SDOH Health Information Exchange
[Post updated with additional article references and updated Outreach Resources page 8/3/22] The Office of the National Coordinator for Health Information Technology (ONC) supports health information technology adoption and standards-based information exchanges. They recently completed their series of webinars in the Social Determinants of Health Information Exchange Learning Forum. Recordings and a primer on the topic are posted online. They are currently working on turning these materials into a toolkit.
For an example of how these systems are playing out in current projects, check this Health Care Innovations article on the current data exchange project in California. More examples might come soon. In a recent ruling on hospital quality measures, in response to new measures for tracking SDOH prevalence among patients, CMS indicated that they anticipate tightening data collection and interoperability standards in this field in the near future:
“Currently, to the extent possible, we encourage hospitals to use certified health IT that can also support capture and exchange of drivers of health information in a structured and interoperable fashion so that these data can be shared across the care continuum to support coordinated care. We anticipate additional emphasis on data collection using certified health IT. We note that Meaningful Measures 2.0 is still under development. in future versions of this measure.”
This subject area matters to food access and health care because the current health information infrastructure makes it difficult for a health care provider to refer patients with food access concerns to external services, learn what happened, and link that back to the patient’s health care records and health goals. The external services might be from community providers (e.g. an Area Agency on Aging that provides meals and nutrition education) or from medical providers in a different practice (e.g. a primary care provider refers to a Registered Dietitian).
The gaps in data also make it difficult to analyze the impact of food interventions on population health or health care cost savings. Added together with the referral information gaps, these weaknesses can make it difficult to identify what’s missing in available resources. Often these gaps show up in translating from community level knowledge to statewide assessments - local groups might have a sense of the impact diet or food access have on health, but there isn’t a great system for adding that up to a detailed statewide analysis for investment, or across a payer’s plan for benefit consideration.
Another way that ONC matters is in how it can help health care systems prepare for, and respond to, new regulations and requirements. These types of regulations appear in a variety of ways, from complying with well known laws like HIPAA to incentives or payment systems that have a data collection element, like the recently proposed Social Risk Screening rules from CMS. Community service providers in some regions are also looking ahead towards how they can respond to new requirements, for example if medically tailored foods become a covered health benefit but require a way for the food providers to directly interact with the health care sector’s referral and billing systems.
The reasons why such systems are not yet in place are multiple and not yet resolved - the need to coordinate many organizations with different starting systems and different data reporting requirements, systems developed in entirely different technology eras that have never been upgraded, the cost of large scale data projects, legal considerations for privacy and safeguarding HIPAA protected information, debates over whether this should be a private sector initiative or more like a public utility investment, competing priorities for the human resource hours that go into these projects, training needed to change current information collection practices, the fact that only a very small number of people on this planet enjoy a Health IT project and people outside that group will do everything in their power to avoid it . . . those types of reasons. Nonetheless, the relevance of discussing the topic is clear even if when the chances for implementation at scale in the near future seem low. The ONC SDOH Learning Forum created an opportunity for that discussion, and did so with enthusiasm and without requiring participants to have a project currently underway. So, check out their project!