An Electronic Health Record

Winter 2017

Behind wooden bookshelves in Pitt’s Falk Library of the Health Sciences lay century-old patient ledgers from what was then called Presbyterian Hospital of Pittsburgh. The records date from 1895, the hospital’s incorporation date, to 1924. The 10 ledgers themselves are about as large as an adult torso. Malgorzata Fort, head of Digital Resource Development for Falk, flips through the thick pages with care. In spiraled cursive, the entries tell of troubles from another time: mal-nutrition, varicose ulcer, insanity, indigestion.

During a renovation project for Presbyterian several years ago, someone came across the ledgers in a closet. Falk director, Barbara Epstein, got a call: Maybe you should have a look at these things. Epstein has since had the ledgers incorporated into the library’s History of Medicine Collection. 

Each entry includes patient name, diagnosis, age, occupation, religion, ethnicity, nationality, treatment plan, and outcome. Once they are digitized, a historian might use the ledger data to pull together statistics on the 1918 influenza outbreak in Pittsburgh. Or an economist could see whether there was a correlation between birth rates and the religions of the mothers in 1900.  
Fort, along with her colleagues Geoffrey Spear and Angie Zack, have been coordinating the digitization of these ledgers for about a decade now. Because of privacy concerns, access to information identifying patients will be limited. (Right now, a facsimile of one of the ledgers is on display on the 11th floor of Scaife Hall. ) 
Digitization hasn’t been so straightforward. One difficulty in the endeavor is that the handwriting on the ledgers is often too ornate or sloppy to decipher with certainty. (Apparently, illegible handwriting is not a new issue in the medical field.) Another challenge has been funding. The project was even put on hold briefly in 2009. However, it has continued to make progress every year since.  “At some point, this data will be available for researchers,” Fort says, adding: “Slow but steady wins the race.”