JMIR Publications

ABSTRACT

People experiencing unsheltered homelessness (PEUH) are a vulnerable patient cohort suffering high levels of disease morbidity and mortality alongside numerous barriers to care [1]. Street Medicine is a practice whereby medical providers travel to encampments, sidewalks, and overpasses to directly treat PEUH [2]. However, these organizations are typically volunteer-based and lack funding for robust electronic medical record systems, many of which are cost-prohibitive [3]. Research Electronic Data Capture (REDCap) is a web application that can be used to create databases for clinical research and projects [4]. It can also be customized for telemedicine consultations. This cross-sectional study describes the use of a custom, REDCap-based electronic medical record for the management of cutaneous diseases in a Miami-based Street Medicine organization. A custom, secure REDCap-based electronic medical record (EMR) was developed in June 2021 for use in a Miami-based Street Medicine organization (Multimedia Appendix 1). Approval was obtained by the University of Miami Institutional Review Board to review records of cutaneous disease among this PEUH patient cohort. Between July 2021 - January 2022, REDCap records were retrieved pertaining to skin or nail-based problems. In cases requiring further elaboration, additional fields were added into patient charts such as wound care (Figure 1). Among 140 unique patients seen in a street setting, 112 diagnoses were recorded. The sample evaluated included 68.1% males and 31.9% females. The patient cohort was diverse, with 50.2% black, 45.8% white, and the remainder asian or native american. Hispanics of any race were 34.8% of the sample. The highest morbidity lesions in terms of disability and risk for infection encountered were chronic wounds and ulcers, many of which required multiple care instances. The use of a free, customizable REDCap system was instrumental in recording the high burden of cutaneous diseases among our cohort of PEUH (80%). REDCap can be used by charitable healthcare organizations with limited funding by virtue of its cost-effective and accessible management of patient data. The high attrition rate (71.6%) is an inherent challenge in caring for transient populations. This could be improved by reliable communication via cell phones or email. Another study limitation is that many topical medications offered to patients were smaller packets distributed without complete documentation. Only medications specifically ordered for patients were included in this synthesis. This can be addressed with more judicious documentation. Future studies should evaluate the satisfaction and perceptions of user-friendliness from providers using REDCap in voluntary settings. An important consideration is the need for medical informatics-trained volunteers to help establish and modify the database. A REDCap-based EMR appears to be a valuable tool for established Street Medicine teams, particularly for the use of specialized services like dermatology. These can be modified for special circumstances and patient populations, thereby improving the delivery of care to PEUH.