Reflections on Homeless Health - Class Presentations

Today, I had the privilege to listen to the presentations of my peers.  It was very informative to observe the acquire/store/analyse/distribute/measure being used in a variety of fields and topics.  This blog post summarizes my key takeaways on how to modify the Homeless Management Information System based on the thoughts of my colleagues.

Appreciation for the importance of m-health in a domestic setting.
After a few presentations on m-health, is clear that the importance of this realm is critical to global health.  Another observation I had was its under-utilization in the domestic realm as well.  Do we not share the same issues in patient adherence in Canada and the United States?  Do we not have greater access to the technology in question? (SMS texing, google voice, etc)


Applying this to HMIS
Imagine a Homeless Management Information System in a completely different construct.
1) A Homeless patient meets with social worker weekly or monthly.
2) During this encounter, the social worker asks the patient about their current medical update.  This does not have to be anything more than compliance to medications.
3) The social worker enters the patient compliance information into the system
4) The primary care physician receives a text during the next interview with the patient to address the issue with compliance.

Utilizing sms technology in this context, providers, social workers, with real-time reminders on what to ask their patients during their encounter.  This appears to be far underutilized and I am curious on how a model could be built around this idea.

Quality Measurement: The ANALYZE in HMIS.

ANALYZE

 The Housing Inventory Count (HIC)

The Housing Inventory Count collects information about all of the beds and units in each Continuum of Care homeless system, categorized by five Program Types.

1. Emergency Shelter: Total number of emergency shelter beds and units that are designated to serve people who are homeless and are recognized as part of the formal homeless system.
2. Transitional Housing: Total number of transitional housing beds and units designated to serve people who are homeless and are recognized as part of the formal homeless system.
3. HPRP Homeless Assistance (new for 2010): Total number of HPRP Homeless Assistance beds and units occupied on the night the annual inventory.
4. Safe Haven: Total number of Safe Haven beds and units that satisfy HUD’s standards, as identified in the 2009 NOFA.
5. Permanent Supportive Housing: Total number of permanent supportive housing beds and units.

The Housing Inventory Count also includes information about unmet need.

Point-in-Time Homeless Persons Count (PIT)

The Point-in-Time Count provides a count of sheltered and unsheltered homeless persons from either the last biennial count or a more recent annual count. Counts are based on:

1. Number of persons in households without children;
2. Number of persons in households with at least one adult and one child; and
3. Number of persons in households with only children. This includes only persons age 17 or under, including unaccompanied children, adolescent parents and their children, adolescent siblings, or other household configurations composed only of children.

Counts are further broken down into subpopulation categories including counts of persons who are chronically homeless, persons with severe mental illness, chronic substance abusers, veterans, persons with HIV/AIDS, victims of domestic violence and unaccompanied children.

Source:  The US Department of Housing and Urban Development.

Understanding the Homeless Management Information System

In order to gain a deeper appreciation for the Homeless Management Information System (HMIS) in Baltimore, I've managed to join their listserve in the past week.  This has given me access to a lot of information regarding their membership, and their strategy from an acquire store, analyze, distribute, measure perspective.

From a demographic standpoint, some of the information is downright shocking.  For example, of the 6000+ homeless individuals last counted, more than 1038 are in fact children.

Here are a few points which I believe have been integral to the HMIS functioning across 30+ separate agencies.

1)  Standardization:  The Baltimore County Universal Intake Form provides one set of questions that all agencies utilize to input new clients into the system.  This is then shared across a central database and is accessible to all other agencies in the network

2)  Information sharing protocol:  There are currently no barriers to sharing information.  Agencies are not protective over their information and recognize that the more that is shared with clients, the better the impact of the HMIS

3)  Participatory communication:  External tools such as the HMIS website and the listerve serve as portals for stakeholders such as agencies and potentially interested parties (such as myself) to appreciate the strength of the HMIS.  This in turn allows for the expansion to neighboring agencies but also serves to keep existing stakeholders involved in continually evolving HMIS.

Breaking News! More developments on e-kasih!

The e-kasih topic appears to be far more dynamic than I assumed.  It appears that the Village Development and Security Committee as well as the Women and Family Development Ministry have begun to realize its potential value for integrating IT with the needs of the population.

I believe that the Ministry's support for e-kasih is absolutely essential for this project to move forward.  as the article below comments, there have already been 50,000 applicants registered.  Imagine the abilities of NGOs and international aid relief organizations if e-kasih was adopted on a global scale!

October 10, 2011 17:29 PM

Grassroot Leaders To Be Appointed To Help Register Poor Under E- Kasih

KUCHING, Oct 10 (Bernama) -- Grassroot leaders of the Village Development and Security Committee (JKKK) will be appointed as "rakan kerja" to assist the state Welfare Department to register poor families under the E-Kasih system, Sarawak Welfare, Women and Family Development Minister Datuk Fatimah Abdullah said Monday.

She said the department, which had limited resources, needed to go all out to the grassroot level to recruit the longhouse and village headmen and leaders of political parties for the task in collaboration with relevant agencies, including the offices of the state secretary, resident and district offices.

"Why not consolidate all our forces as it is high time for us to work together and appoint these grassroot leaders as rakan kerja," she told reporters after receiving donations of 43 water tanks, worth RM30,000, from Weida Resources Sdn Bhd for her Dalat state constituency, here.

Citing the case of only 400 poor Penan families that had so far registered under E-Kasih despite the community having a population of 10,000 state-wide, she said the current data base was a not a reflection of the real situation on the ground.

She said complaints had been received that those eligible to obtain aid under the poverty eradication programme were not being registered as their data base was not captured while some in the list should not be eligible.

So far 50,000 applicants were listed under E-Kasih in Sarawak under an open registration, she said.

-- BERNAMA

Reponse to ONC/HITECH EHR's Strategy Needs

Question: What areas should the ONC focus on for the development of a nationwide infrastructure to support the growth of HIT? Research the ONC and its various programs.  Provide a strategic plan for carrying out the mission of the program of your choice that is aligned with the bigger ONC mission.  Your plan should address how your program will affect the other programs.  How does your plan affect the caregiver community?  Your strategic plan should also include barriers and how you plan to address the barriers to achieve success.  

1. Encourage on-boarding for diverse small practices who may lack capital (even with the stimulus) to fully implement and transition to an EHR. Leverage their role coordinating high uptake of EHRs to negotiate reduced rates on behalf of private practice physicians, partnerships, and small group practices. Benefits for using a common IT system could come in the form of price subsidies, tax rebates, or ongoing, centrally-funded help desks and support services. This will enable greater diffusion of a standard format of service platforms, and increase uptake by minimizing the cost barrier.  

2. Vendor access could be maximized by coordinating nation-wide CME (continuing medical education) classes featuring demonstrations by multiple IT groups. To incentivize participation the government could assist in educational efforts, increase access and participation, and foster greater understanding of how to demonstrate meaningful use.

3. The federal government can offer a contract for technology companies to bid on. The contract will be for creating a standard EMR system that will be subsidized (possibly paid in full) by the government for those physician practices and hospitals who voluntarily wish to participate, thereby paving the way for a universal EMR system. Recognizing, however, that many hospitals may not wish to join based on the potential to lose clients to larger or higher rated hospitals, HITECH should target large regional hospitals which have the most to gain from a standardized process. Once these hospitals implement a standard system, the added value of their services through EMRs would entice other hospitals to join the roster as well.  

Response drafted by Matthew Scally, Tara Vecchione, Anna Diller, Abhishek Raut.

Submitted to Lawrence Aronhime, discussed with ONC's Alan Traylor Strategic Planning, Carey Business School.

e-kasih

Today's unique IT integration that tackles poverty and health comes from the Government of Malaysia with its unique e-kasih system.  e-kasih is the country's national database of families that have been identified as poverty stricken.  The database has been used by charities to specifically target neighborhoods and groups that require assistance more than other regions.

From an IT integration standpoint, the e-kasih system is a very interesting project for a multitude of reasons

1)  Accessibility:  Its database is accessible by most NGOs and charities making it easy for anyone to provide additional information as needed.  This is interesting because the system has clearly recognized that its value comes from its ability to confer information to external groups rather than just keep it as a Government system only.

2)  Reliability:  As a Government database, it relies on census information which is often conduct after a period of years.  While neighborhood data might still have strong validity, I wonder about the household data themselves.  Given the general economic times of the world, if the last census was undertaken in 2008, one may have missed the effect of the entire recession. There have already been issues and accusations on the reliability of the data and the ability to manipulate this information for a political agenda.

Final comments:  I believe programs such as e-kasih are integral to understanding the larger issues surrounding poverty, development, and healthcare infrastructure.  They key take-away from the e-kasih system is its recognition that its value is only as strong as its ability to provide information to a host of users ranging from local grassroots operations to international relief services.


http://www.futuregov.in/tv/e-government/using-technology-alleviate-poverty/