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      Responding to COVID-19: Strategies for Managing Infectious Disease Outbreaks Using HMIS

       

      Introduction

      Infectious disease outbreaks, such as Coronavirus disease 2019 (COVID-19), are a major concern worldwide, and Continuums of Care (CoCs) face the challenge of preparing for outbreaks with a vulnerable population already at an increased risk of exposure to infectious disease. Drawing upon our experience working closely with communities across the country, we would like to share key steps to consider when facing public health risks, as well as suggestions for how to use HMIS and Clarity Human Services in your response to the risk of an infectious disease outbreak.

      Please remember that health information such as infectious disease diagnosis is considered protected health information. Make sure you follow local policies and procedures when implementing any solution related to storing this information in HMIS.

      Preparation: Building a Strong Infrastructure 

      Having a solid infrastructure in place can make all the difference when it comes to responding to a health crisis in your community. There are many moving parts to infrastructure, but we want to highlight three critical pieces: communications infrastructure, establishing a training plan, and building your data infrastructure. 

      1. Shore Up Your Communications Infrastructure

      Crises like a public health threat can arise suddenly and expand quickly. Having a solid communications infrastructure in place ensures that you can respond in a timely manner.

      • Support Communication within the HMIS Community - Keep an open line of communication and build strong relationships between HMIS users, system and agency administrators, and community stakeholders to create a solid foundation upon which collaboration can occur. Newsletters, refresher training sessions, regular user and/or agency lead groups, and message boards are a few ways the HMIS community can keep in touch and share ideas. 

      • Review Data Sharing Agreements - Make sure that data sharing agreements are in place with all relevant entities, and that it’s clear to staff what information can be shared, and with whom. Agency-level agreements can be stored under an agency’s Sharing tab for easy access to who has active agreements in place, and client ROIs can be set up electronically to avoid multiple confusing copies floating around.

      • Use Available HMIS Features - See our “Communicate and Share Information” section under Response: Supporting your Clients and Staff for ways to use Clarity Human Services to support your communication infrastructure.

      2. Establish A Training Plan

      HMIS can function as a key central resource when managing a health crisis, which may demand rapid training of additional staff or volunteers. Having a solid training plan in place ensures these new users are effectively and efficiently trained.

      • Bitfocus Help Center - The Bitfocus Help Center houses guidance on how to use Clarity Human Services, information about new features and functionality, and communication about changes in HMIS Federal guidelines. This resource is available to all users and can supplement regular training.

      • Learn.bitfocus.com - Our Learning Management System provides on-demand video training on a variety of topics, including end user training, reports, HMIS requirements, and frequently asked questions. These trainings provide an easy and efficient way to introduce users to Clarity Human Services functionality and support ongoing training demands. 

      • System Administration Training Plan - If Bitfocus provides your system administration services, you already have a training plan in place, but you can work with your team to ensure that capacity for emergent, ad hoc training is part of that plan. 

      3. Build Your Data Infrastructure

      Since HMIS is likely your central data source for client information during times of crisis, it’s critical that your HMIS data be reliable.

      • Data Quality and Completeness - Accurate and complete data is crucial for connecting clients with appropriate resources and identifying vulnerable individuals. Several Clarity Human Services reports, including the [HUDX-225-AD] HMIS Data Quality Report , [GNRL-220] Program Details Report , and the [GNRL-106] Program Roster as well as the Data Quality Dashboard can help system administrators monitor HMIS data quality. The HUD Exchange also features several resources to support improved data quality in HMIS.

      • Data Timeliness - Set expectations around data timeliness with your community and in your continuous data quality improvement plan. During a crisis, stakeholders will look to HMIS to provide "real-time" data on such things as shelter capacity, occupancy, and demographics of shelter guests to help guide the response. Setting expectations with agencies and clearly communicating those expectations will ensure that stakeholders can get the data they need when they need it.

      • Tracking Fund Sources - Making sure that you’re documenting correct funding sources may be the last thing on your mind in the midst of a crisis, but ensuring that funding sources are set up correctly in your HMIS means fewer headaches later when it comes time to account for money spent. The Funding tab allows agencies to track primary and sub-granted funding and associate those funds with services. 

      Community Example: Data Quality Preparedness

      A robust, continuous data quality improvement plan covers not only the regular data quality review and cleanup for federal reporting, but also monthly special initiatives to identify other potential problem areas including:

      • Clients with missing ROIs
      • Agencies missing data sharing agreements
      • Enrollments that appear to have been abandoned
      • Incorrect household configuration/missing heads of household
      • Missing or conflicting disability information
      • Duplicate clients

      Having their HMIS System Administration team prioritize staying on top of data quality means that they can trust their HMIS data and have the most accurate client information when it comes to potential community crises.

      Mitigation: Preparing to Respond

      When there’s a threat of an outbreak in your community, be prepared to respond by identifying the infrastructure you need to have in place to support your staff and clients. Proactively setting up data collection screens and services, creating client resources, and identifying at-risk clients are just three of many ways that you can use HMIS to support your mitigation efforts. 

      1. Prepare for Data Collection

       Accessing key client data is a critical part of any response, but you have to collect that data in order to use it later.

      • Custom Enrollment Screens - Add fields that allow staff to identify clients who need additional follow-up or service referrals, or to track specific critical information about clients. Be sure to word your questions in ways that don’t reveal protected health information and refer to your local HMIS guidelines on collecting and recording protected health information.

      • Custom Assessments for Screening - Create assessments and/or other screening tools to help identify clients who are at high risk, or to determine whether they’re eligible for particular services.  

      • Community Queue - Use the community queue for more than just Coordinated Entry. Create an additional community queue to support clients who received a custom assessment. Once clients are on the queue, you can use all of the usual queue functionality, like sorting by scores, filtering for tracked characteristics, and referring to other programs. 

      • Services - Create services to track events like health screenings, provision of supplies and other relevant activities. Don’t forget that ESG funds will cover certain items, as will CoC funds, so use financial services as needed to track dollar amounts.

      Tip: to monitor which clients have or have not received a particular service, create a “no-service” service (e.g. “Not screened for medical needs”) and use automated provisioning to assign that service to all clients who enroll. Then, when you start assigning your actual service (“Screened for medical needs”), you can use service-based reports in the Clarity Report Library to easily tell who has and hasn’t been screened.

      2. Create Client Resources 

      Providing clients with resource lists and safety information is an important step in helping clients keep themselves safe during a potential outbreak, especially when they may need to access new resources that are unfamiliar.

      • Client Forms - Create custom forms to provide clients with resources, recommendations, safety information and more. Use toggles on the form to indicate which resources are particularly relevant to a given client. And since the form is automatically stored in Clarity Human Services once you provide it to a client, you can easily see who’s received the resource and who hasn’t, as well as print up additional copies if a client loses one.

      3. Identify At-Risk Clients

      Knowing who’s particularly vulnerable can help ensure that the right services get to the right place. 

      • Data Analysis - Create queries to identify your most vulnerable clients (over or under a certain age, having other disabling conditions, staying outside, etc.) for targeted services and/or proactive connection to resources.

      Community Example: Expanding Homelessness Prevention

      In preparation for a potential outbreak of COVID-19, one community decided to expand homelessness prevention services to assist clients who wouldn’t normally be eligible, but who might become eligible as a result of outbreak impacts.

      They worked with their HMIS System Administration team to plan and create a new program called “Emergency Homelessness Prevention,” and added four financial services to track why clients were receiving services, as well as how much assistance was provided:

      • Health Impact (they or a family member were directly impacted by the virus)
      • Employment Impact (loss of job or reduction of hours/tips)
      • Childcare/School Impact (loss of childcare and/or additional childcare needs due to school closures)
      • Enrollment Extension

      Setting up this program in advance ensured that it would be ready to use as soon as they needed it, and they could track all necessary pieces of information about their clients.

      Response: Supporting Clients and Staff

      When an outbreak happens in your community, a timely and comprehensive response ensures that your impacted clients get the care they need and your staff have ready resources. Your HMIS can help you quickly locate impacted clients and refer them to key resources, communicate and share information with staff, and monitor the ongoing outbreak response. 

      1. Locate Impacted Clients 

      During an infectious disease outbreak, containing the spread of disease is critical. Use these Clarity Human Services features to locate exposed clients in order to minimize additional exposure.

      • Client History - Use the Client History to identify what other programs and services with which a client is currently engaged. Since other clients at those programs may have been exposed to an ill client, this will help identify who to reach out to in order to contain additional exposure.

      • Interaction Maps - Use Field Interactions on the Location tab, or attach Geolocation fields to screens so that you can create scatter plot and heat maps in our Data Analysis module to help identify locations where a client might have been exposed, or might have exposed others.

      2. Refer Clients to Resources 

      Impacted clients may need to access a variety of resources to manage their care, and potentially exposed clients may need screenings. Our referral functionality can help you track referrals and outcomes, to ensure you’re on top of where clients are in the process.

      • Client-Level Referrals - Use the client-level Referrals tab to make referrals to public health facilities or other medical services. Even if those programs are not participating in HMIS, you can set up “dummy” programs at your agency to indicate whether clients have successfully connected with these external resources.

      3. Communicate and Share Information

       Once you know that you have impacted clients, notify staff and other providers as soon as possible so that they can take any necessary additional steps. 

      • Clarity Inbox - Email is often the fastest way to contact staff who might not always be at their desks, but not every agency has secure email access that’s necessary when communicating about sensitive information. The Clarity Inbox provides a secure messaging system within Clarity, that allows you to reach out to any HMIS users at any other agency in your CoC. Users are notified by email when they have new Clarity Inbox messages.
      • Login Screen Message - Use the customizable Login Screen Message to inform staff of immediate next steps for clients who’ve been exposed, and where to find additional resources. 
      • Public Alerts - When you believe clients have been exposed, it’s critical to notify other staff who may be working with the client so that everyone can coordinate around connecting the client to necessary screenings or services. Post public alerts to provide critical information to any HMIS user accessing a client’s record.

      4. Monitor the Situation

       In the midst of a crisis, it’s key to have the information you need at your fingertips. Use our canned reports and data analysis module to get you what you need, when you need it.

      • Service-Based Reports in Report Library - Service-based reports such as [GNRL-400] Program Linked Service Review and [GNRL-103] Service Census can help your staff keep track of which clients have received which services in order to further target outreach efforts.

      • Login Dashboards - Set up a dashboard that staff members will see as soon as they log in. This dashboard can contain information about clients who’ve been contacted for additional screenings, clients who need to be contacted, which clients have or haven’t received certain services or referrals, etc. This information can help your staff quickly target what efforts they need to make next.

      Community Example: Locating and Notifying Clients During a Hepatitis A Outbreak

      In Spring 2019, the Community experienced a Hepatitis A outbreak. Local public health officials partnered with HMIS leadership to identify the period of time when shelter clients may have been exposed to the disease, and the Bitfocus System Administration team quickly created Data Analysis queries to identify potentially impacted clients. 

      Once clients were identified, the Bitfocus System Administration team and community HMIS staff coordinated closely to publish public alerts to over 500 client records in Clarity Human Services in less than 24 hours. Providers were able to immediately see that a client had a public alert and since the alert contained clear information and instructions, were able to quickly support and provide necessary resources to their clients.

      Alert text: 

      This individual was at a service location at the same time as someone diagnosed with hepatitis A. Please immediately let this individual know that they have likely been exposed to hepatitis A.

      Please provide this information:

      - Hepatitis A is a virus that spreads easily and can cause severe liver disease. Sometimes people are hospitalized or even die from hep A.

      - Getting a hepatitis A shot immediately can prevent you from getting sick if you get it within 2 weeks of exposure. You can get a shot from your doctor or clinic. Most pharmacies offer the hep A shot if you have an insurance card. If you don’t have a doctor, the STD clinic at the Medical Center has a limited supply of free hepatitis A vaccine.

      - You should go to a doctor or emergency room if you are experiencing symptoms. Symptoms can include fever, tiredness, nausea, loss of appetite, yellowing of the skin and eyes, stomach pain, vomiting, dark pee, pale poop, and diarrhea.

      Additional information was included, describing where clients could go for vaccinations, as well as the phone number to contact the Public Health Department. 

      Community Example: Emergency Management Communication During Wildfires 

      In the Fall of 2019, the Community experienced environmental impact from wildfires. The Bitfocus System Administration team and City and County staff worked together to send out CoC-wide messaging on fire, air quality, and related Public Safety Power Shut-off events. The City and County departments lead the emergency response communication, and the Bitfocus System Administration team reinforced key emergency management and homeless response system messaging, as well as sharing community resources and best practices for managing poor air quality through targeted email blasts to CoC Agency Leads. The local team worked collaboratively to respond to an urgent community emergency with prompt communication to both educate and connect providers with resources. 

      Resources

      To help CoCs face the challenge of potential infectious disease outbreaks, HUD recently published several new resources and hosted the webinar: Infectious Disease Preparedness for Homeless Assistance Providers and Their Partners. These resources provide guidance on preparing for, mitigating, and responding to infectious diseases in a variety of service settings, including shelters and encampments.

      In addition, the following resources provide helpful information on preventing and managing the spread of infectious diseases, including COVID-19. 

      Need More Help?

      Have questions about any of the Clarity Human Services tools we mentioned above? Reach out to our friendly Technical Support team for answers. You can reach them by email, chat (the Help icon in the lower right-hand corner), or phone (800-594-9854), 5am-5pm PT.

      Want to chat about topics that go beyond specific Clarity Human Services functionality, such as:

      • Best practices and how to configure your system to meet your specific needs
      • Community planning, communication, and training when implementing a mitigation plan
      • What to do when you have lots of ideas but no staff to implement 

      The Bitfocus Professional Services team is ready to help: We are a team of experts who work with communities across the country to help make their plans a reality. Whether you need help planning, need more staff resources, or just want to explore options, reach out to your BFF for more information about how we can help.

      Not sure what you need but know you need something? Contact Technical Support and they’ll route you to the right resources.