her blood pressure and cholesterol under control.

She receives her medical care at Proyecto Salud, Exit Disclaimer one of the eight non-profit health clinics of the Primary Care Coalition (PCC) Exit Disclaimer network, which aims at providing continuity of quality care to the uninsured in Montgomery County.

"Proyecto Salud has been a tremendous blessing to me," Aranibar said. "If I am not feeling well, my daughter calls to schedule an appointment and they see me right away."

Most patients who receive services at Proyecto Salud are adult immigrants and Latinos whose primary language is Spanish.

But even when Aranibar has to visit specialists outside the clinic, it feels like going to a familiar place because they already know everything about her condition and medical history.

Carmen Aranibar at Proyecto Salud.Since July 2005, Proyecto Salud has been using health information technology through the CHLCare program, an electronic medical record (EMR) system which allows their more than 3,000 uninsured patients to have their medical history entered into an integrated system connected to a network of community health care providers in Montgomery County.

"The main advantage of the EMR system is to simplify and allow access to several health providers involved in delivering services to patients like Carmen," said Dr. Livan Rodriguez, clinic coordinator of Proyecto Salud.

Each electronic record includes the patient’s picture and in September 2007 they started to issue picture identification cards to facilitate access to records and as proof of authenticity. Before the implementation of the electronic system, Rodriguez said it was very hard for patients to remember the name of their medications, the frequency of dosage, the specialists they had to visit and their past medical history.

According to Rodriguez, this new system can electronically access all the health information needed on a patient. This gives health care providers the power to make medical decisions when they meet the patient for the first time.

"The goal is to have a more accessible system and a less thorny process," he said.

Dr. Garth Graham, deputy assistant secretary for minority health, is hoping to improve health care quality among underserved populations and optimize the use of health information technology as an additional tool for reducing racial and ethnic health disparities. Graham is working with other experts in one of the federal workgroups of the American Health Information Community (AHIC), an advisory board on health care and information technology.

"The first proposed recommendation is to proactively work to increase the inclusion of racial and ethnic minorities and people with disabilities in HIT delivery systems," Graham told his colleagues at the most recent Consumer Empowerment Workgroup meeting in Washington, D.C. "Any development and use of HIT for patients and providers should ensure that racial, ethnic minorities and persons with disabilities are included."

Graham also said that health information technology can support better communication between patients and providers, where secure information exchange becomes a crucial factor. "Issues around trust and secure information are paramount, especially dealing with underserved communities," he said.

As privacy and security are key issues in building trust among patients and health care providers, Proyecto Salud patients must sign a consent form to make their EMR information accessible and the clinic staff must sign confidentiality agreements, said Dr. Cesar Palacios, executive director of Proyecto Salud.

Palacios said their EMR system prevents medical errors and, through its real-time data entry, makes available constant, up-to-the-minute patient information. This also allows other health care providers to continuously supervise a patients’ health.

"If the patient decides he wants to lose 10 pounds in the next six months, we can enter that information into the system and the medical assistant, the clinical provider and the specialist can ask him about his improvements," Palacios said. "A great achievement for us is when the patient realizes that we are thinking about his health as a team."

In the future, Proyecto Salud is hoping to implement an electronic personal health record system, which will let patients actively participate in the decision making process regarding their health care.

"If the patient has access to his personal health records when he comes to the visit with the doctor he will be more prepared and, as a consequence, he will have more questions to ask," Palacios said. "The personal health record is an empowering tool that can create a more interactive relationship between patients and doctors. In this way, the patient could adopt a more proactive attitude towards his health," he added.

Even though the initial implementation of the personal health record system may represent a challenge in educating patients to use information technologies, Palacios said that health navigators can help patients during this process.

"Knowledge and information are the most powerful weapons in the health field," he said. "We [the clinics] are working hard to do our part in this process, but this is team work between health care providers, patients and their families."


Isaac Itman is a writer for OMHRC. Comments? Email:


Proyecto Salud Exit Disclaimer

Primary Care Coalition of Montgomery County (PCC) Exit Disclaimer

Health Information Technology

Department of Health and Human Services-Montgomery County

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Content Last Modified: 2/12/2008 10:54:00 AM
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