Our team was able to build, launch, and sustain E*Drive for nearly free, all without in-depth tech experience. To do this, we built E*Drive on Drupal—our institution-supported web content management system—and utilized GoogleSlides to create the flow-chart style guidelines. E*Drive is easily accessible via a direct link in our medical record system or a short URL on any device with an internet connection. The platform layout is optimized for rapid information access with an average of three clicks from the homepage or via a robust search tool. The dynamic, modular nature of the E*Drive platform allows continued growth and evolution in response to user feedback. For example, we recently developed a first-of-its-kind Discharge Navigator tool (https://edrive.ucsf.edu/dcnav) that helps clinicians refer vulnerable patients to tailored community resources based on their demographics and needs. We also recently digitized frequently utilized forms, such as procedure consents, that previously needed to be accessed in cluttered filing cabinets.

E*Drive has revolutionized how our emergency department distributes and stores critical clinical information. By creating a system that is affordable, portable, and adaptable, our team hopes to inspire other emergency physicians including residents to develop similar innovations to accelerate guideline accessibility in the future.

Histories of our Present Illness

Luke Messac, MD, PHD, PGY4, Brown Emergency Medicine Residency

As a physician historian, I use techniques from history, anthropology, and epidemiology to study determinants of health outcomes. I completed my MD/PhD with a focus in the history of science, and have written about international opiate regulations, population control campaigns, economic indices, AIDS treatment activism, and hepatitis C diagnostic technologies. The aim of my research is to show how our way of delivering and paying for medical care developed, and how we might do better.

Today, I am studying the history of medical debt collection and the impact these debts are having on Americans’ lives. Since the 1980s, unpaid medical debts have moved from obligations negotiated by doctors and patients to financial instruments traded on impersonal financial exchanges. Spurred in part by cuts in public funding and insurance companies’ turn toward cost-sharing, hospitals have faced more bad debts. In response, health care institutions sent overdue bills to collection agencies and debt buyers. Divorced from the physicians’ bond to patients, debt collectors exercise draconian techniques, using wage garnishments, liens on homes, and lawsuits to extract profits from patients. Aggressive debt collection and third-party debt purchasing have continued to spread. Another area of my research examines how health professionals respond to scarcity. My book, No More to Spend: Neglect and the Construction of Scarcity in Malawi’s History of Medicine, is a history of medical neglect in Malawi. Using the stories of doctors, patients, and political leaders, the book shows how colonial and postcolonial administrations used claims of scarcity to justify the dismal state of health care. Scarcity was not inevitable but was instead the product of choices by powerful actors to siphon financial resources away from medical care.