As the immigration debate continues, I can't help but be reminded of a several-month project I worked on in a community health center which served the Vietnamese population of a major U.S. city. The project involved "Abstracting" data from the paper medical records to the electronic record, so that all of the information was transferred with the ultimate goal of "retiring" the volumes of paper, to be replaced by the electronic medical record.

A primary tool used in this abstracting process was using ICD (International classification of disease) codes, a series of up to 5 digits which are assigned to internationally recognized diseases. I was astounded at the number of patients who carried a positive diagnosis of tuberculosis, or TB. Some of these patients underwent INH treatment, a lengthy course of medication over a period of months. Some patients were "lost to followup" for one reason or another -- either they stopped coming to the clinic, or had moved permanently somewhere else.

Complicating this scenario was the fact that many of these people routinely travelled back and forth from Ho Chi Minh City and other countries of origin to the United States.

I wondered what precautions were taken to prevent additional exposures. I saw no mention in the charts to indicate that there was a comprehensive effort to track these patients or their treatment. There were instances where the patient received one month of treatment and then did not return for follow-up. Some patients completed a treatment course of 18 months. I can say that I became so familiar with the ICD code for TB that I had memorized it.

I considered asking the medical director about this, but being a six-month hire for a limited project did not put me in a position to ask many questions. Clinics have been incentivized with $30,000 to $40,000 grants to migrate their records from paper to the electronic medical record, and these were the conditions of my temporary employment.

The project did not reach its goal mainly because the physicians did not like the whole concept of the electronic record, and that in itself is another story I won't go into here.

Suffice to say, the day I departed from this clinic, I took the elevator down to the first floor, walked past the signs written in Vietnamese, took a last glance at the faces of patients who waited for their appointments... and I never looked back. I must say I am more careful when I'm in a crowded area, if I hear someone coughing, to walk in the other direction.