Contacts in the Field
Dr. Michael Slater: Emergency Medical Physician
Dr. Slater has worked in and around Chicago for 20 years
earning extensive experience with treating the homeless population
"If a provider makes assumptions about a patient based upon a social group they belong to, they are likely to make a wrong judgement which will negatively affect that individual's course of treatment."
"Incomplete and inaccurate information in a homeless person's record is a huge problem. Add that to the lack of interoperability that often exists between hospital record systems and you can imagine the range of devastating effects this has on a person's care."
Dr. Slater shared an example of an individual case in which mistaken identity proved to be fatal. In December, 2019, a woman came into the ER saying she was having a miscarriage. She presented a plastic medical ID card that actually belonged to one of her family members. She was so desperate for help that she was willing to falsify her identity in order to receive the benefit of expedited care. She was hemorrhaging so intensely that she required a blood transfusion. The doctor noticed that the identity which came up on record showed she had been in the ER just three days before and he asked the patient to confirm. She said yes. In actuality, her family member had visited the hospital on that date and her blood type was already on file. The patient received an emergency blood transfusion which matched her relative's blood type. The antibodies in her blood refused the transfusion immediately with fatal effect. Dr. Slater added that similar cases of mistaken identity occur frequently in the ER system.
"Any system that would allow me to have valid medical information about a patient regardless of their housing condition would make a huge difference to my ability to treat people and save lives."
"...often need to deal with unconscious individuals or sift through a fog of alcohol or drug induced effect or state of advanced mental illness in order to identify someone and diagnose their most emergent needs. In the case of an individual who is not homeless and still unable to speak for them-self, the first course of action is to look to a 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 containing life saving information such as the existence of allergies, pre-existing conditions or clues a doctor can follow based upon the medications that patient has been prescribed. Homeless people are almost never among the lucky few who have these life saving clues in place."
University of Chicago - Third year Med Student
Completing his hospital training
between Rush and Stroger Cook County Hospitals
"There are members of the homeless population who use hospitals for malingering purposes [using access to medical resources for secondary gain], it is important not to allow any personal bias of the population get in the way of how you treat an individual. Homeless are some of the sickest people in the world, so it is important to take them seriously."
"One of the most frustrating aspects I've come across in the hospital system is trying to get health records from other hospitals. There are five or six different electronic medical record systems that are most commonly used. For example, the Northshore health system uses a database called EPIC. These different databases are unable to communicate with each other which makes it nearly impossible to obtain an accurate, full medical history when patients have received care from multiple hospitals."
"As long as the hospital is the only entity that has access to an individual's medical information, and it doesn't release it to any outside parties, linking an individual's history to their fingerprint would not legally violate any privacy concerns."
"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."
Cara Demyan: Registered Nurse
Northwestern's Prentice Hospital
"Most medical errors that occur are the result of errors in communication, mistaken identity and incorrect medical record number rank high in that category of error."
" 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."
Shelley Cooper: Chief Community Relations Officer
The Primo Center For Women and Children
- Chicago's largest holistic homeless center
"Providing improved conditions and empowering individuals with arriving at their own informed decision to seek care are the two most proven ways of obtaining trust among the homeless."
Jason Kaley: VP Data Storage Architect
- Medline Industries
Medline Industries is a HITRUST , HIPAA Covered Entity
- storing, protecting and managing medical data
"Being a "Covered Entity", we have a responsibility to vet anyone we contract with to ensure they also protect patient data. ....HITRUST dictates that the controls we implement to comply with CCPA and HIPAA regulations cover physical technology such as firewalls, intrusion detection and data encryption. We monitor data handling activities- ensuring that those allowed to access data prove related purpose, possess proper training, and will be tracked for breaches. We further implement "governance", meaning we regularly oversee, monitor and keep logs of compliance for anyone we contract with."
"Every year the number of controls that are required to meet the standard of HITRUST increases in order to remain ahead of any newly arising threat to technology. This creates a higher burden and responsibility for any entity engaged in the processing of patient data."