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Hennepin Healthcare uses EHR data to identify patients at risk of homelessness

Hennepin's Alex Knutson-Smisek says using the EHR to pinpoint SDOH was a hard sell but the work that followed was not overly complex.

Beth Jones Sanborn, Managing Editor

More and more over the last year or two, identifying and addressing social determinants of health is emerging as a new priority for providers as they seek ways to improve the health of the populations they serve, improve outcomes and reduce readmissions and avoidable admissions.

Despite the growing collective realization that social determinants must be part of a system's overarching strategy for care delivery, identifying them remains a challenge on both a patient- and population-level.

Homelessness is by its very nature a critical social determinant of health. And the number of homeless people being hospitalized is on the rise, in many cases they are showing up at the emergency department for non-emergent situations, according to research in the journal Medical Care.

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To prevent such admissions, better control unnecessary spending and generally strive to make that population healthier, hospitals such as Hennepin Healthcare are undertaking initiatives to reap social determinants.

Hennepin is not alone of course. Kaiser Permanente committed $200 million to decrease homelessness because having housing is crucial to an individual's health.

Hennepin, for its part, has already successfully identified patients at risk of homelessness using its EHR, according to Alexander Knutson-Smisek, a clinical informaticist at Hennepin.

Whereas using an EHR to identify social determinants made sense to Knutson-Smisek, the concept was not an easy sell.

On the clinical side, he said Hennepin has been working to address social determinants for a long time, but everyone has their own biases and areas of focus.

The main barrier for someone in informatics is the division that we've put around EHRs being focused on medical information in the past, Knutson-Smisek said. Getting over that took some coaching of IT staff and clinicians on the fact that it really is intended as a comprehensive health record and that social determinants are huge portions of a patient's overall health.

"That's usually where the conversation has to start. Clinicians should be looking at the whole patient perspective as much as possible and really marrying the social side of things along with the medical side of things into a single view as the best way to inform people about that whole patient," he said.

In the past, clinicians have taken the initial patient interview and assessment as the main way of identifying these people, but over the last few years they have started to look at what data is available across the whole patient population to identify at-risk patients, using the regular address that is collected by the front desk of a clinic, hospital or emergency department and matching the address with locations that would indicate the patient is at risk of homelessness -- such as a person listing a shelter address as home.

"Patients will use those addresses as their own because they don't actually have one," he said.

Hennepin's approach builds such information into risk scores that already existed for patients based on medically-focused factors, and incorporates the social complexity to inform that risk and deliver a better understanding of it to clinicians.

Knutson-Smisek said this should be a standard approach across all healthcare systems for starting to pinpoint these risk factors.

"The actual work itself is not that complicated once you get all the right stakeholders to the table -- and it adds a whole new lens on the patient and what is affecting them," he said.

Knutson-Smisek will discuss Hennepin Healthcare's success at HIMSS19 in a session titled "Identifying Homelessness Through Data." It's scheduled for Wednesday, February 13, from 1:00-2:00 p.m. in room W300.

Twitter: @BethJSanborn
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