OPAL

Homelessness is on the rise in the United States, with the average life expectancy for the unsheltered being only 41 years compared to the housed at 79 years. People experiencing homelessness face disparities and complex health needs that are often difficult to manage due to a fragmented healthcare system. Moreover, those experiencing homelessness are subject to the digital divide without access to specialized services that could be delivered to them via mobile-led solutions. We believe that digital solutions provide important socioeconomic impact and can connect patients with care providers to improve health outcomes, connect to social services, identify housing resources, and improve overall well-being.

The fragmented healthcare system in the US can be challenging for housed individuals - imagine the complexities faced by those experiencing homelessness. Those experiencing homelessness must navigate a complex system while also facing stigma that leads to trauma and distrust. The healthcare system is not built for those experiencing homelessness and does not always take into account the complex circumstances and contexts of living on the street. For example, a patient can not simply leave their belongings for days to undergo a medical procedure without the risk of theft. These scenarios often leave individuals with little choice but to select out of medical intervention in order to ensure they can survive in their surroundings. 

Providing continuous, coordinated care across multiple access points poses major communication hurdles for providers serving the homeless population. Many programs still rely on outdated paper records to track client health information and care services. This fragmented approach severely limits the ability to share data and connect care across street medicine teams, shelters, clinics, and hospitals. Additionally, as homeless rates increase, the ability of social service providers and medical providers to respond decreases. With that being the case, those experiencing homelessness will be required to be more self-sufficient, making their access to connectivity all the more relevant for their care. 

Research shows people experiencing homelessness regularly use mobile phones and the internet, and they are more likely to access the internet from their mobile devices when compared to the general US population. As health and non-profit organizations continue to look to technology to increase efficiencies and lower costs, mobile-led solutions focused on connecting care providers and patients can reduce wasted spending and avoid further costs such as hospital readmission. In the US alone, there are 1.5 million people (and growing) experiencing homelessness each year, representing a cost of $27 billion to US taxpayers per year for homeless ER visits. 

Furthermore, mobile-led solutions can provide a safe space for people experiencing homelessness to locate, assess, and interact with a network of health and social service providers while offering providers working in separate organizations and health facilities a user-friendly interface to manage cases together to enhance coordinated care.

A perfect solution to enhance healthcare for the homeless does not exist. However, investments in open source, mobile solutions that can address care coordination and advance health equity among the homeless must be made. 

Our solution aims to improve health and address the fragmented healthcare system by creating a platform to enable coordinated care among health and social service providers and individuals who are experiencing homelessness. The platform, which goes by the name Opal, is a partnership between the PathCheck Foundation, ZVMS Street Medicine/Mayo Clinic, Madison Street Medicine, and Miami Street Medicine. Once the platform has been successfully launched, we intend to scale it to other cities with unhoused populations and replicate it for additional communities facing barriers to care.

Electronic medical records (EMRs), combined with an encrypted, open messaging protocol, offer a powerful solution by enabling seamless information sharing between disparate providers caring for the same clients. Opal will give authorized staff real-time access to comprehensive medical histories, treatment plans, medications, diagnostics, and other critical data regardless of where a client received care last. This continuity of recordkeeping is essential for delivering integrated, effective care to an especially vulnerable population lacking housing stability.

Beyond care coordination, the Opal platform provides invaluable data that service programs can leverage to optimize operations and demonstrate impact. Detailed data enables more accurate tracking of client encounters, services delivered, treatment outcomes, and other key metrics that can append the traditional EMR with insights on anything from shoe size to dietary restrictions. These insights help providers enhance programs, report to funders, and advocate for supportive policies in an evidence-based manner.

Opal will be the first tested solution to offer real-time superior care coordination to enhance the outcomes for those experiencing housing insecurity. Its infrastructure will be the first natively interoperable digital health information system for decentralized health and social service providers to be developed in an open information exchange protocol and will use machine-readable standards to cryptographically protect the provenance of health information of users without having to impose an operational cost on the partners using this system. 

It is well documented that those experiencing homelessness also experience inferior health outcomes. People lacking a permanent place to live are likely to experience increased morbidity and mortality. The National Health Care for the Homeless Council noted that unhoused individuals in their late 40s and early 50s present with health and functional needs of their housed peers who are in their 60s or 70s (but without access to Medicare benefits). While the average life expectancy in U.S. adults is 79 years, it is only 41 years in people experiencing homelessness.

Digital innovation within the homeless community has not kept pace with innovation in other sectors and remains important to deliver specialized services to those experiencing homelessness. For unsheltered people, mobile-led solutions have far-reaching benefits, including access to services, improving health outcomes, and identifying housing opportunities. Existing research has shown that mobile-based pilots and interventions have improved health outcomes and interventions of those experiencing homelessness. Studies have seen positive impacts of medication adherence, appointment attendance and prescription intake.

This collaborative pilot implementation involves deploying Opal for use by the Miami Street Medicine  (MSM) Team and 5 of their community and medical partners serving unsheltered clients over a 24-month timeframe. Approximately 35% of MSM's clients are female and 64% are male. 47% have identified not having a primary physician, with nearly 20% identifying that they have not seen a doctor in 1-3 years. 46% of MSM patients who identify as Black, 31% as Hispanic, and 12% as white. Focusing first on a defined local area allows us to work closely with those experiencing homelessness, gather feedback, optimize workflows, identify technical issues early, and serve the community to improve the lives of patients.

The PathCheck Foundation has a track record of success building and deploying open source tools for public health having worked with WHO, Google, MIT, and several state public health agencies, including Minnesota, Alabama and Guam. We are a non-profit, citizen-centric, open source, open standards, ‘privacy-first,’ digital solutions consortium of epidemiologists, engineers, data scientists, digital privacy evangelists, medical providers, developers, professors, and researchers

The organization is now focused on working with partners to advance technology that supports vulnerable populations through care coordination and will address social determinants of health (SDOH) to increase health equity.

To build this platform, PathCheck has strengthened its expertise by partnering with the Zumbro Valley Medical Society, Madison Street Medicine, and Miami Street Medicine. Each team is focused on delivering equitable and compassionate care for those experiencing homelessness. Each team’s local knowledge, coordination challenges, and identified needs will shape the design and build of Opal. 

We know that for Opal to be successful, the platform must establish trustworthiness and prioritize relationship-building with those it will serve—those experiencing homelessness. Using a human-centric design approach, PathCheck will incorporate people’s lived experiences into its development and use. With the help of each street medicine team, PathCheck will hold partnership forums with patients and clients both locally and virtually to meaningfully understand the challenges and pain points of receiving care in order to design a platform that will solve for the needs of this population. 

To date, OPAL is in the prototype stage. We are currently building this prototype in partnership with the Miami Street Medicine Team and Madison Street Medicine (WI). The prototype has not been rolled out to beneficiaries yet as we are still building. 

We are applying to the MIT Solve Global Health Equity Challenge because their network and expertise would be invaluable in helping build and scale Opal, a mobile-led solution aimed at improving healthcare access and outcomes for people experiencing homelessness.

The homelessness crisis in the United States is a pressing issue, with those without shelter facing a staggering life expectancy gap of nearly 40 years compared to the housed population. This disparity is exacerbated by a fragmented healthcare system that is ill-equipped to cater to the unique challenges and circumstances faced by the homeless community.

Opal seeks to bridge this gap by leveraging the power of mobile technology to connect individuals experiencing homelessness with a network of healthcare providers and social services. By offering a user-friendly platform for both patients and providers, Opal can facilitate coordinated care, streamline communication, and empower the homeless community to take an active role in managing their health and well-being.

The MIT Solve community's wealth of knowledge and resources in the areas of technology, healthcare, and social impact would be instrumental in refining and scaling Opal's solution. Its network of experts could provide invaluable insights into the specific challenges faced by the homeless population, as well as guidance on navigating the complex healthcare landscape and fostering partnerships with relevant stakeholders.

Furthermore, the recognition and support from a prestigious institution like MIT Solve could amplify Opal's impact and drive broader awareness of the urgent need to address health equity for the homeless. With Solve's support, Opal would be better positioned to secure the funding, partnerships, and policy support necessary to bring this transformative solution to communities across the United States and beyond.

By harnessing the power of mobile technology and leveraging the expertise of the MIT Solve network, Opal has the potential to revolutionize healthcare access for one of the most vulnerable and underserved populations, ultimately making strides towards achieving true health equity for all.