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Best Practices for Integrating SDOH Data into the EHR

Health systems and health information exchanges across the country are trying to identify and integrate social determinants of health data, but it is not an easy task.

Identifying and implementing social determinants of health (SDOH) data into the EHR is critical to finding answers to a state’s most significant issues. 

Once identified, SDOH data helps healthcare providers make social services referrals, but the process for doing so using technology is challenging.

“It's not that physicians have totally ignored social determinants of health, but impactful information—such as the fact that the patient had to take time off from a low-paying job and ride two buses to get to the doctor's office—isn't typically collected in electronic medical records,” said Brian Dixon, PhD, director of public health at the Regenstrief Institute.

Health systems across the country are attempting to implement SDOH data into EHRs and health information exchanges (HIEs). However, most health systems face significant issues, such as interoperability, when implementing SDOH into the EHR.

“Interoperability remains a major challenge because even though we have datasets available to us through the federal government or through local organizations and local community groups, that data is often not brought into the EHR system,” Dixon said.

“Connectivity remains a challenge,” Dixon continued. “A lot of the focus right now is on generating a summary of care from that encounter and maybe passes it onto the next provider or potentially accessing historical clinical information on the patient. But there is not a lot of interoperability between clinical organizations and non-healthcare or non-clinical organizations.”

Developing a Platform or Picking a Vendor

A growing number of statewide HIEs are accepting the challenge of integrating SDOH.

The Regenstrief Institute and its partners in Indiana developed the Indiana Network for Population Health (INPH) to add behavioral health data, such as SDOH, into the HIE.

Regenstrief partnered with the State of Indiana, Indiana University, and the Indiana Health Information Exchange to access the state’s data, including patient housing stability and access to nutritious food. 

In Regenstrief’s case, the group wanted to help combat the opioid epidemic and other widespread addictions in Indiana.

The Indiana Network for Patient Care is the state’s health information infrastructure that includes health information from major hospitals. The Indiana Network for Population Health is a continuation of the network and has access to over 12 billion pieces of clinical data.

“Integrating social determinants of health into a health information exchange network from the patient's medical file is a big challenge,” Dixon reiterated. “It seems to make more sense to retrieve data from the CDC, various state departments, census, Social Security, the food stamp program, etc. since all these entities routinely collect this data. This is our vision for the Indiana Network for Population Health.”

In 2020, Nebraska Health Information Initiative (NEHII), Nebraska’s statewide HIE, also implemented SDOH data into its HIE.

The statewide HIE partnered with a vendor network of social services organizations to create Unite Nebraska, aiming to connect health and social care providers to enhance care coordination and delivery across the state.

With this partnership, Nebraskans can access nutrition services, employment and benefits, and housing through community-based organizations. Nebraska and the vendor are working to break down existing barriers between clinical and social care providers, enabling them to provide care with trackable outcomes data.

“NEHII is delighted to back a statewide infrastructure that will enable better support to address risk areas that influence health outcomes for the people of Nebraska,” said Jaime Bland, CEO of NEHII.

Also in 2020,  Idaho Health Data Exchange (IHDE), Idaho’s statewide HIE, leveraged a separate vendor to implement a search and referral platform for its users to better understand SDOH data and further the exchange of that data. 

The platform also helps IHDE users connect their respective patients with social services.  

The solution provides Idaho-based health systems and community-based organizations with tools and tips to enhance interoperability, the vendor said.

This partnership aims to provide resources, such as public safety, increased access to health services, availability of healthy foods, access to education, and affordable housing throughout Idaho, while also providing a platform to ultimately improve patient care.

Leveraging Data Standards

SDOH and behavioral health data are the most difficult types of information to share through HIEs, according to an eHealth Exchange report

“A clinician may have noted in unstructured free text in the medical record that an individual is a heavy smoker or homeless, for example, but free text information, with its lack of uniformity, can be difficult to extract correctly,” Dixon said.

The Gravity Project, a community-led HL7 Fast Healthcare Interoperability Resources (FHIR) Accelerator, published an SDOH data implementation, recommendation, and terminology guide, focused on food insecurity, housing instability and quality, and transportation access.

The guide has a terminology overview, educational materials, coding submissions, data element submissions, and a community meeting where webinars are posted. 

Gravity Project aims to expand healthcare for all individual and community needs by capturing and exchanging SDOH data.

Regenstrief Institute, the ICD-10 Coordination and Maintenance Committee, and SNOMED International help Gravity Project translate consensus data recommendations on food insecurity into code for integration.

Gravity Project leverages Regenstrief’s COVID-19 standardized codes for laboratory testing and clinical observations to the Logical Observation Identifiers Names and Codes (LOINC) dataset as the gold standard of data integration.

LOINC strives to streamline health data standardization for more effective EHR use and health data exchange.

“The Gravity Project’s development of data standards and exchange of SDOH data will be critical to our ability to understand the social needs of our members, patients and communities, and make decisions that best support our customers,” said Deborah Donovan, executive committee member of The Gravity Project and vice president of Social Determinants of Health Strategy and Operations at Highmark

Integrating SDOH into the EHR is a significant challenge, but health IT leaders are focused on improving interoperability and the technology to meet that challenge.  

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