Technology lends homeless a hand
Physician's assistant Jill Roncarati searched the streets of downtown Boston as the snow fell, peering inside train stations and bagel shops. She was looking for homeless people who needed medical care, and especially for one woman who had broken her leg and was living outdoors on crutches.
Roncarati, part of the street team for Boston Health Care for the Homeless, carried a new device strapped to her belt: a BlackBerry that allows her to send her patients' prescriptions electronically to the nearest pharmacy. The nonprofit group is one of the most recent medical organizations to test e-prescribing. And since the group's homeless patients often lose paper prescriptions, or forget to bring them to the pharmacy, doctors hope electronic prescriptions will encourage more of Boston's homeless to pick up their medicines.
"On the street, we're looking for any edge we can get to reach folks," said Dr. James O'Connell, the organization's president.
Until last month, Roncarati wrote most prescriptions on small paper slips, standard in most doctors' offices, or called in prescriptions to pharmacies if she had the phone number and could get through.
"This is a huge improvement in quality for our patients," said Roncarati, walking along Summer Street on Wednesday morning. Health Care for the Homeless does not know exactly how often its 9,000 patients fail to fill prescriptions, but "we knew it was a problem," said Peter Malloy, chief information officer.
A grant of about $15,000 from the Massachusetts eHealth Collaborative, a coalition of insurers and medical providers, will allow 16 of the group's doctors, nurses, and physicians' assistants to test Dallas-based Zix Corp's e-prescribing system for one year.
On Wednesday morning, Roncarati stood outside the Park Street subway station and called Hector Ruiz, an outreach worker for the Pine Street Inn homeless shelter, to see if he knew where to find the woman on crutches and a man who needed surgical staples removed from his scalp. Ruiz decided to join Roncarati in the search.
From 9 to 11, they hit the likely spots: Finagle A Bagel on Tremont Street, the sidewalk outside St. Anthony's Shrine on Arch Street, South Station and the nearby bus terminal, stopping to ask a half dozen homeless people if they needed food or medical care. Finally, Ruiz spotted a woman moving slowly on crutches down Summer Street and headed into McDonald's. It was her.
Roncarati followed her in. The woman, who wanted to be identified only by her first name, Laurie, complained about pain in her broken leg and lapsed into prolonged coughing from asthma and bronchitis.
"I'm out here and I'm in pain and I can't sleep," she said.
Roncarati took her temperature and pulse and decided to prescribe Prednisone to reduce swelling in her lungs. Roncarati typed Laurie's name into the BlackBerry, and her birth date and health insurer -- the Massachusetts Medicaid program for the poor and disabled -- popped up. Health Care for the Homeless had previously transferred its list of patients into the Zix database. Zix is working with Medicaid to get the state agency to load patients' medication histories into the e-prescribing database, so doctors and physicians' assistants can quickly see a patient's current and past medicines.
Roncarati chose an eight-day course of Prednisone and the CVS pharmacy across the street from McDonald's. She told Laurie she could walk across the street in an hour to pick up the medication. Roncarati knew from talking to the pharmacy on Friday that Laurie had not picked up the medicine, but she was still hopeful.
Health Care for the Homeless is working with Medicaid so that eventually staff can look up on their BlackBerries whether a patient has retrieved their prescription, and can track their medical care more closely.
Liz Kowalczyk can be reached at kowalczyk@globe.com.
