How a NY HIE Transformed Healthcare for Homeless Population

Healthix, one of the largest public health information exchanges (HIEs) in the country, was faced with major challenges that severely impacted healthcare for the homeless community.

Published by: EHR Intelligence

August 17, 2020 – In March, roughly 61,000 people in New York City were reported homeless, a number that rivaled the Great Depression. As a result of this staggering number, Healthix, a public health information exchange (HIE) that covers New York City and Long Island, used a coordinated approach to improve the health outcomes of individuals without stable housing.

However, Tom Moore, VP of innovation for Healthix, and its provider partners, quickly found three major challenges that stood in the way of executing that goal.

For one thing, it’s hard to connect an individual who is homeless to an HIE if you can’t connect the individual to an address.

“One of the ways that we can help is by notifying our participants who are working with the homeless population by notifying them when one of their homeless patients shows up at a hospital. It’s an opportunity for them,” Moore said in an interview with EHRIntelligence. “Sometimes, they’ll just shoot right over there to the ED and try to engage with the patient.”

When Healthix received a $1.1 million grant through New York eHealth Collaborative (NYeC), the HIE developed the ability to “tag” homeless patients.

“We began to use proxies for homeless patients,” Moore continued. “These are addresses that are shelters, places of worship, government facilities, or healthcare facilities. When the patient gives one of those proxies as an address, that’s an indication that they’re homeless.”

“Proxies help us identify the homeless population to let our participants know when the patient shows up to the hospital.”

Providers then faced another challenge of qualifying the homeless patient for social services benefits, like public housing.

“A handful of organizations want to place individuals into a shelter or get them bumped up into housing or better housing,” Moore said. “The health information exchange can help with that by identifying clinical needs. If an individual is chronically ill, particularly if the patient has HIV, the person is fast-tracked into a better housing situation.”

Recently, Healthix added the New York City Department of Social Services as a participant as part of the HIE’s efforts to help a larger homeless population. Although 69 community-based organizations that provide social services are currently connected to the HIE, the organization had never had a social service agency in its network.

“That addition creates a real opportunity to coordinate care because often when somebody is in a shelter, it’s beneficial for their care providers to know that they’re housed in the shelter and what their status is,” Moore explained. “If the provider is taking care of somebody and they know the person is in a shelter, knowing their clinical history is also very useful.”

Once connected to the HIE, Healthix tapped Verato’s Master Patient Index (MPI) to link the individual’s medical records. Then, HIE participants can use primary services to access patient data and information.

The MPI streamlines the often arduous task by reducing duplicate medical record rates at registration and improving both positive patient identification and EHR matching accuracy.

Moore also said Healthix works through policies at the state, local, and federal levels to achieve the same goal.

“We’ve had to do some work there to open up our HIE to the city Department of Social Services and allow for certain use cases to be used,” Moore said. “We have to keep pushing the policy to open it up because social determinants of health, social services, and healthcare, have traditionally been seen as separate.”

After the medical records are linked, the process is complete, and the homeless individual is fully connected to Healthix.

To increase its social determinants of health (SDOH) and homelessness awareness, Healthix convenes with its board members and its participants regularly.

“When social determinants of health started becoming an important issue to our members, we formed an advisory group of our board to decide how we were going to address it,” Moore said. “There isn’t a consensus in the industry about how social determinants should be exchanges between the provider and the HIE.”

Integrating SDOH into these health IT systems has long proven a difficult task.

“We spent several thousand dollars of our innovation fund into SDOH work because it’s still fairly new, and it hasn’t become mainstream yet,” Moore explained.

Along with convening with its board regularly, Healthix started a project with the community health center of New York State, which is a collection of healthcare providers.

“A majority of them are in the federally qualified health center category, which serves a large Medicaid population, to send social determinants of health to us through a vendor that they use,” Moore said. “They adopted the PRAPARE standard, which is a comprehensive social determinant of health standard, and we’ve pulled that data in, and it’s available to our participants.”

Moore, who leads the innovation group, said as an extension of the grant the HIE received, his team now can send alerts to providers of when their patients become homeless.

“It could be a trigger for them to try to reach out to the individual or get the individual involved with types of care assistance,” he said.

Moore also said his team has recently implemented an HIV trigger in its system since the disease is prevalent in the New York City area.

“We do a lot of work with the HIV population,” Moore explained. “We have over 100 participating organizations to care for people with HIV, so we’re able to detect when a viral load, which measures the level of HIV in an individual’s system, reaches a critical level.”

Healthix is continuously optimizing its HIE system to adapt to the issues that run rampant in its community. With the help of the innovation team, Healthix has the potential to serve what can become the largest HIE network in the country.