The HIMSS Electronic Health Records Association recently analyzed how healthcare organizations collect social determinants of health information. 

While EHRA's Social Determinants of Health and Health Equity Task Force sees great value in using SDOH to help address healthcare disparities, it says a gradual transition toward more widespread adoption of standardized screeners – in sync with the health IT industry's evolution and readiness to adopt new tools – is the correct approach.

WHY IT MATTERS

This past year, social determinant screenings were voluntary under the Centers for Medicare and Medicaid Services' Inpatient Prospective Payment System, or IPPS, under which more than three-quarters of the nation's inpatient acute-care hospitals are paid, according to the American Hospital Association.

But they're now required reporting: Hospitals must report on their screening of patients for five social determinants – food insecurity, housing instability, transportation needs, utility difficulties and interpersonal safety. 

However, among healthcare organizations that prioritize and define social-risk domains by different stakeholders, there is no "consistent, universally agreed-upon and prioritized list of domains appropriate for assessment by providers," the EHRA task force said in a whitepaper consolidating its recommendations for SDOH data capture.

That inconsistency led to overlapping domains, complicating the exchange and understanding of data the task force said.

"We recommend [CMS] wait to require any new or different risk areas beyond these five drivers to learn more from the provider community," Kate Jenkins-Brown, product manager for population health solutions at Meditech, and vice chair of the task force, told Healthcare IT News.

In the whitepaper, EHRA proposed:

• EHRs should standardize how they represent domain risk.
• The standards industry should determine how domain risk is represented in data exchange. 
• The healthcare community should list and prioritize which domains should be assessed. 
• Risk assessment methods should remain flexible for now. 

"We suggest regulatory agencies align on industry practices that emerge as inpatient organizations report results of patient screenings around the initial five determinants," Jenkins-Brown said.

She noted that the Gravity Project "is doing some great foundational work with its efforts to identify data elements and associated value sets for documentation of determinants in the EHR across four clinical activities; screening, diagnosis, goal setting and intervention activities." 

In short, EHRA recommends "a simple standard that indicates an area of risk, e.g., transportation insecurity; a classification of the presence or absence of risk, ideally using a yes or no format and, optionally, information about how the risk was assessed," she explained.

THE LARGER TREND

In 2023, the American Health Information Management Association studied how SDOH data is used in healthcare and found that a lack of standardization, insufficient training and limited cross-sector use hinders health equity.

After surveying more than 2,600 members and nonmembers, AHIMA found that translating patient needs into coded data for actionable use in addressing SDOH was needed. The top two ways that organizations use SDOH data are to refer patients to community-based organizations and to identify and assess community-level needs. 

Focusing on the documentation of SDOH needs and translating those needs into coded data for actionable use is foundational, AHIMA researchers said.

"The effective collection, coding and use of SDOH data are vital to improving health and healthcare outcomes," Wylecia Wiggs Harris, AHIMA chief executive officer, said in a statement about the study. 

ON THE RECORD

"We suggest that CMS pause to allow enough time for the healthcare delivery industry (providers, EHR developers and policymakers) to learn from the first years of this initial state before moving to a more advanced screening requirement," Jenkins-Brown said, "such as requiring providers to act on the screening information or expanding the areas of risk to be screened."

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.