A Room with ICD10: Navigating Vulnerability and Shelter through the Electronic Medical Record during the Covid-19 Pandemic
Just Tech Covid-19 Rapid-Response Grant – Fall 2020
San Francisco is known as a city of innovation and inequality, where the massive footprint of tech giants like Twitter and Salesforce overlook sprawling tent encampments. In the US, it was among the first cities to take an aggressive approach to controlling Covid-19, instituting a shelter in place (SIP) ordinance on March 17. Then, April 10 saw an outbreak at the city’s largest homeless shelter. A public outcry emerged, resulting in a flurry of rapid decisions to commission 7000 hotel rooms for the homeless. To date, there are nearly 50 hotels around the city featuring onsite medical and nursing care. The Electronic Medical Record (EMR) is a key technology used to triage homeless persons residing on the streets into SIP hotel rooms according to vulnerability criteria established by the CDC. Personal narratives of medical history must be verified by persons working for the public health department using a specific EMR called Epic, a program used across many large health systems, which provides access to a limited dataset of local hospitals. This research project examines the forms of surveillance and care in play in these SIP hotels and their relationship to the EMR. In the context of the Covid-19 SIP hotels for the homeless, this project asks: What is the role of the EMR in defining or contesting vulnerability? Further, how do modes of risk and care circulate between digital platforms like the EMR and the forms of living and dying occurring in these sites?
Naomi C. Schoenfeld
Nurse Practitioner, San Francisco Department of Public Health
Naomi C. Schoenfeld is a medical anthropologist and public health nurse practitioner in San Francisco. She has worked for the San Francisco Department of Public Health for 18 years and previously held a position as assistant clinical professor at the University of California San Francisco School of Nursing. She received her PhD from the University of California, San Francisco/UC Berkeley Joint Program in Medical Anthropology in June 2020. Her dissertation research intervenes in medical anthropology, STS, and critical global health. She conducted ethnographic research examining (post)socialist technoscientific formations through Cuban cancer vaccines. Her new research brings her ethnographic lens to her years of clinical experience with marginalized and vulnerable communities in San Francisco by examining a novel emergency program providing thousands of rooms in tourist hotels to persons experiencing homelessness during the Covid-19 pandemic.