While the HITECH Act of 2009 spurred widespread EHR adoption across healthcare organizations, national health information exchange (HIE) investments have largely left out community-based referral organizations, limiting social determinants of health (SDOH) data interoperability.
SDOH data exchange is key for improving population health, with factors such as housing, food and nutrition, transportation, and education accounting for up to 50 percent of county-level variation in health outcomes.
When healthcare providers and social services exchange SDOH data, they can coordinate care that addresses both the clinical and social needs of patients.
CRISP Shared Services (CSS), a nonprofit providing health IT services to HIEs across six states, recently appointed Marc Rabner, MD, MPH, as CMO to help advance SDOH data interoperability efforts.
Rabner, a practicing pediatrician at Children's National Medical Center, served as a clinical advisor to CSS for the past four years, helping drive cross-agency projects for SDOH interoperability.
"I've always been interested in how systems impact patients and their health outcomes," Rabner told EHRIntelligence in an interview. "I got into pediatrics because I thought if I could intervene early in a patient's life, I could have a big impact on their life course."
However, soon after he began his career, Rabner recognized that the current healthcare delivery system is not ideal for improving patient outcomes.
"I've had patients admitted for the second or third time for an asthma exacerbation," Rabner noted. "I'm very good at treating them, but I can't do much about the mold and rodents in their house triggering their asthma or the fact that their parent works two or three jobs and can't supervise their inhaler."
"Those kinds of structural problems in the healthcare delivery system drove me to preventive medicine and public health, and the fact that we can better deliver data to members of the care team got me really interested in health IT," he added.
Rabner noted that while the industry is progressing towards SDOH interoperability, SDOH data is still largely siloed because community-based organizations did not receive the same interoperability funding as healthcare organizations from the HITECH Act.
A 2023 AHIMA survey found that most healthcare organizations collect SDOH data, but providers noted limited use of SDOH data exchange with community-based referral organizations to close care gaps.
"We're trying to combine the healthcare and social care sides of a person's health, and these systems don't really talk to each other," he said. "There are not the IT resources or the IT expertise at these community-based organizations to be interoperable with healthcare, and with each other for that matter."
As the industry seeks to address SDOH needs and close care gaps, HIE networks can serve as conduits for cross-agency data exchange and deliver on critical use cases.
Take Maryland's Medicaid Redetermination project, for example.
In Maryland and most other states, Medicaid beneficiaries need to renew their coverage annually to determine if they still meet the qualifying requirements to receive benefits.
However, during the COVID-19 pandemic, federal legislation allowed state agencies to pause Medicaid redeterminations.
Now that the public health emergency (PHE) has ended, members must resubmit their information to determine whether they are eligible for Medicaid. Rabner noted that ensuring patients know about this policy change is critical to care access.
"We were worried about patients showing up to their clinic visit without insurance because they didn't get the message or forgot to do it, and then they would either have to pay out of pocket or cancel their visit, which is probably more likely," Rabner said.
As the health IT services provider for CRISP, Maryland's statewide HIE, CSS worked with the state Medicaid agency to compile a document for each provider with deadlines for patients to resubmit their redetermination paperwork. In most states, redetermination must occur by the date the member first began participating in the Medicaid program.
"The provider sends us a list of the patients that they see, and we match that list from Medicaid to the panel that the provider sent us," Rabner explained.
Then, on a monthly basis, the HIE pushes patient panels to providers with each patient's date for redetermination. From there, case managers and community health workers can reach out to patients and ensure they have submitted their Medicaid redetermination paperwork and assist if needed.
"We're trying to connect these dots and make sure there are not patients falling through the cracks when they show up to their visit without insurance and not knowing why."
Rabner noted that for HIE to be valuable, it should deliver the right data to the right place at the right time to avoid burdening providers with information overload.
"Part of my role as CMO is making sure that the tools we develop are valuable to the user," Rabner explained. "We don't want to develop tools for the sake of developing tools."
"We are thinking about how to develop those tools to be useful for folks, and that includes getting data into the workflow directly into the EHR," he noted. "How do we get data directly into the EHR so that I, as a clinician, don't necessarily need to go into the national network or into the HIE to get that data with extra clicks, but that data is surfaced to me when I need it?"
An example of CSS' EHR integration efforts is its work with the Maryland Department of Health's prescription drug monitoring program (PDMP).
PDMPs are electronic databases that track controlled substance prescriptions. Clinicians check PDMP data for prescription opioids and other controlled medications patients have received from other clinicians to determine whether a patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.
Previously, providers would have to leave their EHR workflows and navigate to the PDMP tool to search patient data. With the EHR integration, the PDMP automatically pops up within the EHR once a provider orders a controlled substance.
"They don't have to exit their workflow to find the right data and search for the patient," Rabner said. "The data is served up to them in a way that's user-friendly and helps improve patient care because you're spending less time searching, you're seeing the right data when you need it. It's just very actionable."