Social determinants of health account for up to 80 percent of health outcomes, while medical care accounts for its equilibrium , according to County Health Rankings.
Experiences with COVID-19 are a stark reminder that unaddressed social determinants and health inequities play significant roles in the comorbidities which have led to countless deaths attributed to the coronavirus since early 2020.
Rahul Sharma, CEO of HSBlox, social determinants of health platform vendor, says there are several obstacles the health care industry must overcome to fully leverage SDOH, including :
- Disparate and siloed data from multiple sources across businesses , organizations and agencies in the public and private sectors, each with its own structures .
- Roughly 80% of healthcare data being unstructured.
- In the realm of social determinants, stakeholders which are not subject to HIPAA regulations.
Healthcare IT News interviewed Sharma to dig into these hurdles to SDOH progress and talk about possible ways of overcoming these hurdles.
Q: Social determinants of health account for up to 80 percent of health outcomes. How has this manifested itself throughout the COVID-19 pandemic? What needs to be done?
A: We saw vulnerable populations disproportionately impacted by COVID-19, leading to higher infection rates and deaths. While many of us leveraged telehealth throughout the pandemic, members of such populations , many with comorbidities, were probably working on site during business hours and not able to make appointments. Even if they could, they frequently faced technology barriers such as lack of an Internet connection to facilitate telehealth visits.
They also faced barriers on the social care side of this equation. Essential employees like grocery clerks, custodians, housekeepers and others were’t able to work from home. What’s more , many take public transportation , and others didn’t have the wherewithal for food delivery to their houses , situations that raised their risks for infection .
In addition , they might have had to leave their kids alone to tend to e-learning, not able to afford a caregiver, or they might have forsaken work to take care of children. If they did have a caregiver, it may have been an older relative more vulnerable to infection . Even if schools provided mobile devices for e-learning, they often lacked the Internet , or Internet speeds not high enough for learning, impacting their kids .
All these events speak to the real need of integrating medical and social care so that we understand people holistically in the context of their lives . Doing so will help us prevent a disproportionate impact on vulnerable people throughout the next pandemic.
Q: You’ve suggested there are plenty of obstacles the health care industry must overcome to fully leverage SDOH. What are a couple of those obstacles and why are they a problem?
A: The current model of healthcare caters to ill care and emergency management as compared to being proactive and preventive in nature. Among the important reasons for this is the data challenge that exists in the industry – not only pertaining to interoperability, but also to digitization of the wealth of information available in unstructured and semi-structured data sets .
If the pandemic has taught us anything, it’s the value of getting quality, verified data available to care providers and public officials to help combat the spread of a communicable disease. Even before the pandemic, efforts to capture and incorporate SDOH data throughout the healthcare continuum have been plagued with interoperability issues, culture gaps and lack of coordination.
Specifically, there are several obstacles to data sharing.
The first is disparate and siloed data from multiple sources across industries , organizations and agencies in the public and private sectors, each with its own unique structures, i.e., lack of standardization and lack of adoption of standards .
Another is that 80 percent of healthcare data is unstructured. Such data can take the kind of clinician electronic notes, patient-reported information such as portal messages, IoMT ( Internet of healthcare Things) data, pictures , audio/video records , surveys, and transcripts from telehealth visits that often are hard to access.
A third in the area of SDOH is how certain stakeholders aren’t subject to HIPAA regulations. Therefore there has to be a mechanism for obtaining and handling patient consent for sharing data with and involving stakeholders.
Given the value of SDOH in determining individual and population health outcomes, it’s evident that payers and providers can benefit from a comprehensive and secure medical and social longitudinal health record that captures SDOH data points to connect patients with community resources that address unmet social needs.
Q: How can healthcare provider organizations overcome these challenges ? And what’s the role of health IT here?
A: Technology can make it possible to synthesize data sources of different types to address their inconsistencies, help identify mistakes or misreporting, and integrate credible new feeds. Screening tools, meanwhile, can be augmented with external data collections , like the 12 Dimensions of the Social Environment, for the Centers for Disease Control and Prevention has created a directory.
The challenges can be overcome with digitization of the data , forming a longitudinal health record for your patient across different data sets for greater predictive and risk score evaluation , and by ensuring that data is shared in a safe and permissioned basis only.
1 way to ensure authorized disclosure and use of SDOH and other health data is to leverage distributed ledger technologies for secure and permissioned sharing in near real time, and in a granular level. This approach ensures that the reliability of the information and its source(s), providing the transparency required for decision-making. Additionally, it ensures that the concerned parties are seeing the same data with no need for reconciliation.
Furthermore , any plan for sharing information across stakeholders must create protected health and other personally identifiable information a top priority. Safeguards can contain biometrics data for proper patient identification verification and matching . Data should be encrypted at rest and in transit.
Additionally , the underlying tech must incorporate a consent management capability to ensure patient-permissioned data sharing with an immutable audit trail of disclosures.
Q: If enhancing individual and population health while decreasing health costs requires that healthcare stakeholders capture and leverage social determinants of health data , what are the next steps the industry needs to take to achieve this goal ?
A: Providers, community-based organizations, payers and other stakeholders will need to work together to deploy multi-stakeholder collaboration technology using a longitudinal health record to optimize care coordination and population health measures. Delivering SDOH data at the point of care provides clinicians and other caregivers a comprehensive view of the individual , allowing them to approach care holistically and act on it.
Moreover , more hospitals and physician practices need to display for SDOH variables like food insecurity, housing instability, social violence, and transportation and utility needs . Digitization of unstructured data sets using AI algorithms can provide a wealth of information for enhancing the longitudinal health record of patients. Machine learning can then be applied to build models for individual health and societal risk scores, cost forecast and individual behaviour .