INACCURATE MEDICAL RECORDS of HOMELESS
Have Wide Reaching ILL EFFECTS
the damaging effects of inaccurate medical records upon homeless
begins with understanding their unique circumstance
Medical errors which occur as a result of clerical mistakes or mistypes - particularly in the stressful and hurried circumstances of emergency rooms affect patient charting every day. These mistakes happen despite a patient's ability to fill out a medical history form, present valid photo identification, insurance card and accurately convey their chief complaint to medical professionals.
Homeless patients who enter emergency rooms with legitimate illnesses represent some of the sickest people within any country. They often show up as a result of conditions which have grown to desperate or critical status. ER doctors and nurses " often need to deal with unconscious individuals or sift through a fog of alcohol or drug induced circumstance or state of advanced mental illness in order to diagnose the most emergent needs of the patient. In the case of an individual who is unable to speak for themself but is not homeless, the first course of action is to look to that patient's cell phone, wallet or purse for clues to their identity. When an identity is obtained, hospital and pharmacy databases are quickly scanned for a match which often results in a Medical Record Number (MRN) containing life saving information such as previously diagnosed allergies, pre-existing conditions or pharmaceutical clues a doctor can follow based upon the medications a patient had been prescribed. Homeless people are almost never among the lucky few who have these critical life saving clues in place. " *
Even under circumstances when a homeless person finally elects to enter an emergency room in seek of care and
is able to communicate their needs; most often, one of two paths will follow from there -
Homeless patients are often fearful of being found by someone they are running from such as a circumstance of domestic abuse or an element of the law or even an imagined threat. For this reason, they will intentionally conceal their given name or even go so far as to create a fictional identity. This may happen multiple times throughout the course of a single year for the same individual. " When a "new" patient file is added to the records system, it now represents just a small portion of the patient's medical information and history. Rather than consulting a complete medical record, a physician may be looking at a fragment of the patient data. If important health information is not included in the file, the patient's health is at risk. " **
Another path which often occurs is that the clerical check-in for a homeless patient will begin with a search based upon name or birth date and when there is not an exact match found, the employee will create a new patient file in the interest of processing an emergent need as quickly as possible. This engages the same dangerous effect that a fictional identity has upon a patient's present and future treatment - yet another "small portioned record" results.
* Michael Slater, M.D. - Emergency Medicine, Evanston Hospital
** Conor Flavin, Third Year Medical Student - Stroger and Rush Hospitals, Chicago
the wide reaching ill effects of
Inaccurate Homeless Medical Records
Homeless patients suffer their own unfortunate results when inaccurate or partial medical records are attached to their care. That said, there are also radiating ill effects that rise out of the unique circumstance of their emergency room experience.
The critical time that is spent registering and gathering "chief complaint" information on a homeless patient affects other patients, hospital funds and taxpayer dollars. A homeless patient who is operating under an intentional alias in order to retain the anonymity of their given name or is naively interested in expediting their check-in process is causing the hospital to waste excessive money. In the more immediate sense, the pitfalls of homeless identity-based issues also cause other uncomfortable or suffering patients around them to experience delayed care.
Hospitals report the demographics of patients who are unable to pay for their emergency room care, subsequent treatments, therapies and/or social support to the federal government in order to obtain some degree of taxpayer funding. (these demographics include age, race and gender. Given names are not relevant and therefore not included in these reports) The hospital needs to cover the remaining costs and the sums are staggering. Taking into account the fact that nearly one-third of all visits to the emergency room are made by people struggling with chronic homelessness, it is easy to see how the inefficiency and inaccuracy of homeless records can contribute to exponential financial burden. To make one example, " Stroger/Cook County Hospital in Chicago, IL spent $246.9 million dollars in one year (2016) after federal aid on free healthcare they could not collect on. " *
* reported by WBEZ Chicago in August of 2018 during an interview with a breast cancer patient who was unable to pay her medical bills and was subsequently prescribed to go to Stroger for care.