founded on trust - protected by technology
Capitalizing on Trust and Stories of Success through Community Outreach
Hospital social workers and case workers provide invaluable support and organize entire networks of care for homeless patients who originate through the Emergency Room. Once a diagnosis is made and treatment is given, it is most often the case that a patient will need to establish a temporary but ongoing routine for obtaining and using prescription medications, getting themself to follow up visits for continued care or to receive the support of anything ranging from proper nutrition, dressing changes, suture removal or even provisions of fresh socks on a regular schedule. A Clinically Licensed Social worker (CLSW) sticks with these patients over time and deep trust, respect and gratitude is mutually established between them.
Through these experiences, countless success stories emerge and patients not only rise out of the emergent medical condition that brought them through the ER to begin with but adjacent issues of depression/some factors of their social conditions improve exponentially. (ie their inability to gain transportation or access to a shelter or proper nutrition and hygiene) " When homeless individuals come to trust social workers through receiving critical care and when they become a part of their own solution-based-care it really begins to make a difference in their life and they begin to express gratitude and a desire to give back in some way. " *
When a CLSW and a high achieving homeless individual build a success story together that is infused with gratitude, a profound opportunity arises:
The CLSW would be empowered by the hospital to recommend such a patient be qualified to receive minimally necessary preparation and on-site experience in becoming a part-time hospital advocate. If the patient agrees, he/she would work side by side the CLSW and attend monthly outreach events to occur within the immediate serviceable area of the hospital (ie warming/cooling centers, soup kitchens, churches) where homeless individuals are already gathering with perceived trust.
The intention would be twofold:
The patient would be empowered to experience the opportunity to give back and begin to build a trusted perception of the hospital within the homeless community. While doing so, they would also gain some work experience along with a mutually agreed personal compensation they uniquely need to improve their life. This may include an authenticated need that is directed toward their child(ren).
The hospital gain is to begin to inspire established trust which is a necessary perception for homeless patients to feel. Beginning there will cause more individuals to offer accurate medical and personal identification when entering the ER. This is critical to avoiding the rampant duplicity of records, loss of time, unnecessary tests, incorrect diagnosis or provisions of services which all serve to increase hospital costs across the US and skew federally funded data records which are based upon the demographics of people.
A proposed solution such as the intimacy of building trust is unique to every relationship. Together, the relationship between the CLSW and homeless hospital advocate would ongoingly look for real evidence that trust was growing based upon the experiences of ongoing outreach interactions and the homeless community's approach of them. The team would contribute their unique strengths to quantifying such change and communicate them back to the hospital.
The CLSW and hospital advocate would align themselves with the providers at any particular outreach location and operate through a stress-free culture of sharing word of mouth examples of medical and social culture improvements which are made every day for homeless individuals within the hospital. Success stories would be shared with specific detail but never with specific names. It would be evidenced over and over that the safety and security of a patient's identity is never at risk and that HIPAA rules are designed to punish hospital workers and institutions with large fines, loss of licence and even jail time in the event of a breach of information. Hospitals have a lot to lose and homeless do not realize this without education. Conversely, patients are at the center of protection by law.
By and large, the work of these outreach events would be to build a more educated and secure feeling within the homeless community by making examples of individual success stories. Individuals would come to understand the benefits of seeking care, the detriments of waiting until their condition becomes desperate, the safety they can expect, the ongoing advocacy their care may include and they will arrive at these opinions on their own and in their own time - making them in charge of their own lives.
* Cara Demyan, Registered Clinical Nurse - Prentice Hospital, Chicago
Capitalizing on Technology: to Develop an Accurate and Secure National Patient Identifier System
Since 1996 with the inception of The Health Insurance Portability and Accountability Act (HIPAA), which serves to protect the privacy of patient data (through the HIPAA Privacy Rule) from entities outside of a patient's medical care team, there has been a desired course of action called for to develop a National Patient Identifier System. Logistical and financial challenges relating to interoperability and privacy have been hindrances for the entire population of patients but even more remarkably for the homeless population.*
Fingerprint scanning technology is extremely accurate. In 2014, it was proven that the probability of two people having the same fingerprints was about 1 in 64 million. With today's improved technology and ability to capture multiple prints in one scan, that chance becomes exponentially smaller. When identifying using bio-metrics in a hospital setting, common sense catches further reduce this chance of error. For example, if a 65 year old Latino man is scanned and some small section of his print were to establish a match to a 15 year old Asian girl, his obvious demographics would serve as a built in catch. Such layered "checkpoints" are necessary to any system of identification but fingerprint scans are based upon statistical matching and a referential database that is continually updated so providers can have absolute confidence in the resulting records. The ability to assign national patient IDs to homeless patients would enable data sharing across systems with speed and accuracy rather than continuing to place patients at serious risk for being misidentified, represented by wrong / duplicated records and treated with dangerous effect. The promise of an improved system is undeniable.
Through ongoing community outreach, Clinically Licensed Social Workers will continuously assess that segments of the homeless population have shown improved evidence of trust for ER departments and hospital healthcare workers. Homeless individuals will learn that a system of care has been designed to protect them medically and socially with absolute anonymity. It will be made known to each individual that their questions can be answered if they would like to know more next time. Whenever each individual shows interest, the CLSW will share a concise understanding of the identity protections they are assured, the motivations of the hospital, the improved medical treatment they will be given as patients and they will understand that each healthcare provider and the hospital itself is liable to protect their privacy forever, by law. Once educated, each individual then holds the potential to spread the good news of it within their community. It is important to educate individuals before they experience a need for hospital care so that they will willingly seek care once an inevitable situation arrives for them to require medical support. With proper education, trust will lead the way to accepting the benefits of one reliable record which is linked only to their unique Medical Record Number (MRN). This MRN would be authenticated at the onset of each ER visit and also when picking up prescription medications from free standing pharmacies through use of an instantaneous fingerprint scan. As is currently the case, MRN data is not collected by hospitals when reporting general populations of patient demographic for federal reimbursement packages. Entirely separate databases exist within hospitals for this purpose and no names, addresses or other uniquely private information to a single patient are relevant or collected for the purpose of predicting financial aid needs. All data linked to a patient's MRN would be used strictly by individuals who are providing them privacy protected healthcare by law.
It is conceivable that the Privacy Rule under the HIPAA Privacy Act could seek another act of Congress relative to biometric data collected on patients. Currently, " the HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically." It would not be a far reach to include finger scans among "personal health information". Finger scans have been proven for accuracy and security since the 1980's and are widely used today, making their data collection extremely affordable and remotely accessible. Third party companies which manage the secure housing of such data fit the long expressed need for a Secure National Patient Identifier System. This third party would be removed from receiving direct financial compensation or backing from any governmental entity under such act of congress.
* Statement by the Department of Health and Human Services Office for Civil Rights. The governing body given the power to investigate complaints about HIPAA violations.