New research out of NewYork-Presbyterian and Weill Cornell Medicine revealed that economic factors like income, educational attainment, and social issues like social stigma and discrimination are the leading social determinants of health limiting care access for patients. The data, published in the journal Ethnicity and Disease, aims to inform public policy and help healthcare providers better understand the social determinants of health affecting patients. In doing so, the researchers said providers can cater their treatment plans to account for SDOH, according to Erica Phillips, MD, an associate attending physician at NewYork-Presbyterian/Weill Cornell Medical Center.
The team conducted qualitative roundtable discussions with community members ranging from policy makers, community-based clinicians, patients, faith leaders, and other key community leaders. These roundtables sussed out the leading social determinants of health affecting patient access to care. The
Alongside federal partners and other healthcare stakeholders, ONC advances social determinants of health data exchange by steering the development, dissemination, and adoption of health standards.
The authors noted that ONC informs policy development that addresses challenges surrounding social determinants of health data interoperability and use.
Currently, ONC is developing a toolkit that aims to help states, payers, community-based organizations, and other healthcare stakeholders implement social determinants of health data exchange within their communities. The toolkit will include suggestions for applying health IT standards, infrastructure, and interoperability to ensure social determinants of health data is accurate, actionable, and easy to access.
ONC is exploring electronic data tagging capabilities, as well as clinical guidelines that use social determinants of health data for clinical decision support. The agency is also exploring ways to exchange health
Within ONC’s focus of medical and public health data-sharing and interoperability has been the work to connect systems to address COVID-19. ONC has collaborated with the Centers for Disease Control and Prevention to drive a data-driven response to the COVID-19 pandemic, Tripathi said, building off an experience of connecting public health data systems and infrastructure by identifying gaps throughout the process.
Another Cures Act element that Tripathi focused on is the information-blocking rule that ONC finalized on April 5. Since the provisions have gone into effect, ONC has been working on outreach to health information exchanges, providers and IT developers to educate them in information-blocking, and the agency is working with the Office of Inspector General to shape respective enforcement.
The ability to easily send and receive data can be critical to advancing the fight against COVID-19. The second strategic action of the HIMSS COVID-19 Global Policy Call to Action Report highlights this issue by addressing the need for policy promoting data sharing and interoperability within the health field. Interoperability is the key to improving various facets of the healthcare spectrum.
Patient care can be improved in clinical settings by connecting patients with multiple practitioners. While in medical research, collaboration can expedite the understanding and response to the studied material. As underscored by the following examples, research and clinical improvements are just some of the benefits from policies promoting interoperability.
ONC announced its health IT demographic EHR certification requirements to standardize race and ethnicity data collection in the pursuit of health equity. ONC outlined that the agency’s “demographics” certification criterion requires health IT to record race and ethnicity at the same level of detail as the CDC’s Race & Ethnicity code technology. This system encompasses over 900 concepts for race and ethnicity, giving patients precise options for self-identifying their demographic information.
The technology must also be capable of coding multiple races and ethnicities for a patient in the EHR. This allows individuals to report their race and ethnicity in a manner that most closely aligns to how they self-identify, ONC noted (i.e. Japanese-Indian as opposed to Asian American). ONC called for healthcare providers to work with their health IT developer to implement a strategy for recording race and ethnicity that best supports the populations they serve.
The National Academy for State Health Policy (NASHP) is launching its Second Health and Housing Institute. The goal of the institute is to help states break down inter-agency silos and strengthen services and supports to help low-income and vulnerable populations become and remain successfully housed. Permanent supportive housing programs require affordable housing and housing-related services financed by Medicaid. Importantly, the new institute will focus on state deployment and execution of newly available federal resources.
With the passage of ARPA and the proposed American Jobs Plan, the following are new programs, policy, and funding opportunities:
Blue Cross Blue Shield Association (BCBSA) announced a national health equity strategy that focuses on measuring racial health disparities, forming community and clinical partnerships, scaling effective programs, and influencing local and federal policy decisions. The strategy is centered around improving racial health disparities in maternal health, behavioral health, diabetes, and cardiovascular conditions.
To measure its progress in tackling maternal health disparities, the payer will use the CDC Severe Maternal Morbidity metric and report results annually. BCBSA's National Health Equity Strategy will focus heavily on community partnerships. For instance, in recent months BCBS companies have fostered relationships with local leaders to provide vulnerable communities with COVID-19 vaccine access.
Additionally, Blue Cross Blue Shield of Massachusetts (Blue Cross) has convened its own advisory council of leading local and national experts in health inequities to he
If interoperability is one half of the healthcare innovation story, security and privacy are the other, more challenging half. Interoperability in healthcare often involves sharing individual patient data, which often falls under HIPAA’s definition of Protected Health Information (PHI). So, if an app requests a member’s first name and address, both those fields are PHI-protected and need to be handled in a certain way.
Providing data access to third parties whilst maintaining a semblance of privacy is an important and costly tradeoff. Moreover, the expectation with the newer regulations is to provide public access to certain types of information as APIs, which means those APIs need to be protected from common public attacks as well. The former is addressed in part by SMART on FHIR guidelines, which provide guidance on how OpenID Connect and other technologies can be used for API security. The latter needs to be addressed by complementary security features available
The Biden administration this past Friday released a letter outlining President Joe Biden's request for fiscal year 2022 discretionary funding in advance of Congress's annual appropriations and budget process. The letter, addressed to Appropriations Committee Chair Sen. Patrick Leahy, D-Vermont, along with several other top federal lawmakers, includes a range of proposals that reflect Biden's broader agenda.
The request includes several items aimed at improving the nation's digital health response, including $8.7 billion to the U.S. Centers for Disease Control and Prevention. That additional funding would go toward modernizing public health data collection nationwide, in addition to supporting core public health capacity improvements in states and territories, training new epidemiologists and other public health experts, and building international capacity to detect, prepare for and respond to emerging global threats, according to the letter.
Although access to computers and the internet continues to soar on a yearly basis among Americans, within the U.S. and globally, the digital divide continues to widen at an alarming rate as unrelenting technological advances often aim to serve the elite and already technologically savvy. As technology itself becomes more complex, the capabilities and intricacies of its applications become more elaborate and wide-reaching, requiring higher skill levels for efficient use. With a global reach of 3.8 billion smartphone users worldwide in 2021, the conventional considerations of the past in assessing mere access to the internet and internet-capable devices are not and were not sufficient.
These challenges, many of which are driven by structural determinants of health—cultural norms, policies, institutions and practices that define the distribution or maldistribution of social determinants of health—will require focus, sustained attention and dedication on the part of he
Social determinants of health account for up to 80% of health outcomes, while medical care accounts for the balance, according to County Health Rankings. Experiences with COVID-19 are a stark reminder that unaddressed social determinants and health inequities play significant roles in the comorbidities that have led to countless deaths attributed to the coronavirus since early 2020.
Rahul Sharma, CEO of HSBlox, a social determinants of health platform vendor, says there are several obstacles the healthcare industry must overcome to fully leverage SDOH, including:
Disparate and siloed data from multiple sources across industries, agencies and organizations in the public and private sectors, each with its own structures.
Roughly 80% of healthcare data being unstructured.
In the realm of social determinants, stakeholders that are not subject to HIPAA regulations.
InterOp.Community – a new venture of the Interoperability Institute, Integrating the Healthcare Enterprise USA, Interopion and Red Hat – will offer a developer sandbox to spur use of open platforms for health data exchange. They'll provide standards-driven interfaces for electronic health records, hospitals, health information exchanges, labs and insurers – acting as an incubator for interoperability innovation. The sandbox is expected to be launched during the second quarter of 2021. Once it's complete, the plan is to use it in a series of "interopathons" for application development and testing, the groups said.
The goal is for the cloud-based InterOp.Community to serve as a next-generation proving ground – offering open source developers tools to help build, launch and test health apps. It will also offer synthetic data to enable modeling of real-world healthcare scenarios.
IOI already runs Interoperability Land – an AWS Marketplace-hosted collaborative environme
The Office of the National Coordinator for Health IT's top goals include prioritizing interoperability, aligning with federal partners, centering health equity and continuing to work toward addressing the COVID-19 crisis, said ONC head Micky Tripathi in an opening keynote for the agency's annual meeting Monday.
Finally, Tripathi forecasted a future emphasis on "health equity by design": centering equity as a guiding principle for system developers. "That's a very important part of how we're thinking about health equity and interoperability and health information in general," he said. "Making sure health equity is a prime consideration."
Implementation of the 21st Century Cures Act's interoperability rules will give stakeholders the opportunity to eliminate some interoperability-related confusion, he predicted – as will wider availability of APIs. The Trusted Exchange Framework and Common Agreement, or TEFCA, can also be an important lever to work toward low-effort
To be most clinically effective, and as routinely occurs in private care, referral providers (CCN providers in the context of the VA) must have access to the medical history and essential records of the veterans in their care. Unfortunately, historical VHA medical systems were not built with the intent of ever sharing patient data outside of the tightly controlled and secure military-like environment. So, as it exists today, veterans records are primarily shared through manual efforts – CDs for imaging and paper files for other data types.
Interoperable technology to exchange important clinical data and images has existed for nearly 15 years, but adoption has been slower than the need. Implementing new technology and driving change management within a healthcare facility to shift workflows and processes across a health system as large as the VA is a huge undertaking. It may involve growing pains during the transition, but the value of enhanced accessibility of data
Not only will providers have to abide by the ONC final rule, but the CMS interoperability rule addresses admission, discharge, and transfer (ADT) notifications. Providers need to fulfill a CMS condition of participation that will require all healthcare facilities to send outbound event notifications by May 2021. All healthcare facilities must send direct electronic notifications to a patient’s provider once the patient is admitted, discharged, or transferred from another facility.
The CMS rule will require all providers to send a notification to a patient’s provider after the patient is admitted, discharged, or transferred from another healthcare facility. HIEs can help enable this by embedding their own ADT notifications structure within the HIE service.
The ONC interoperability rule primarily focuses on making patient data exchange more fluid for patients, payers, providers, and virtually the entire healthcare network. To comply with the interoperability rule, co
A prominent example of this kind of discrimination is an algorithm used to refer chronically ill patients to programs that care for high-risk patients. A study in 2019 found that the algorithm favored whites over sicker African Americans in selecting patients for these beneficial services. This is because it used past medical expenditures as a proxy for medical needs. Poverty and difficulty accessing health care often prevent African Americans from spending as much money on health care as others. The algorithm misinterpreted their low spending as indicating they were healthy and deprived them of critically needed support.
In another instance, electronic health records software company Epic built an AI-based tool to help medical offices identify patients who are likely to miss appointments. It enabled clinicians to double-book potential no-show visits to avoid losing income. Because a primary variable for assessing the probability of a no-show was previous missed ap
The Biden Administration will provide nearly $2.5 billion in funding to states and territories to address the nation’s mental illness and addiction crisis, which has worsened during the COVID-19 pandemic. The Substance Abuse and Mental Health Services Administration (SAMHSA) at the U.S. Department of Health and Human Services (HHS), will direct $1.65 billion in Substance Abuse Prevention and Treatment Block Grant funding and $825 million in Community Mental Health Services Block Grant funding to states and territories.
The Community Mental Health Services Block Grant program allows states and territories to provide comprehensive community mental health services and address needs and gaps in existing treatment services for those with severe mental health conditions.
The Substance Abuse Prevention and Treatment Block Grant program allows states and territories to plan, implement and evaluate activities to prevent and treat substance use disorder. This funding will al
As healthcare continues to lean on technological innovations, a new social determinant of health is coming to the forefront: the digital divide. The digital divide is the chasm between those who have access to technologies and the digital literacy to work them, and those who don’t. In healthcare, the digital divide can lead to disparities in patient portal adoption, telehealth care access, or ability to utilize patient-facing practice management software, like online appointment schedulers.
In more recent years, healthcare experts have learned that the digital divide is more nuanced than that. Some older adults may be excited to utilize telehealth, while a younger, potentially low-income, patient might not have the infrastructure to support it. Population health leaders are starting to look into the digital divide and where it is leading to health inequities and ultimately health disparities. In uncovering those issues, experts can craft better multimodal patient e
Based on social determinants of health and health disparities alone, the number of people the US healthcare industry loses is comparable to seeing a 747 airplane crash out of the sky every day, according to Alisahah Cole, MD, system vice president of population health at CommonSpirit Health.
By now, the topic of social determinants of health and the health equity issues that can stem from them is commonplace. The rise in value-based care contracts have given financial imperative to combat the social issues that impact an individual’s ability to achieve and maintain health and wellness. And that’s not to mention the moral imperative Cole presented. Clinical care interventions only comprise about 20 percent of an individual’s overall health status, while the rest shakes out to things like physical environment, individual behavior that is largely in response to personal circumstance, and social determinants of health.
And as healthcare faces the moral imperative to ad
In pursuit of health equity, CVS Health is addressing one of the most significant social determinants of health, housing insecurity, through affordable housing investments that focus on communities of color. In 2020, CVS Health invested over $114 million in affordable housing, which will result in the construction and rehabilitation of over 2,800 affordable housing units across the country.
CVS Health worked alongside community organizations to provide 460 permanent supportive housing (PSH) units to people facing significant challenges, such as homelessness, chronic illness, domestic violence, addiction, and behavioral health conditions. In addition to affordable housing, PSH residents will have access to social, behavioral health, and addiction recovery services. CVS Health invested $4.3 million in a 24-unit PSH project for residents of Wasilla, AK. This development is designed to meet the needs of Alaskans who face access barriers to mainstream housing. Additiona
