Capturing and Integrating Social Determinants of Health for EHR

Heather Chartier, MS, RHIA, CCA EMR Leave a Comment

Capturing and Integrating Social Determinants of Health for EHR

Social Determinants of Health: Everyone's Challenge and Benefit

Concurrent with a refined focus on Social Determinants of Health, the benefit of using electronic health records for managing the health of populations as well as individuals has garnered attention. With the implementation of provisions of the ONC’s Cures Act Final Rule, patients, providers, health systems, health I.T. developers, and federal and state agencies have many challenges to overcome and many benefits to be derived before improvements in outcomes can be achieved.

Social Determinants of Health (SDH)

Capturing Social Determinants of Health (SDH) in electronic health records has become a priority of the Office of the National Coordinator for Health Information Technology (ONC) and more of a focus for health care providers as they realize capturing data external to traditional clinical findings can provide a broader perspective on sources and drivers of a patient’s health status and can identify their approach to improving health care outcomes. SDH are defined as the social factors that make up where people live, work, learn, and play that contribute to most health inequities.1 Social factors account for 25-60 percent of deaths in the US in any given year according to results from various meta-analyses depending on the scope and definition used.2 SDH can be separated into two camps: individual-type determinants specific to the individual such as education, housing, or employment status; and community-type determinants, which measure socioeconomic, environmental, or neighborhood characteristics that affect the general population.

Major Challenges

A major obstacle to capturing and using SDH data is an electronic health record’s lack of interoperability. The source of this challenge is due to the amount of variation regarding data and standards; policy; infrastructure; and implementation—the four set focus areas the ONC is tackling for health I.T. advancement in interoperability efforts. Other variations to note, are major stakeholder responsibilities; a hospital system’s usage of different E.H.R. vendors; hospital administrative personnel’s data entry of health care information; choice of quality improvement targets; and research priorities.

21st Century Cures Act

The provisions of the 21st Century Cures Act implemented in December 13, 2016, has allowed for improvement of flow and exchange of the electronic health record by initially pushing for medical product development and faster and efficient means to new innovations and health care advancements for patients in need. The ONC’s Cures Act Final Rule takes the Cures Act one step further to allow for enhancement of clinical data. Recent changes to the existing 2015 Edition Health I.T. Certification Criteria are to better implement the 21st Century Cures Act, advance interoperability between certified health I.T. systems, and allow patients easy and instant access to their electronic health information via smartphones and software applications. Benefits for patients allows for ease of access to their health record, better security through two-factor authentication applications such as OAuth2—the same secure conventions used in the banking industry; and promotes transparency for comparison shopping to manage health care costs. Some benefits for clinicians allow for choice of apps and improving patient safety.

The ONC is responsible for implementing those parts of the Cures Act pertaining to delivery, related to advancing interoperability, prohibiting information blocking, and enhancing the usability, accessibility, and privacy and security of health I.T.3 The ONC is collaborating with federal partners, among others, such as Health and Human Services (HHS) whose created an initiative called Healthy People 2030 and created a SDH workgroup made up of subject matter experts with different backgrounds.

Why are the SDH important to executive leadership and hospital systems?

One thing is certain that SDH in electronic health records needs to also be a focus for executive leadership and hospital systems who rely on providing better health outcomes, generating revenue, and reducing health care costs. Currently, there is too much variation to determine exactly what patients, providers, and health systems require to improve outcomes. Perhaps a solution to resolve the variability issue regarding capturing SDH in the electronic health record is to tackle it one variable at a time. As new evidence presents itself and additional research is conducted, this issue will likely evolve.

Resources:

https://healthit.gov/curesrule/overview/about-oncs-cures-act-final-rule

https://health.gov/healthypeople/objectives-and-data/social-determinants-health/literature-summaries/access-health-services

https://www.sciencedirect.com/science/article/pii/S0749379719303228

https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1252

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