Community Development, Homelessness, State News, Supportive Housing

Tracking Homelessness Through the Electronic Health Record System

Partnership for Strong Communities (PSC)
 

Kyra Ray, Second Year Medical Student, Frank H. Netter School of Medicine, Qunnipiac University

Before starting medical school, I spent a year working with children and their families at a homeless shelter in Seattle. I was astounded by the barriers and challenges to navigating the healthcare system for someone experiencing homelessness. For this reason, I knew I wanted to focus on homelessness and health care for my Capstone, a four-year, independent research project at my school.

Last fall, I began working with Christi Staples and Jane McNichol at Partnership for Strong Communities to learn more about some of these issues, with a focus on “high utilizers” of hospital emergency departments. I started my research by interviewing the administrators of Community Care Teams (CCTs). CCTs are local medical, behavioral health and social service providers, which work together to identify community members with complex social and health care needs and then develop and implement comprehensive care plans. As a result of these interviews, I realized there was no standardized way to track people utilizing health care who were experiencing homelessness. 

This summer, I interviewed representatives of thirteen Connecticut hospitals to determine their current method of tracking homelessness or housing status in their electronic health records (EHRs). Only two of thirteen hospitals had a way to “track,” and only one hospital had the ability to track housing status over time, and to run reports on that data. As a hopeful, and perhaps naïve, medical student, I thought the most pressing reason a hospital would want to track a patient’s housing status would be to connect patients to the services they need, and to tailor the care to the individual. However, the overwhelming majority of participants said the information would be most useful in order to gather data for research. 

Figure 1. Percentage of the 13 participating CT hospitals that have a method of tracking homelessness within the EHR. 

 

Several hospitals across the country are testing out the “housing first model,” by helping people to secure housing to serve as a platform for achieving other goals and a better quality of life. The hospitals are funding housing for some of their patients in hopes that it will improve health outcomes and reduce healthcare costs.1,2,3,4 If Connecticut hospitals want to test that theory, or CCTs want to make the argument that they are improving healthcare, they need the ability to track individuals experiencing homelessness who are using emergency services. 

In collaboration with the Partnership for Strong Communities and the Connecticut Hospital Association, we hope to develop a standardized way to track this important information through the adoption of standardized questions regarding a patient’s housing status and policies for recording the answers in two places (address and social work note) in the EHR. The goal of standardizing the process and only having two places to look for the information is to minimize interruptions in workflow and maximize the number of patients whose housing status can be captured in the EHR. These capabilities will hopefully allow for more extensive research and better care for individuals experiencing homelessness.



1. 6 Portland health providers give $21.5M for homeless housing. US News & World Report. http://www.usnews.com/news/news/articles/2016-09-23/6-portland-health-providers-give-215m-for-homeless-housing. Accessed February 15, 2017.
2. Better Health Through Housing. UI Health. //hospital.uillinois.edu/about-ui-health/community-commitment/better-health-through-housing. Accessed February 15, 2017.
3. UVM Medical Center Targets Affordable Housing. America’s Essential Hospitals. https://essentialhospitals.org/quality/uvm-medical-center-targets-affordable-housing/. Published September 23, 2016. Accessed February 15, 2017.
4. Lola Butcher. Why Hospitals Are Housing the Homeless. Hospitals and Health Networks. http://www.hhnmag.com/articles/7818-why-hospitals-are-housing-the-homeless. Published January 5, 2017. Accessed February 15, 2017.
 
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