ONC Brief Outlines How Standardized SDOH CDS Can Support Health Equity

Clinical decision support (CDS) that includes social determinants of health (SDOH) factors could help advance health equity and improve health outcomes, according to an ONC brief.

CDS uses computable logic to assess patient data and apply recommendations based on clinical guidelines within a provider’s EHR workflow.

If developers build CDS with health IT standards, the systems can interact with other health IT that support those standards.

ONC includes SDOH data elements in the US Core Data for Interoperability (USCDI) version 2 and in subsequent versions of USCDI. These USCDI data elements can support a standardized SDOH CDS approach, ONC officials noted.

Over 50 percent of health IT modules are certified to the CDS criteria as of the end of 2022, according to an ONC HealthITBuzz blog post.

“Utilizing standards creates the possibility of a one-to-one conversion between a guideline recommendation and a CDS implementation of that recommendation,” the brief noted. “Singular representation in CDS allows for a more rigorous approach to and oversight of the narrative to computable process.”

Utilizing standards may also help advance health equity, ONC officials suggested.

“Well-resourced healthcare institutions may be positioned to implement their own proprietary CDS services (a component that accepts requests containing patient information and provides responses),” they wrote. “For recommendations with SDOH considerations to have the most impact, they should be implemented broadly across a variety of settings and services.”

Proprietary SDOH solutions and CDS services may be less likely to be available in lesser-resourced care settings where the need may be the greatest, the brief noted.

“Once a CDS service is developed, it has the potential to be widely utilized,” the brief authors wrote. “With a standardized approach, healthcare sites can leverage previously developed and vetted CDS services to support broader adoption.”

There are several HL7 FHIR standards and tools to support a standardized approach for SDOH CDS. These include terminology standards to consistently identify data concepts or application programming interfaces (APIs) to help patients and clinicians access and share EHR data more easily.

“These types of FHIR Resources are growing in support among EHR systems, as they provide a common language that facilitates the retrieval and sharing of health information among different systems,” the brief explained.

The development of CDS should follow a rigorous development and review process, ONC officials noted.

“Translation from textual narrative to electronic evaluation is not without risk,” they wrote. “Subtleties in interpretation or logical expression can develop the risk of electronic interventions no longer aligning with the guideline authors’ intent.”

The authors emphasized that following standards, specifically the FHIR Clinical Practice Guidelines (CPG) IG, can help mitigate the risk of misinterpreting clinical guidelines.