ONC Annual Meeting 2021: Perspectives on the Impact of SDOH on Health Equity and Care

Health equity and social determinants of health (SDOH) data were a recurring theme at this year's ONC Annual Meeting. Leveraging these important data, which reflect where people are born, live, learn, work and play can have a significant impact on patient care and public health. SDOH data provide opportunities for promoting health equity and improving patient outcomes if they are better integrated into the electronic health record (EHR).

We had the opportunity to moderate a panel of health information exchange experts in several states at this year's Annual Meeting. We talked about the challenges they faced in integrating SDOH data with patients' electronic health records, the progress they realized, and key takeaways that may help other entities working towards similar goals.

Ohio Health Information Partnership

Dan Paoletti, CEO of The Ohio Health Information Partnership, and his colleagues have worked to address the disparities they've seen in the health outcomes of populations of focus in their community. They concentrated their initial efforts on pregnant women and prenatal care with the goal of reducing infant mortality and pregnancy-related health complications. The idea was to examine and improve health equity for pregnant women and apply what they learned to tackle the needs of other populations. Dan explained that they knew integrating the community and socially-relevant data was critical to reducing infant mortality rates since approximately 75 percent of health outcomes are affected by SDOH.

After six months of interviews with stakeholders (providers and caregivers, public sector, community service, technology vendors), they found there were significant issues with data and information gaps. For example, there was a lack of alignment between quality improvement projects and community service efforts across the state. Although Ohio health providers have a strong record of clinical interoperability, they lacked the same levels of visibility, coordination, or integration when it came to referring patients to community services.

To begin tackling this problem, the team knew they needed to focus on standards. While HL7® Fast Healthcare Interoperability Resources (FHIR®) standards have great potential for facilitating health interoperability, many community organizations in Ohio had not adopted the standards' capabilities.

So, OHIP decided to leverage the 360X Project. 360X, sponsored by ONC, has developed two Integrating the Health Care Enterprise, or IHE, profiles designed to track patient referrals and transfer processes across healthcare organizations and systems until the loop is closed. This helped to reduce the burden on providers in Ohio while enhancing care coordination. During the next year, 360X is looking to build on these standards and the work of HL7's Gravity Project to develop a closed-loop referral specification for SDOH referrals. The goal is to again use widely-adopted technology to have a low development bar and promote immediate adoption.

Nebraska's CyncHealth

In Nebraska, a critical challenge is breaking down the existing data silos between care organizations. Melanie Surber, chief clinical officer and vice president of clinical services for CyncHealth shared how community organizations were operating multiple databases with different solutions, preventing them from effectively sharing data with each other. Health systems, payers, and community organizations all needed patient information, but lacked the technical infrastructure that could enable a seamless exchange of patient data. For individuals who needed assistance, this meant they had to share their stories multiple times. On the organizational side, it was difficult to know if individuals received the referral or care they needed, and there was little possibility of an interoperable, closed-loop follow-up.

Leveraging existing HIE infrastructure, CyncHealth was able to aggregate records from multiple data systems and connect records of social care to an individual's longitudinal health record. The result of these connections means individuals have an integrated care experience that seamlessly combines SDOH data with their other health data.

San Diego Health Connect

Another key aspect of enabling better integration of SDOH data in health care is consent management. Mohammad Jafari, the Leading Edge Acceleration Projects (LEAP) in Health IT project director and principal investigator with San Diego Health Connect, shared that patient consent has always been an issue for organizations - but a solvable one.

During the Annual Meeting session, Mohammad showed how his organization addressed the challenge of multiple consent forms. In the model used by San Diego Health Connect, consent is gathered once; it stays attached to records, and the next entity does not need to obtain consent again. HL7 FHIR Consent Resources enables consent to be obtained in a variety of ways, including text, email, paper, phone, or in-person, customizable according to the entity's needs.

This process provided a standardized way to manage patient consent while considering the policy context and specific purposes of use. FHIR Consent provided a structure for consent and highlights the API's ability to retrieve, create, update, or insert patient consent stored in the form of FHIR Consent Resources.

The Bronx RHIO

Kathryn Miller, chief operating officer at the Bronx Regional Health Information Organization (Bronx RHIO) spoke about Bronx RHIO's efforts to directly impact housing related social determinants of health on the ground. In their work on the Frequent Users of Systems Engagement (FUSE) project, Bronx RHIO worked with the Corporation for Supportive Housing (CSH), four different managed care plans, as well as New York City Department of Homeless Services.

Together they were able to identify high-cost, high utilization individuals from each of the managed-care plans, evaluate their housing status, incorporate patient specific information, and run analysis through CSH. This allowed CSH to identify groups of people who most needed supportive housing, identify the common characteristics those people share, and provide direct points of contact to link housing providers with individuals in need.

More Perspectives on SDOH

In addition to these valuable state and local perspectives, we also received an update from the Gravity Project. The Gravity Project is currently seeking to develop consensus-driven data standards to support the use and exchange of SDOH data within the health care sector and between other sectors.

To hear more perspectives on the future of SDOH interoperability and the role SDOH data plays in achieving health equity, the following ONC 2021 Annual Meeting sessions have replay options available for registered attendees:

PLENARY: Social Determinants of Health Data Use and Interoperability for Improving Health Equity and Outcomes: Federal, State, and Local Perspectives

BREAKOUT II: Social Determinants of Health Information Exchange: Innovation, Referrals, Consent, and Equity

BREAKOUT V: Spotlight on HHS Health IT Activities to Advance Social Determinant of Health Data Use and Interoperability for Health Equity

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