New York City Hospital Brings Care to Homeless Population

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Shani-Andre-thumbShani N. Andre, M.D., Chief Medical Officer and Vice-President

Federally Qualified Health Centers provide a valued service to underserved populations across the country. In New York City, one center offers dedicated service to the homeless population.

About 80 percent of New York City’s homeless population is comprised of families, and many are victims of domestic violence. The Floating Hospital is the sole contracted healthcare provider at the point of entry into the city’s shelter system. The organization has two larger clinics in Long Island City and six smaller satellite clinics.

The Floating Hospital is growing and adapting to meet changes in the industry, while satisfying the unique needs of its patients.

Providing patient-centered care

The Floating Hospital has undertaken an initiative to bring all clinics under the Patient-Centered Medical Home (PCMH) model. The larger clinics have been operating under this model for about two years, and the organization is bringing on the smaller clinics.

The satellite facilities have smaller volume and limited support staff, some as small as three or four people, including providers.

“It has been a challenge to make sure our smaller facilities can do everything they need to as a PCMH,” said Shani Andre, M.D., chief medical officer and vice president. Dr. Andre has been with the organization since completing her residency program and possesses a deep and abiding dedication to the clinic’s mission.

The Floating Hospital is pursuing PCMH recognition through the National Committee for Quality Assurance.

“The recognition is mostly about engaging patients to make sure all their care is comprehensive through our medical center,” Dr. Andre said.

The clinic offers family medicine and wellness services, along with mental health and dental care, to all ages from children to seniors. The staff is made up of physicians, psychiatrists, nurse practitioners, physician assistants, licensed psychologists, social workers, substance abuse counselors, and case workers.

Because the clinic serves a transient population, it has to approach care a little differently than other healthcare facilities. Dr. Andre said follow up is a challenge, and when patients are in, they try to run all services needed at that one visit because the patient may not come back soon, if at all.

“We have to understand the limitations of our patients,” she said. “If our patients are moving throughout the shelter system, their support isn’t the same as a typical family, and their priorities aren’t the same. Addressing a chronic medical condition is not always a priority. We have to figure out how we can meet patients where they are.”

Staying connected through technology

In support of the clinic’s mission to meet patients where they are and adhere to PCMH standards, The Floating Hospital implemented an electronic health record (EHR) in 2010 using eClinicalWorks.

Dr. Andre said getting the EHR finalized in 2011 was one of the biggest accomplishments since she has been on staff. The first step was getting the organization’s chief executive officer, an attorney by trade, on board with the system.

“With clinics in different boroughs, having one record we could all share was vital,” Dr. Andre said. “As we look toward PCMH initiatives and integration of care, all providers need to be working on the same medical record. Two providers can have a conversation about managing a patient’s depression and diabetes.”

With the CEO and other leadership on board, the next step was making sure the staff and providers were accepting of and trained on the system.

“Everybody was open to the EHR, so that made it work,” Dr. Andre said. “We didn’t have anyone who put their foot down and refused to adopt it.”

Uniting the staff around EHR

That doesn’t mean implementation wasn’t without challenges.

Dr. Andre said some younger providers who are immersed in technology and could easily navigate the system struggled with typing, making documentation slower at first. Older providers, who were a little technology averse, needed some nudging and training on the best way to use the system.

Creating access for all providers was also a challenge. The clinic has one provider who is blind and one who has a tremor, making typing difficult. Both have adapted by using voice dictation software.

“We ensure everyone has access to the system despite their limitations,” Dr. Andre said.

When it came time to roll out the system to the individual sites, the clinic used a phased approach. They brought on the main Long Island City health center location about eight months before bringing on the satellite clinics.

“By bringing on a smaller subset first, we were able to see how it works in practice, how to modify work plans, without disrupting everyone at once,” Dr. Andre said.

The Floating Hospital has since continued working to ensure it is using the system to its full capacity. As the clinic’s technology needs have grown, Dr. Andre said the organization had outgrown its existing IT firm and recently began working with a new company.

“Our IT company had longer turnaround times and was needing to subcontract out many of our requests, so we knew we had outgrown their capacity,” she said.

This year, the organization will be looking at requirements for the later stages of Meaningful Use and the shift to ICD-10.

by Patricia Chaney

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