Several years ago, a young woman visited health clinics in Fort Wayne, Ind., with symptoms that included a cough and low fever. Each doctor noted her symptoms at the time, but none of them learned about her exams at the other clinics, said Meg Distler, executive director of the St. Joseph Community Health Foundation.

Without a complete picture of the woman's medical condition, the doctors failed to see she had tuberculosis. The disease eventually killed her.

"If they had seen a whole chart, it would have been obvious," Distler said.

Local health-care organizations were already discussing how "safety net" clinics -- those that serve patients with no health insurance and patients on Medicaid -- could share information to gain complete medical histories for their patients. The woman's story served as an emotional trigger, spurring organizations in Fort Wayne to take action.

The result was the Health Access Program (HAP), an application that places patients' information in a central repository for easy sharing. Building complete medical histories for patients at safety net clinics is often a challenge.

"A lot of the patients we see at our clinics tend to bounce around to a lot of the other clinics," said Dave Fiess, informatics director of the Fort Wayne-Allen County Health Department, which operates four safety net medical facilities.

Local health officials didn't realize how dire the problem was until they implemented electronic medical records (EMR) systems. Then they discovered that 20,000 patients were seen in more than three locations, said Doug Horner, co-founder and president at Medical Informatics Engineering (MIE), the Fort Wayne company that developed HAP.

A patient doesn't always remember to relate all the details of his or her medical background, such as past illnesses and treatments, medications, surgeries and parents' medical histories. If much of that information is inaccessible because it's filed at other clinics, the attending physician could lack potentially critical information.

The St. Joseph Community Health Foundation, a private, faith-based organization, laid the groundwork for HAP by providing grants to local clinics to implement EMR systems. All of them chose MIE's program, Web Chart, which most private physicians' offices in the area use as well, Distler said. Then the foundation and the clinics started to look at ways to connect their separate Web Chart databases.

"I can't say there was one 'aha!' moment when the idea of connecting them came up," Distler said, adding that the story of the woman with tuberculosis pushed the process along.

The foundation provided the computer hardware and funding for someone to coordinate meetings where participants could hammer out the details of the new system, and MIE contributed the software development.

Privacy, Accountability

Officials from local hospitals lent their expertise to make sure the system complied with the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA).

"The local hospitals were very generous in helping to walk through each of the steps with their compliance officers, to make sure that what we did was really at the top letter of the law," Distler said.

The governing bodies of all four clinics had to agree on procedures they would use to get permission from patients to share their information, she said, and the clinics share information only on patients who give written consent. Participants also had to agree on accountability procedures, to make sure records shared through HAP aren't misused.

Clinics that have implemented Web Chart and HAP include: Matthew 25 Health and Dental Clinic, a free, faith-based medical facility; the Fort Wayne Medical Education Program family practice clinic, a residency program of the Indiana University School of Medicine; Neighborhood Health Clinics Inc., a private nonprofit organization; and Fort Wayne's four city-county Health Department clinics, which specialize in sexually transmitted

Merrill Douglas  |  Contributing Writer