Health care stakeholders have long recognized that factors outside the health care system –the social determinants of health (SDoH) – influence an individual’s health and well-being. Many hospitals, health systems, and health plans are navigating the challenges of effectively linking data related to the SDoH and clinical services to improve health outcomes in the long term. The SDoH are sometimes described as the economic and social conditions that impact health, such as the environment in which people are born, grow, live, work, and age.
Clinical systems are not currently designed to collect that kind of data in a way that can be easily accessed and acted upon to make an impact. However, due in part to the shift from fee-for-service to value-based care, stakeholders are recognizing that they need these data for better clinical decision support, quality measurement, care coordination, and population health management. This summer, the Office of the National Coordinator held a public webinar on how to leverage health information technology to support SDoH. And earlier this year, CMS launched its Accountable Health Communities Model, to provide funding, over the course of five years, to 32 provider organization to act as bridges between clinical and community services. The hope is that this model and other programs around the country will provide lessons learned and leading practices.
Challenges to integrating SDoH information into the health care system include lack of standardized data that can be easily integrated, and the lack of a full set of medical terminology codes that capture SDoH data. Some health IT stakeholders have emphasized the need for representing patient-reported and community-level SDOH using common vocabulary standards that take into account data on genetics, lifestyle variables, and environmental factors.
One bright spot is the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) – a multi-year effort between several health care associations and pioneering health center networks across the country to pilot test and promote a national standardized patient risk assessment protocol to assess and address the SDoH. PRAPARE is a screening tool combined with a patient engagement tool, and a compendium of implementation and response resources. It is designed to be integrated into the electronic health record (EHR) to facilitate assessment and intervention. The EHR vendors that are set up to use PRAPARE represent about 60 percent of the health centers in the country, and more vendors and health center networks are in the process of adopting the system in response to growing demand from providers and health plans to have these data integrated into the EHR.
This spring, the Deloitte Center for Health Solutions surveyed nearly 300 hospitals and health systems around the country to learn about health system initiatives and investments in SDOH to date. The survey showed that value-based care appears to be driving better alignment of clinical care and SDoH. However, many health care organizations are not yet able to support sophisticated capabilities to collect relevant data from the patient population and across the health care system, identify methods to integrate the data and measure performance, and develop relationships with community organizations that are also addressing social needs in their communities. The survey showed that less than one-third of hospitals are integrating social needs into the EHR for most of their target population. In supplementary stakeholder interviews, some hospitals that are integrating SDoH into the EHR said that much of the data can get missed by the care team if it comes in the form of notes.
Although EHRs have the potential to provide critical information to providers who treat patients with such social needs, SDoH data has not been linked to clinical practice until recently. Further integration of data into the EHR, and strategies for making this data more useful for the care team, may help hospitals improve their population health strategies in the future.
Looking ahead: The Institute of Medicine and other organizations have recommended the types of measures and domains health systems should consider integrating into the EHR. They are looking at the opportunities for linking EHRs to public health departments, social service agencies, or other relevant non-health care organizations. Some forward-thinking organizations and leaders are starting to think about linking grocery purchases, retail purchases of over-the-counter medical products, data from remote monitoring devices or wearables, as well as environmental data such as weather patterns, and water and air quality, to get a fuller picture of someone’s risks. To realize this vision, the health care system will need to overcome challenges around data-sharing, governance, and privacy concerns.