Overcoming Obstacles to Social Determinants of Health

We often hear from our community that there is a struggle to identify how the healthcare industry can help address the social determinants of health, or SDOH.

SDOH are defined by the World Health Organization as:
“The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.”

What Challenges Do We Face?

The issues we’re facing, unfortunately, will be around for some time. However, this means there is an opportunity to start tackling these challenges to better the health and care of our populations tomorrow.

There are many issues around the social determinants, including:

• Lack of standardization in what variables define the social determinants of health and the appropriate screening tools to track these variables
• Inconsistent data and measurement
• Inadequate healthcare-based solutions for the core problems such as access to care, poverty and food insecurity

We see a natural flow of issues to be tackled, and a subsequent domino effect once we focus on establishing a common language or standardization within the industry.

Learn more about how barriers to care can be traced to the social determinants of health in this HIMSS TV deep dive.

Where Do We Start? Address Standardization

HIMSS recently asked members what the biggest issue keeping the social determinants of health from being integrated into healthcare is. One response that resonated is from Paul Matthews, chief technology officer with OCHIN, Inc., and a HIMSS Interoperability & Health Information Exchange Committee member:

“The most pressing obstacle to integrating SDOH is the lack of standardization—of screening questions, tools and even what factors count as SDOH. Before we change workflows, culture, or technology, we must agree on what we’re trying to accomplish and move forward collaboratively.”

There is a lot of truth in this statement. How can we have a meaningful discussion around integrating these complex social and structural factors if we are not consistent in how we screen or build tools; let alone agree on what factors should be included.

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As evidenced by this lack in standardization, defining the social determinants of health is extremely difficult. Factors include place-based conditions such as education systems, safe housing, accessible healthcare and opportunities for recreation. These are tied to other intangible factors that don’t necessarily have a physical presence, such as cultural and societal values, public policies and governance.

A widely recognized framework from the U.S. Office of Disease Prevention and Health Promotion, Healthy People 2020, approaches SDOH from five key domains:

1. Economic Stability
2. Education
3. Health and Health Care
4. Neighborhood and Built Environment
5. Social and Community Context

These “buckets” of SDOH attempt to encompass all the conditions from birth, growth and environment and create achievable objectives for improving health. One objective is to address access to care issues, which raises another question around how we bridge social determinants criteria with healthcare standards such as the ICD-10.

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While initiatives do exist, an agreed-upon confluence between social determinants criteria and standards such as the ICD-10 codes has yet to be established. Yet, even with an established convergence, there are still some social determinants of health variables that are not clearly matched to ICD-10 codes or that lack codes altogether.

Perceived neighborhood safety or threat of environmental violence, which could greatly impact a person’s psychological health and ability to access healthcare, is not clearly matched to an ICD-10 code. Transportation issues, which are arguably even more critical to healthcare access and consistently receiving care, lack an ICD-10 code altogether.

These are just a few areas that our industry needs to focus on in order to move forward together. Melissa Kotrys, chief executive officer of Health Current and a HIMSS North America board member summarizes this beautifully.

“The significant variation within the dozens of SDOH assessment tools being used today plus the lack of national standards regarding exchange format and content for the exchange of SDOH significantly restricts the ability to exchange meaningful and actionable information.”

With so much upstream potential, the question that remains is, where do we go from here?

The first thing we need to ensure is that we have appropriate data sets and elements.

How do we do this specifically? By working collaboratively with health systems, provider groups, payers and vendors to look at the factors that affect a patient’s health and care outside the clinical setting. It is imperative that we work within standards development organizations, such as HL7, to develop standards, profiles and ensure the ongoing maintenance and ownership of the intellectual property. Standardizing the collection and sharing of data, integrating data with information systems, and how that data is processed are all key elements to consider.

Why does consistent data matter? Having consistent data will lead to better research, identify new reimbursement payment models, optimize how population health management programs are designed and increase coordination of care within a team-based, patient-centered care setting. These are just a few impactful areas where having consistent data can sustainably improve patient care.

It is imperative that we establish these standards today so we can move forward together in the development of technologies and adopt a culture of awareness that is empathetic to our patients and providers.

By starting a dialogue to address the lack of standardization first, we have the opportunity to use health information and technology to make a difference in population health across the globe. By knocking over this first obstacle, the many other dominos—improving communication, shifting the culture and incorporating technologies to assist with streamlining workflows—will begin to fall.

Originally published 24 September 2019; updated 25 September 2019.