diseases, tuberculosis, lead poisoning and refugee care.

The Health Department was the last to start using HAP because it implemented Web Chart later than the others, in early 2005, Fiess said.

Most medical offices use a hosted version of Web Chart, which runs in an MIE data center. HAP is just another Web Chart system, Horner said. Its database provides a repository for data from all participating clinics.

At the Health Department clinics, when a new patient calls for an appointment, the receptionist creates an electronic record in Web Chart, entering information such as the patient's name, sex, birth date and Social Security number.

When the patient arrives for the appointment, HAP checks that information against its database to find out whether any other participating clinics have seen that patient. If it finds a match, it alerts the operator. The software includes an algorithm that compares records, and in the event of a near-match -- for instance, the same sex, birth date and Social Security number but a different last name -- the system will present the two records for the operator to evaluate.

If there's a match, Fiess said, the HAP tab will appear for the patient on screen. "The receptionist will then inform the nurse or doctor that this patient has some information in the HAP system."

What You Scan Is What You Get

Although they're using an EMR, the clinics also continue to record information on paper. The software lets them print out the forms they use in their exams; later, employees scan the completed paperwork into the system, Fiess said. When an employee in one clinic uses HAP to access another clinic's records, he or she sees the scanned documents.

"If clinic A handwrites it, that's what you see. If it types it, that's what you see," Distler said, adding that this flexible design decision was significant. "It's working very well, because everyone's using it as part of their process, versus trying to force people to take on a new process that they may or may not have liked."

A second phase of the HAP rollout will bring local hospitals into the system. That will start with a pilot in an emergency room, Distler said. At first, hospital personnel will be able to pull up records for Medicaid patients, or patients without insurance, who have been seen at one or more safety net clinics. In the next step of the development, Distler added, hospitals will determine which of the collected data they will send to HAP. "They don't want to kick back everything, for a lot of confidentiality reasons."

Once the emergency rooms of Fort Wayne's two hospital systems are up and running on HAP, the hospitals' obstetrics departments probably will start using it as well, Distler said.

The Fort Wayne-Allen County Health Department hasn't been using HAP long enough to get a good handle on how effective it's been, said John Silcox, communications director for the department. "We're probably going to have a little more of an idea and a way to quantify its success once we've been using it longer."

Clearly many benefits arise from giving physicians more complete information about the patients they see. For example, if a patient visits a city-county health clinic and later goes to another facility, the physicians there can see the medicines prescribed, so they don't prescribe something that can't go with it, Fiess said.

HAP aside, simply moving to electronic medical records has greatly improved service to patients, said Distler. For example, at Matthew 25's free clinic, where volunteers process and maintain medical charts, a patient visit used to take as long as five hours. Now, using the EMR, the clinic whittled that time down to probably two hours to go in, get an exam and go through the dispensary, she said.

Along with providing benefits to patients and clinics, Fort Wayne's HAP project offers an excellent example of a public-private partnership, Distler said.

"To get that kind of collaboration in a community over five years is a wonderful thing. It's a real testament to a lot of people who really are working on good solutions for health care."

Merrill Douglas  |  Contributing Writer