Dr. James Withers (top left) treats homeless patients on the streets of Pittsburgh.
Hard to believe, but there really is a physician who has used an electronic medical record for nearly a quarter century, who believes in patient engagement and who makes house calls — well, sort of.
“The street-dwelling population is a real burden on our healthcare dollars,” Withers said Monday at the World Health Care Congress in Washington. Homeless people tend to have all kinds of untreated ailments and lack primary care physicians, so they use emergency departments at high rates, said Withers.
If his name sounds familiar, that’s because he made the top 10 of the CNN Heroes list for 2015.
But Withers has been at it much longer, since 1992. This whole time, he has practiced for Pittsburgh Mercy Health System, an affiliate of Trinity Health, and now runs a program called Operation Safety Net. He also founded the Street Medicine Institute to promote care for homeless people in other cities.
“I had a real existential crisis as a resident physician,” Withers said. He wanted to get out of the hospital because, as he put it, “I couldn’t be effective in dealing with the real issues” that people face daily. The concept of “Go to the people” is something he saw in a hospital in Haiti, Withers reported.
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Withers previously focused on treating victims of domestic violence. Homeless people, like victims of domestic violence, were underserved, and not always comfortable with clinical environments. “Many people said, ‘I would rather die than go to the hospital,'” Withers recalled.
“They wouldn’t work on my terms. I would have to learn to work on theirs.”
So, he did. “I was pretty quickly embraced as ‘Doc Jim,'” Withers said.
After winning the trust of a group of Pittsburgh’s homeless, Withers set up a clinic at Mercy, with the help of grants from the hospital and other local charities. While Withers did and still does go out on the streets, he sends people with chronic diseases into the clinic so Mercy can get these needy patients into case management.
Then, as now, technology underpins much of his practice, though Withers knows there is more than he can do. In the 1990s, he gave his phone number — for a pager — to homeless patients.
He built his own EMR in 1992. “We still have that,” Withers said. Of course, today, he has a smartphone, and he uses the UpToDate app for clinical decision support. http://www.uptodate.com/
Withers hasn’t gotten into remote patient monitoring or other, advanced forms of digital health just yet, but he called digital health “a largely unrealized potential.” He does dabble in telemedicine by dialing up dermatologist friends, for example, for video consultations on consumer-grade apps. “It’s very informal,” Withers said.
He also consults by video with new practitioners at Street Medicine Institute member organizations worldwide to get them acclimated with treating homeless people in the field.
Withers noted that another Street Medicine Institute member, Mercy Care, a federally qualified health center in Atlanta — also affiliated with Trinity Health — does employ telemedicine more formally for on-street care. “That’s got a lot of potential,” Withers said.
Photo: Pittsburgh Mercy Health System
