Visits to Chicago usually include exploring attractions like the Willis Tower and Cloud Gate (“the Bean”). However, a lesser visited destination, the Hull House, may be the most important site for those of us in the medical field. A turn of the century settlement house, this museum is a reminder of how an integrated model of delivering social services and health care impacted the entire nation.
The founder of the Hull House, Nobel prize winner Jane Addams, spearheaded the development of one of the first American facilities to offer recent immigrants a variety of services under one roof. To this end, she offered room and board while also providing health care, child care, education and entertainment. Her larger vision included a still wider variety of social services, including job skills training and advocating for a national social welfare system. These early efforts proved vital to the overall health and empowerment of Chicago’s most underserved communities. Over a century later, fulfilling Addams’ Hull House vision is more fantasy than standard of care. America’s underserved continue to be dogged by social determinants of health difficult to address in a clinic. While integrating social services and health care are complex, perhaps it is time for us to re-imagine how a revolutionary system may come about.
One solution may be to use modern technology to design a system which better addresses these underlying factors. Health information technology (HIT) like electronic health records (EHR), third-party software, and other information technology could be used to close the gap between social services, community resources and health care.
Currently, very few EHRs meaningfully integrate social determinants of health. Those that do simply keep the information static and do little to assist providers in taking the next step in addressing patient needs. In particular, this means facilitating the relationship between the patient and an array of relevant social services in their vicinity. The Institute of Medicine indicated in 2014 that the American health system could impact patient health more significantly if EHRs could meaningfully integrate clinical data and social determinants. Furthermore, studies involving Boston Medical Center have shown that simple tools like EHR integration of a letter helping low-income patients retain utility services resulted in a significant increase in patients maintain heat and electricity.
Ideal systems would house virtual resource guides, integrate referral tracking, and develop cross-talk with software at social service agencies or community resource centers. One example of this methodology in action is the use of the software Purple Binder by the University of Illinois Health System (UIH). Purple Binder, a third-party program, is an electronic community resource guide which allows users to look up different resources and obtain its location and hours, eligibility information, and much more. The software is very easy to use and is kept updated with Chicago’s ever-changing resource make-up.
Purple Binder’s integration into UIH’s intranet provides an additional tool for physicians and other providers to easily help patients. Addressing a patient’s need for food assistance is as easy as looking up a food pantry or a location to apply for food stamps. Furthermore, Purple Binder is developing technology to “close the loop” on referrals, allowing for community agencies to update the software with patient information. This includes initially making a referral, updating statuses on patients who made an appointment, indicating whether patients were found eligible for the service, and finally whether they received the service or not.
The scope of Purple Binder’s work and its integration into UIH’s health IT represents the promise of technology in health care, particularly for providers. But Purple Binder is not alone; the Public Health Management Corporation of Philadelphia has also made a push to create an EHR that includes community resources, social service referrals, and tracking mechanisms. These new systems leverage technology to make addressing social determinants of health much easier from the clinical space and this technology can help empower our neediest patients.
Perhaps the biggest pitfall for this new paradigm is additional work. EHR’s have certainly become more burdensome on physicians. What I’m suggesting is not providing more buttons to click, but a strong commitment to addressing social determinants. This should lead to a well-integrated and systematized process similar to that of medicine reconciliation. Now, instead of increasing reporting requirements, these tools can be left to the disposal of the physician, empowering them to act up on their patients’ needs.
The clear heir to Jane Addams’ Settlement House movement is our twenty-first century technology. Software, like Purple Binder and its integration in EHRs, empowers patients and providers to get involved in addressing needs beyond the four walls of the clinic. Now the onus is upon us, as future physicians, to champion these tools as the new nexus of social services, community resources, and ultimately health care.