Data-driven technologies such as health information technology could help advance the work of health equity, with a goal toward achieving better health outcomes and reducing costs. Doing so in practice, however, has been a challenge, given that social determinants of health (SDOH) issues affect many healthcare services.
SDOH refers to the conditions “in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” The Healthy People 2030 Framework, a federal initiative that addresses health and wellbeing from a societal perspective, outlines five SDOH domains that influence health outcomes: economic stability; education access and quality; healthcare access and quality; neighborhood and environment; and social and community context.
A new toolkit by the Office of the National Coordinator for Health Information Technology (ONC) aims to provide the health information technology (IT) community with a practical resource for implementing SDOH initiatives. The toolkit includes 11 foundational elements of SDOH information exchange such as mission and purpose, community readiness, and technical, finance, legal and policy considerations. These are approaches healthcare professionals can use to advance their unique SDOH information exchange goals.
The toolkit also includes case studies designed to build or update data on SDOH.
AHIMA spoke with JaWanna Henry, MPH, MCHES, interoperability systems branch chief in ONC’s Office of Policy, to find out more about the organization’s vision for the toolkit, and how it might be applied across healthcare sectors. This type of work takes a lot of collaboration, Henry says. “It’s thinking about all the partners that would be at the table for social determinants of health information exchange.”
Q: ONC convened a panel of health and human service experts to identify core components for this toolkit. Why was there a need to develop this now?
A: The 21st Century Cures Act of 2016, and the ONC Cures Act Final Rule. Congress identified the importance of interoperability and setting a path for interoperable exchange of electronic health information. Healthy People 2030 also has an overarching focus on SDOH. But for ONC, we were looking at the opportunity to advance the use and interoperability of SDOH data.
Our mission at ONC is to create systemic improvements in health and care through the access, exchange, and use of data. This includes SDOH data. We wanted to make sure that we could provide a resource to guide organizations looking to do SDOH data exchange.
Q: Could you briefly highlight some of the foundational elements and building blocks of this toolkit?
A: The technical expert panel decided that these should be the basic elements to look at when you're talking about SDOH information exchange. When you're thinking about this work and all the partners involved [which may be federal, state or county agencies, healthy systems, community-based organizations, etc.], there should be a shared mission and purpose for the SDOH information exchange initiative. So that's one of the foundational elements — figuring out how you do that as a group. And making sure that everybody agrees on that mission and that purpose, as it’s developed.
We do this work in different environments across different landscapes. So you also have to consider community readiness and stewardship.
Partners need to take the time to take a step back and look at the landscape. That could be from a geographic area, from a population of focus, but also thinking about the capacity and the willingness of the community to participate in something like this, looking at the challenges as well as some of the successes.
Q: How can health information (HI) professionals use the toolkit to benefit their organization’s SDOH efforts, particularly the section on technical Infrastructure and data standards?
A: We believe the toolkit can benefit organizations in multiple ways. Throughout the toolkit, we describe opportunities and challenges that organizations implementing SDOH information exchange initiatives may encounter. For instance, an opportunity we note related to technical infrastructure and data standards is that organizations can advance SDOH information exchange by developing initiatives or technology products that support standardized open application programming interfaces (APIs) to enable vendor-neutral implementation strategies.
On the other hand, a challenge noted in the toolkit could be software with limited interoperability capacity. By acknowledging this and other challenges, HI professionals can get ahead of the issue and develop a plan to effectively address the potential challenge.
Additionally, health professionals can consider the questions posed in the toolkit. For example, one potential question related to technical infrastructure and data standards is: What technical infrastructure and capacity building is needed to support community-based organizations to meet technical requirements? Identifying the most pertinent questions to ask given an organization’s resources and circumstances will enable HI professionals to anticipate potential opportunities and/or challenges and better support implementation of SDOH information exchange initiatives.
Q: Can you provide an example of how a user might apply this toolkit in the real world?
A: One example of a federal agency actively using the toolkit to support their SDOH information exchange initiatives is the Centers for Disease Control and Prevention (CDC). The toolkit provides our CDC partners with important information to support efforts to increase the capacity and efficiency of social service data systems and to share SDOH information in a consistent and reliable manner.
Q: Ultimately, how can this help patients?
A: When we talk about SDOH information exchange, some partners think it's just clinical, but it's not just for the clinicians. There's an opportunity to share information either with the patient or receiving that information from the patient. A prime example is looking at the opportunities to engage patients through patient-facing apps, and an organization and their partners deciding on whether that will be part of their SDOH information exchange initiative.
Q: What relationship does the toolkit have with ONC's SDOH Information Exchange Learning Forum?
A: We didn't want to just put out this resource for people to read through. In the second phase of this work, we wanted to provide a forum for partners to engage with interested parties who have done the work in these different foundational elements.
Through a series of forums in 2022 and 2023, our partners shared the challenges and successes they had in developing technology infrastructure around SDOH information exchange. We have the recordings available for people to go back and look at. We also offer the opportunity for attendees to ask questions as a follow-up to those presentations. So, again, it was more of a space to be able to engage with partners who have done work in this space.
Q: Any initial feedback or results from the toolkit?
A: Everybody is grateful to have a resource that they can share with their partners as they are developing or updating their SDOH initiatives. It’s not just for partners who are starting the work but may have already had a plan in place and there's some foundational elements that they may not have considered.
Q: How do people access the toolkit?
A: The toolkit is available on our website, healthit.gov, and we have a specific Social Determinants of Health page. We also have the forum recordings that are available on YouTube.
Where we are now is trying to engage as many partners as possible, letting them know that the toolkit is available.
Q: Any advice on using the toolkit?
A: Once you pick up the toolkit, it’s not about "I need to start here." It's about looking through the different foundational elements and deciding which ones would be applicable to the plan that's being developed at your organization.
Jennifer Lubell is a freelance healthcare and medical writer based in the Washington, DC, area.