Taking It to the Streets: Recording Medical Outreach Data on Personal Digital Assistants

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Introduction

Gathering appropriate clinical information "on the streets" has proved elusive for healthcare providers to the homeless. Although complex systems are in place to collect health data and medical reference information in hospitals and outpatient systems, acceptance of these systems has been mixed because they have not been user friendly. Since the street homeless, by definition, have no fixed address in a shelter, halfway house, or other location, it is common for outreach team members to see patients at a variety of sites rather than in the same place. This circumstance generates a need for a highly portable, highly coordinated information delivery system, perhaps more so than what would be needed in a more traditional delivery setting.

Background

The street homeless actually reflect a minority of the total homeless population in most urban centers, comprising approximately 10%.[3] They differ from other homeless groups regularly accessing shelters and halfway houses because they do not have any kind of stable residence. The transient nature of this population makes it very difficult to assess, evaluate, and track, a problem further exacerbated by its lack of strong affiliations with any organization or location. At a macrolevel, there are two major issues complicating the provision of care. The migration patterns of individual patients around the city are not well modeled, making it difficult to locate individuals for follow-up care. In addition, the lack of an integrated care system between health institutions is problematic. Hence, there is a need for health information to be available to clinicians at the time of contact and "better communication between medical institutions throughout the community."[4](p1) Street outreach programs have become a common feature of many community health service programs out of necessity.[5–9] In such programs, clinicians encounter homeless people in diverse settings (soup kitchens, on the streets, under bridges and overpasses, and in shelters) "for the Purpose of improving their health, social functioning, or utilization of human services and resources."[10(p261)] HHH assembled a clinical team in 1999 that worked in collaboration with local case managers of the homeless to bring healthcare to individuals living on the street.

Results

Limited research has been done on interactions between the street homeless and healthcare providers. Because these patient/provider interactions are inconsistent and brief, the objective is to be more focused than traditional healthcare encounters taking place in office or clinic settings. Indeed, one of the main goals is to help the street homeless become more engaged with the healthcare system.[5] Without knowing exactly how these interactions function, it is not clear what the impact of the technology would be. Moreover, there is limited evidence in the literature about other homeless healthcare programs adopting mobile technology for homeless healthcare

Summary

With minimal funding and no permanent IT staff, HHH has been able to do what many large corporate organizations have not accomplished: create an EMR system containing all encounter information for homeless patients across multiple care settings. Efforts with PDA implementation taught valuable lessons about the enormity of the challenge communities face serving the homeless population whose medical histories are complex, ability to communicate is often hampered by the same mental health and medical issues placing them on the street, and contact with healthcare professionals is sporadic.

Comments

The integration of mobile devices to be used for homeless healthcare is in line with the holistic approach of meeting the homeless at their level, it creates a flexible environment that would otherwise be lacking if restrained in the traditional hospital or clinic, where majority of the homeless population do not visit.