In the first of our series of three blogs on the Social Determinants of Health (SDoH), we discussed exactly what they are, how they are defined, and the importance of including them in the overall assessment and treatment of a patient. As mentioned in the first blog, SDoH are “health promoting factors found in one’s living and work conditions, rather than individual risk factors that influence disease,” according to Wikipedia.
More simply, environmental factors such as housing, food and money are just as significant an influence on our overall health as are items related to disease state. In the second part of the blog series, we’ll discuss the provider’s role in managing SDoH in context of the course of treatment with the patient.
In a value-based market, it’s more important that a physician include SDoH as part of their overall assessment and care and treatment for a patient. Given the flexibility of these programs, it is assumed that providers would be more open to inclusion of SDOH in the process of treating a patient; however, a recent study by Leavitt partners demonstrated that this might not be the case. “Even though most clinicians agree that SDoH are important to patient health, most of them say it is not their clinical responsibility to address these social issues” (Partners, 2018).
If we dig deeper into the rationale (why it’s not their responsibility), it comes down to the time a clinician has to spend with the patient and the availability of tools and resources to assist them. It is well documented that providers are experiencing burnout, and an alarmingly high percentage are leaving the profession, taking early retirement. Given the changes in healthcare and the technology overload that has occurred in the past 20 years, the idea of adding another tool or factor to consider is overwhelming. Further, provider practices are generally not equipped with technology to help support them; there is often little to no compensation associated with SDoH, and again, time is a consideration. On a daily basis, providers are forced to look and manage through multiple technology platforms to gather the information necessary to treat a patient. What this means is that SDoH adds another layer.
One last factor is that providers are afraid to open the proverbial can of worms by asking these questions or using screening tools. For the provider to be willing to address this, there must be a streamlined rooming process done by clinical support staff, and/or seamless integration with links to applicable resources in direct response to the screening results, which are then entered into the EMR in the after visit summary (AVS). A majority of this work could be accomplished by clinical support staff, and while there are emerging technologies in this area, most of the major EMRs have made limited strides. What is needed is a single point of care where it’s made simple for the provider to have access to integrated information to treat the patient, including SDoH.
As we move into a more transparent health industry across all levels of care, it’s going to become more important that we share our information efficiently, effectively, and safely. Interoperability is the way we accomplish that. Strategically, organizations need to align their PHM strategy and value-based care quality goals. There are a number of programs, both commercially and at the federal level, that continue to evolve the landscape. An enterprise EMR alone cannot respond to this evolving landscape in a timely manner. To thrive in the transition, organizations need to focus on these key strategies:
- Adopt innovative technologies that unlock access to data across their communities, regardless of the technologies in play, and independently of the vendors involved.
- Curate meaningful, rich, timely insights from the data across their ecosystems (clinical, claims, social determinants of health, patient reported outcomes, and more).
- Present contextual data to the clinician at the point of care, in the workflow, so action can immediately be taken to enhance the patient satisfaction, improve clinical outcomes, lower costs, and remove administrative burden from the care team.
In our next and final blog on this subject we’ll focus on technology in this segment. This is an emerging market which includes new technologies and solutions as well as the traditional EMR vendors who are trying to quickly adapt their systems to accommodate inclusion of SDoH in the clinical workflow.
The second in a three-part series, this piece was written by Renee Broadbent, who is currently Senior VP for Population Health at Holon Solutions. Previously, she served as Assistant VP of Information Technology & Strategy at UMass Medical Health Care that achieved $22 million in savings for the ACO. The final post will focus on the technology aspect of incorporating SDoH into the clinical workflow.