In April, the Obama administration appointed Dr. Neil Calman to the newly created Health Information Technology Policy Panel, a committee established by Congress and charged with helping shape the nation's health information technology system. In essence, the panel is mapping the nervous system for health reform.

Calman, president and chief executive officer of New York's Institute for Family Health, seems ideal for the role. He founded the Institute as a means of bringing to the South Bronxthe best aspects of private-practice healthcare. Against all odds, the network has grown to encompass 25 clinics with more than 600 employees, a robust IT capability and a hard-earned reputation for delivering high-quality care.

The overarching goals of health reform being pursued by the administration and Congress"controlling costs, providing care for the tens of millions who lack health insurance, improving the system's overall quality"are challenges Calman has confronted for more than a quarter century. Long before the term "meaningful use" became a linchpin of healthcare quality, Calman grappled with the problem in a 1979 paper, "The Computerized Family Problem Profile."

Computer epiphany
As an undergraduate at the University of Chicago in the late 1960s and early 1970s, Calman frequented the school's computer center, located a block from his apartment, where he learned to program in Fortran and SNOBOL using IBM punch cards. Smitten, he later bought an original IBM PC and a Compaq Portable that "looked like a 28-pound suitcase."

"I found a spiritual connection to those crazy machines," Calman recalls.

By 1984, dissatisfied with the quality of institutional healthcare provided by New York Cityclinics, Calman and three like-minded colleagues founded the Institute for Urban Family Health. It sought to deliver personalized care to its patients"the poor, the uninsured and recipients of Medicaid"people "who normally are made to get care in institutional settings," says Calman. He envisioned cultivating "one-on-one trusting relationships [of the kind] that people develop when they have good insurance and go to private doctors." Patients would see providers "who would be on call for them on nights and weekends."

Calman's first health IT grant, from the New York State Department of Health, supported a hypertension outreach project based on an early spreadsheet application used to track patients with high blood pressure. He also created a database of patients' diagnostic codes and a program that used the information to construct new problem lists. The database became an index of patients' records.

IT in perspective
The big leap forward, in terms of IT, happened in 2001, when a consortium of hospitals asked the Institute to take over a group of six large ambulatory care centers operated by a health insurance company. The deal would double the Institute's staff and patient visits. Calman, concerned about taking on this new responsibility without the means to monitor quality of care, agreed to accept the offer if the hospitals would pay half the cost of a major IT acquisition.

So it was that in 2002 the Institute became one of the first community health center networks in the country to launch a fully-integrated electronic health record and practice-management system.

Working with Epic Systems, the Institute migrated to applications that allowed it to begin identifying best practices that save money and improve care. Calman learned, for example, that different practices excelled at different aspects of primary care. The provider who succeeded in controlling patients' lipids didn't necessarily have the same success in controlling blood sugar.

One of the Institute's first ventures with its new IT system was to create a clinical decision support tool for improving vaccination rates of patients who were at risk of developing pneumonia. In its first month of use, the alerts helped to raise the number of vaccinations administered from 16 to 299, an 18-fold increase.

Those results aside, Calman says IT alone doesn't improve healthcare. It can, however, make the job easier. "We were very engaged with quality improvement before we had an electronic health record," he says. "I'm afraid that we will expect too much from the technology alone. Learning to become meaningful users of these sophisticated systems to improve quality of care, efficiency, patient engagement and reduce health disparities is the real goal."