Abstract
Harlem Hospital was created in the late 19th century to serve as a waiting station for patients being transferred to other parts of New York City. As Harlem grew and changed, the hospital became more advanced and capable of serving the needs of the community. There was initially significant problems relating to the treatment of people from the community. While staff at the hospital was mostly white, most of the patients were African American, and there were many tensions and claims of mistreatment. This was in the early twentieth century- long before the civil rights movement had made inroads. It was the strengthening of the research relationship with Columbia University which led to changes, as research focused graduate students and professors questioned many aspects of care from a sociological and social justice perspective. Today this research is facilitated by the modern era of health care, where not only billing information, but patient medical records, medication administration, and other details provide data that are tracked, monitored and managed, and used in hospital reporting in addition to providing for research.
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In 1958, Dr. Martin Luther King, Jr. was rushed to at Harlem Hospital after an assassination attempt. This hospital is one of the finest in a city, despite being located in an area known for poverty (Thorpe, 2017). Physicians were able to save Dr. King with emergency surgery (Thorpe, 2017). Dr. King referred to this care in his final speech. Harlem Hospital has been involved in the making of history, and it has cared for important historical individuals, but the historic event which will be discussed in this paper is the alliance between Harlem Hospital and Columbia University which sought to increase research which would support better quality of care and patient outcomes.
Harlem Hospital was created in the late 19th century to serve as a waiting station for patients being transferred to other parts of New York City. As Harlem grew and changed, the hospital became more advanced and capable of serving the needs of the community. There was initially significant problems relating to the treatment of people from the community. While staff at the hospital was mostly white, most of the patients were African American, and there were many tensions and claims of mistreatment. This was in the early twentieth century- long before the civil rights movement had made inroads (Thorpe, 2017). It was the strengthening of the research relationship with Columbia University which led to changes, as research focused graduate students and professors questioned many aspects of care from a sociological and social justice perspective (Thorpe, 2017). The hospital responded with a plan to hire more staff from the community, as well as achieving higher rates of diversity as a management goal. The first black physician was hired in 1919, and a specific attention to diversity and intercultural relationships became an overt focus of the vision of the hospital (Thorpe, 2017).
Harlem Hospital, in collaboration with Columbia University, has been making important contributions to evidence-based practices in health care in both sociocultural and clinical terms for decades. For example, a 1935 study concerned itself with the pregnancy and labor of very young women, while a 1952 study sought to understand whether narcotics addicts in Harlem were at an increased risk for hepatitis (Altschul, Foster, Paley, & Turner, 1952; Posner & Pulver, 1935). In the late 1950s there were a number of converging events and situations. The Harlem local population was by this time mostly African American, and low income, and this had an impact on the direction and approach of the hospital towards its operations (Thorpe, 2017). This culminated in 1990 with the assertion of patient navigation as an important lens from which health care should be viewed, one which had been influential in motivating a more patient centered perspective (Siba, Culpepper-Morgan, Schechter, Alatevi, Jallow, Onaghise, & Sabbagh, 2017).
A service which is provided by Harlem Hospital which impacts access to healthcare and the quality of health in the community is preventative care and screening. It can be difficult to motivate patients to take the time for preventative care, particularly in an economically depressed area where few people had health insurance. Harlem Hospital provides Medicare and Medicaid covered services, but they also actively market public health messages and preventative services in the community, making a greater difference to the health of local residents, while publishing studies that provide evidence of the efficacy of such programs (Siba et al., 2017). For example, improved access to colorectal cancer screening ten years previous has had the result of fewer colorectal cancer deaths in the African American patient population (Siba et al., 2017). By promoting free clinics for various screening services, and then marketing them, Harlem Hospital is contributing to the local care of residents, and the research evidence that can contribute to global improvements in health care by providing important data about preventive care services.
Information management technology at Harlem Hospital has an impact on healthcare delivery because the data is used to facilitate continuous improvement and higher quality of care for the patients at the hospital, as well as for the health care profession generally, by providing evidence for practice.
Harlem Hospital uses emerging technology like new methods of data capture and analysis to support research projects and initiatives in collaboration with Columbia University. These studies tend to be for the purpose of improving health care through capturing, analyzing and provide evidence of best practices that can translate into processes and interventions for care. This is something which stands out as part of their history, and with new goals for a more efficient health care system with better outcomes for patients, the hospital and the partnership are well positioned to contribute to this urgent mission. Recent studies which target evidence which will translate into practice include Dinesh, Polanco, Khan, Ramcharan, and Engdahl, (2018) and their study of inner-city pediatric burn victims. There is also the use of big data to do regression analysis that contributes to patient care and health care structuring, including supportive information on how other research hospitals can achieve this level of evidence development (Lama & DeVita, 2018).
Information management technology and expectations relating to it also have an impact on Harlem Hospital’s healthcare delivery because they are used in performance indicators that impact on the financial sustainability of the hospital. Performance indicators for a variety of health care related patient outcomes are determinants of reimbursement by Medicaid and Medicare, a major provider of reimbursement for services provided to patients. Hospital Compare is an online tool which takes the performance information collected by the Centers for Medicare and Medicaid (CMS). This provides the general public with a way to use the same information which is used in assessing reimbursement payments to make their health care decisions. It also provides a profile of the hospital and identifies whether the hospital participates in certain information management technology initiatives. In the case of Harlem Hospital, the Hospital Compare tool states that the facility participates in the Nursing Care Registry, and the facility can receive and track patient lab, test and referral results electronically and between visits (CMS, 2018). Having to capture, analyze and report on such data helps hospitals to provide better care by raising the profile of empirical outcome indicators, and this can fuel continuous improvement.
Another example of how information management initiatives are influence health care delivery can be found in the pediatric tele-psychiatry pilot initiative at Harlem Hospital (NYC H+H, 2016). This project is meant to facilitate care for this vulnerable and specialized population of children in need of psychiatric services. Telemedicine can help specialists to cover a broader area and see more patients, which enables a higher quality of care. The tele-psychiatry initiative therefore has the potential to raise the capacity to deliver mental health services to the children of the community (NYC H+H, 2016).
All of this information and analysis is facilitated by the modern era of health care, where not only billing information, but patient medical records, medication administration, and other details provide data that are tracked, monitored and managed, and used in hospital reporting in addition to providing for research. Harlem Hospital has been attuned to the importance of information and its management as a contributor to patient care for nearly one hundred years, typically at the forefront of cutting edge approaches and aims.
- Altschul, A., Foster, P. D., Paley, S. S., & Turner, L. (1952). Incidence of hepatitis among narcotic addicts in the Harlem Hospital, New York. AMA archives of internal medicine, 89(1), 24-31.
- Dinesh, A., Polanco, T., Khan, K., Ramcharan, A., & Engdahl, R. (2018). Our Inner-city Children Inflicted with Burns: A Retrospective Analysis of Pediatric Burn Admissions at Harlem Hospital, NY. Journal of Burn Care & Research.
- Lama, K. M. W., & DeVita, M. A. (2018). Trigger Criteria: Big Data. Critical care clinics.
- NYC H+H (New York City Health and Hospitals Corporation). (2016). Medical And Professional Affairs Committee Minutes. Available from: https://www.nychealthandhospitals.org
- Siba, Y., Culpepper-Morgan, J., Schechter, M., Alatevi, E., Jallow, S., Onaghise, J., … & Sabbagh, R. (2017). A decade of improved access to screening is associated with fewer colorectal cancer deaths in African Americans: a single-center retrospective study. Annals of gastroenterology, 30(5), 518.
