Stream: argonaut
Topic: Homeless
John Moehrke (Feb 01 2022 at 15:43):
Is there a well-defined way in US-Core to indicate that the Patient is homeless?
Eric Haas (Feb 01 2022 at 17:02):
In the latest ballot version of US Core, we support the USCDI v2 Data Element and specifically SDOH Assessments
... for any Social Determinants of Health domain such as food, housing, or transportation security...
As part of ballot reconciliation, are currently in discussion on the choices we made, but it points to the direction we are taking.
See: http://hl7.org/fhir/us/core/2022Jan/StructureDefinition-us-core-observation-social-history-assessment.html,
http://hl7.org/fhir/us/core/2022Jan/StructureDefinition-us-core-observation-social-history-assessment.html
and of course:
http://hl7.org/fhir/us/core/2022Jan/sdoh.html
Brian Postlethwaite (Feb 01 2022 at 20:06):
Curious if the question was targeted as the social side, or just the address side?
A person can have no fixed address and not be homeless.
Cooper Thompson (Feb 01 2022 at 20:13):
They can also have a fixed address and still be homeless. For example, they get mail sent to their parent's or friend's address, or have a PO box.
Shamil Nizamov (Feb 01 2022 at 20:14):
In CA Core we use the no fixed address extension on the Patient.address level. FYI
Brian Postlethwaite (Feb 01 2022 at 20:15):
Same in AU base.
John Moehrke (Feb 01 2022 at 21:07):
Either way... the patient positively indicates they have no home address.
John Moehrke (Feb 01 2022 at 21:07):
vs, someone has not yet discovered the patient address
David Pyke (Feb 01 2022 at 21:12):
Just FYI, the Project US@ tech doc has homeless as a metadata flag, so that's the recommended way in the US
Eric Haas (Feb 01 2022 at 21:13):
What is Project US@ tech?
David Pyke (Feb 01 2022 at 21:13):
https://www.healthit.gov/buzz-blog/health-data/todays-the-day-for-project-us
John Moehrke (Feb 01 2022 at 21:20):
is there a FHIR Profile for that Project US@ concept?
David Pyke (Feb 01 2022 at 21:20):
Nope, it's an address formatting spec and touches on metadata so no profiles are really part of it.
David Pyke (Feb 01 2022 at 21:21):
however, that might be a useful project to create whatever needed extensions
John Moehrke (Feb 01 2022 at 21:23):
this is why I asked US realm... I did like the AU solution of a type of address extension for non fixed that also allows the entry of city/state as appropriate.
Brian Postlethwaite (Feb 01 2022 at 21:23):
Maybe PA should consider a standard extension on address for this.
John Moehrke (Feb 01 2022 at 21:23):
IHE needs this concept for am EMS report.
David Pyke (Feb 01 2022 at 21:23):
I think a standard NFA extension is a great idea
Brian Postlethwaite (Feb 01 2022 at 21:24):
Can one of you create a tracker for this?
David Pyke (Feb 01 2022 at 21:24):
Can do
John Moehrke (Feb 01 2022 at 21:25):
could just be a type of address... right?
David Pyke (Feb 01 2022 at 21:28):
https://jira.hl7.org/browse/FHIR-35923
David Pyke (Feb 01 2022 at 21:28):
A type of address? Like business, home, homeless?
John Moehrke (Feb 01 2022 at 21:32):
yes
John Moehrke (Feb 01 2022 at 21:32):
well, not "homeless"... but something like that.
John Moehrke (Feb 01 2022 at 21:32):
just that those codes are not extensible today
Brian Postlethwaite (Feb 01 2022 at 21:32):
I don't think that it's a type, I think the extension approach is more appropriate.
John Moehrke (Feb 01 2022 at 21:33):
my point is that if PA is going to update FHIR core... they have more power to do something like that, vs an IG that would be stuck doing an extension
John Moehrke (Feb 01 2022 at 21:33):
it is their home, it is just not very specific. right?
John Moehrke (Feb 01 2022 at 21:34):
im not against any solution, just need a solution.
David Pyke (Feb 01 2022 at 21:35):
I would suggest that you use a Boolean extension that indicates the subject is experiencing homelessness
David Pyke (Feb 01 2022 at 21:36):
That would manage how the receiver is to handle the address (if any)
John Moehrke (Feb 01 2022 at 21:37):
heck my home is still not mine permanently, the bank still owns 30%
David Pyke (Feb 01 2022 at 21:41):
IF the bank kicks you out, make sure your hospital's EHR sets the homeless flag on your record
Brian Postlethwaite (Feb 01 2022 at 21:41):
I'd want to not conflate the no fixed address with homelessness.
David Pyke (Feb 01 2022 at 21:42):
Right, you could put NFA in the address field and then set the flag if both apply.
Brian Postlethwaite (Feb 01 2022 at 21:42):
I don't think homelessness belongs in the address, I would expect that to be an observation.
Brian Postlethwaite (Feb 01 2022 at 21:42):
But that's for patient care I'd think.
John Moehrke (Feb 01 2022 at 21:43):
fair
David Pyke (Feb 01 2022 at 21:44):
I wouldn't put it in the address, I'd put in it Patient
John Moehrke (Feb 01 2022 at 21:45):
The EMS case is when capturing details about the patient, in order to inform the ED prior to arrival. So they are not making a homeless assessment. They are wanting to indicate (a) Here is the address they gave, (b) They said they have no address, or (c) They never gave us an answer.
David Pyke (Feb 01 2022 at 21:45):
b) set address as NFA c) leave it blank
John Moehrke (Feb 01 2022 at 21:46):
right... well there is not yet an NFA.. is there?
David Pyke (Feb 01 2022 at 21:47):
Put NFA as address.line as "No Fixed Address" and leave others blank
David Pyke (Feb 01 2022 at 21:47):
If the person is known local, you could put in City and State if desired
John Moehrke (Feb 01 2022 at 21:48):
as a hack?
John Moehrke (Feb 01 2022 at 21:48):
or do you think that is a final solution?
David Pyke (Feb 01 2022 at 21:48):
It's not a hack, address.line is type string. That's a good solution
John Moehrke (Feb 01 2022 at 21:50):
no, it is a hack
John Moehrke (Feb 01 2022 at 21:50):
fine with that as an R4 solution, but I hope-that-something-better-comes-along
John Moehrke (Feb 01 2022 at 21:54):
a solution should also distinguish from "temp" use code. Because I could not have a fixed address, but I do have a temp address. Is there overlap or not?
David Pyke (Feb 01 2022 at 21:56):
Temp is like "I'm on vacation, this is where I am right now"
David Pyke (Feb 01 2022 at 21:56):
But yes, a person with NFA could list their home address as NFA and their temp address where they are currently
David Pyke (Feb 01 2022 at 21:57):
Such as a shelter they are staying in, etc.
John Moehrke (Feb 01 2022 at 21:58):
yes, which is why I asked for a distinction. I can think of many scenarios where they need to be different.
Lloyd McKenzie (Feb 02 2022 at 00:22):
Gravity's SDOHCC IG has Observations that capture housing-related issues. It's not a boolean thing, as there are issues related to safety, reliability, etc. "Housing situation" is completely orthogonal to "Where do I mail stuff?" and "Where do you live?" Someone may have a permanent home address, but not live there because of the conditions. Or they might have stable housing in a non-traditional environment that just can't be mailed to (or even have a fixed location - e.g. a boat). So I think that having extensions on address that deal with "no fixed place to mail/visit this person" is a good idea, but one should never infer SDOH risks from the presence/absence of those flags.
Lloyd McKenzie (Feb 02 2022 at 00:22):
SDOH stuff belongs in Observation.
Eric Haas (Feb 02 2022 at 00:57):
@lloyd... that was my response but is not what John is looking for
John Moehrke (Feb 02 2022 at 12:47):
It was not, but it might still be useful. The EMT is just trying to convey facts. If it is best to leave address empty and provide an Observation, then that might be the right thing. It might be good to have alternatives for different settings. So I think it is good to get these out on the table so they can be evaluated.
Last updated: Apr 12 2022 at 19:14 UTC
