By Jessica Kent, Health IT Analytics | June 4, 2019
Sanket Shah, clinical assistant professor at the University of Illinois at Chicago, discusses how communication and data sharing can help providers collect social determinants data.
By now, it seems that every player in the healthcare industry recognizes the impact social determinants have on overall health.
The circumstances in which individuals live, work, and play have a significant effect on physical well-being, and as the industry shifts its focus to holistic care delivery, it’s becoming critical for providers to look beyond what happens to patients when they’re in the doctor’s office.
Additionally, with more health systems using artificial intelligence and other technologies to extract meaningful insights from their data, providers will need information on the social determinants of health to help develop targeted treatments for patients.
“When you add social determinants information together with other clinical markers, you make a tremendous impact on the quality of available data,” Sanket Shah, Clinical Assistant Professor at the University of Illinois at Chicago Master of Science in Health Informatics and Health Information Management, told HealthITAnalytics.com.
“Studies have shown that the more variables you have, the more you can improve the accuracy and precision of predictive capabilities, especially when it comes to machine learning and advanced analytics.”
However, collecting social determinants data from patients can be challenging. Providers often feel that they don’t have the time or the resources to gather and capture this data, which can keep them from addressing the barriers that affect their patient populations.
“If a patient lives in an underserved area, and they don’t have access to public transportation and/or a support system that takes them to and from their primary care physician, that’s important for a provider to know so they can better manage the individual,” Shah said.
“Without that information, providers are just seeing that this individual is not compliant or is not seeking the care they need. They don’t know the reason why.”
Talking with patients about these issues can be especially challenging for clinicians, Shah noted.
“One of the major obstacles providers face is connecting with the individual and extracting the contextual information that they can’t get from a healthcare claim,” he said. “The straightforward questions that providers are accustomed to asking – such as when a patient’s last visit was or when their last A1C reading was – are important. But it’s the non-clinical things that come up that provide a holistic picture of the individual.”
“If someone has recently lost their job, or if they have an ailing mother that they’re taking care of, these things could be affecting their physical health. But this data isn’t always easy to collect. It’s hard to gather unless the patient is willing to discuss that information.”
To encourage more conversation around the social determinants of health, providers can ask their patients questions that go beyond just physical health.
“Providers may want to consider expanding some of the techniques and approaches that they’re accustomed to when engaging with their patient population. They could start asking the questions that lead to pertinent social determinants information, and change their style a little bit,” Shah said.
“Physicians can still have their typical checklists of healthcare ailments and pains, but augment and supplement these questions with additional contextual information. They could ask questions about what’s going on in a patient’s life, or how things are going at home. Doing this could help them understand some of the barriers patients are facing, and many providers are asking these questions.”
Shah pointed out that finding a standard way to capture and store social determinants data is also an obstacle for clinicians.
“Although a lot of providers may be gathering this data, capturing it can be very challenging. Conversations about patients’ preferred language or income level are becoming more routine, but it can be hard to store this information in a medical record,” he said.
“There may not be a field for this data in the EHR. Or, if the information is captured in free text, it could get lost somewhere. There are tools out there, like natural language processing, that can extract that information. But there’s no uniform, universal way to gather this information directly from the patient.”
Several organizations have announced initiatives aimed at creating more standardized ways to collect social determinants data. CMS recently encouraged providers to take advantage of “Z-codes” in ICD-10, which allow providers to create structured information about social determinants.
The American Medical Association has also partnered with UnitedHealthcare to generate new ICD-10 codes that will identify and address the social determinants of health, including food security, housing security, and transportation access.
Communicating with patients and capturing social determinants data is only half the battle, Shah said. Once providers have this information, they need to use it to inform care decisions. In addition to advanced analytics technologies, clinicians can leverage data sharing to develop targeted treatments for their patients.
“Providers can share social determinants information to enhance their understanding of patients’ conditions,” he said.
“Data silos are one of the biggest obstacles to gaining actionable insights from social determinants information. Obtaining socioeconomic data and sharing it amongst peer providers can help deliver a more comprehensive picture of patient health.”
Going forward, collecting patients’ social determinants of health data will be a major part of enhancing care delivery.
“There is an increased focus on the social determinants of health. As we shift towards AI, machine learning, and beyond, this information is going to be critical, and it’s going to accelerate data standardization and sharing,” Shah said.
“It’s imperative that providers focus on integrating not just traditional healthcare data that they’re accustomed to collecting – whether that be a claim, or a feed from an EHR, or self-reported information. Providers should start to augment that into new data sources, such as public census information, income levels, family history information, and so forth.”
Ultimately, having access to more data is the key to improving patient care and reducing healthcare spending, Shah said.
“Without this information, we’re operating at half-speed,” he concluded. “If we want to deliver holistic healthcare, having access to social determinants of health data will help us get there. Having more information at our disposal will help us improve the quality of care while lowering costs.”