Supporting the Gravity Project to expand interoperability among health, human, and social services

Often people ask how we enable care providers to actually refer their clients to another service. The answer is, well, Open Referral doesn’t actually deal with the process of “making a referral” at all!

We’re working to ensure that there’s open access to information about the services to which someone might be referred. 

But the challenges related to actually sending a person’s information from one provider’s system to another? That’s a whole other tangle of knots. I’ve long hoped that someone somewhere would work on those problems, while believing it should remain outside Open Referral’s scope.

So I’m excited to see that this work is now under way.

The Gravity Project is like kin to the Open Referral Initiative: Gravity is a community of practice that is developing and testing consensus-based open standards to facilitate capture and exchange of data pertaining to people and their social circumstances across a variety of healthcare and social service systems.
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Innovating Around the Intervention: Activate Care’s Coordination Tools, Powered by Open Referral

[Welcome to Jonathan Abbett, VP of User Experience at Activate Care!]

Imagine if our healthcare and social service systems were able to seamlessly coordinate care around all of our physical, behavioral, and social health needs. Back in 2012, inspired by this vision, I joined a technology start-up that is now known as Activate Care.

Activate Care logo

I am joined now by a much larger team of colleagues supporting our pursuit of that vision, and we’re honored to work with a community of hundreds of healthcare and social services organizations using our platform. Every so often, we stop to look around our industry and ponder what else we could be doing to help people in need, and to better serve the helpers – the people who work in healthcare, social services, and I&R agencies – who are the end-users of our tools.

What is clear is that communities across America are all at different stages in their efforts to address the social determinants of health (SDoH). These non-medical factors like housing stability, food security, and community safety all play an outsized role in the physical and behavioral health of all of us.

For this reason, many communities have launched or are in the process of developing a portfolio of interventions that help to address SDoH. Think of a coordinated entry system for housing services, the placement of food pantries in hospitals, or a high-risk young-mothers program designed to prevent involvement with the justice system. These efforts have the potential to change lives.

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The most successful social interventions go further than this screen-and-refer approach, and embrace the approach that Activate Care calls screen-and-intervene. In order to help communities leverage the power of coordinated care interventions, our care coordination and referral management systems need to talk to each other. Open Referral helps us solve a critical piece of this puzzle. Continue reading

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Collaboration in crisis: responses to the pandemic across our network

Map of resources in Toronto

With the world in crisis due to the COVID-19 pandemic, health, human, and social service providers face a harrowing dilemma: need is skyrocketing, even as providers’ ability to actually help is severely compromised. Many institutions have struggled to respond or even closed down entirely – while many new efforts to meet communities’ needs have emerged with astonishing speed.

We’ve seen a wave of new efforts to connect people with information about resources — and, in many cases, these new projects quickly ran into some of the same challenges that the information-and-referral sector has been grappling with for years. Information about the availability of community resources is often harder to find – and harder to trust – than one might expect.

Some of the best instances of rapid action have emerged in places where different kinds of organizations can work together to respond in new ways. This is where Open Referral comes in handy. By facilitating cooperation among organizations that maintain and use information about the resources available to people in need, we make it easier for community leaders to respond to rapidly changing circumstances in ways that make the most out of limited time and resources.

Below, we’ve collected a range of examples of new initiatives from across our network. The breadth of experiences is impressive: in some cases, new initiatives are presenting simplified versions of complex resource data to present for a specific context. In other cases, simplified sets of resource data are being shared with more complex systems, which augment them with local knowledge from end users. And in all cases, we can see a balance between the need to respond to this particular extraordinary moment, with a long-term vision of transformed systems. Continue reading

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The DC Community Resource Information Exchange: Phase One Report

The District of Columbia’s community of health, human, and social service providers are struggling with a familiar challenge: they want to be able to more effectively coordinate care among their patients and clients, yet their systems can’t currently ‘talk’ to each other.

In response to this issue, DC’s Department of Health Care Finance (DHCF) initiated the DC Community Resource Information Exchange (DC CoRIE) to develop data infrastructure that supports coordinated screening, referral and tracking across a range of health, human, and social services in DC. DHCF selected the DC Primary Care Association (DCPCA) and Open Referral to lead an initial planning phase to help understand how to build infrastructure that would facilitate these functions. As part of this planning phase, we were tasked with the development of a Community Resource Inventory that can sustainably aggregate up-to-date information about the health, human, and social services available to DC residents. Continue reading

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