Using EHR Integrations to Understand Social Determinants of Health

Lawrence General Hospital in Lawrence, Massachusetts has leveraged a MEDITECH EHR integration to boost social determinants of health (SDOH) data analytics and track health outcomes.

The large community hospital, which sees about 65,000 visits a year, services one of the most underserved populations in the state.

Lawrence has most recently been in the spotlight for seeing some of the largest amounts of COVID-19 cases in the state, Omer Moin, MD, FACEP, chief of emergency medicine noted in a session at a recent MEDITECH forum.

“COVID-19 was an uphill task for our population,” Moin said. “It really helped us recognize what we need to do better as an organization to help our patients.”

In the winter of 2020, the CDC came out with a report that found the Hispanic population was the most adversely affected population with respect to COVID-19 mortality in the country. With 80 percent of the hospital’s population being Hispanic, this report prompted Moin and other hospital executives to analyze the hospital’s COVID-19 mortality rates in relation to ethnicity.

Moin said that this was the “steppingstone” before the hospital started analyzing social determinants of health data on a greater scale.

"On initial review, we found that the overall mortality rate in the first surge of the pandemic jumped from 1.7 percent to 12.9 percent in the Hispanic population, which likely showed the impact of COVID-19 on that population," Moin told EHRIntelligence in an email. "This was compared to a mortality rise from 2.4 percent to 3.3 percent in our White population and a 1.1 percent to 14.3 percent rise in our population that did not specify a race. When we were able to capture the data more accurately from the second surge onwards, we found that our mortality numbers were the same in all populations."

In the summer of 2021, Lawrence developed a diversity, equity, and inclusion committee that aims to boost health equity through data collection and analysis and executive leadership. 

After having success working with MEDITECH to develop a dashboard for the EHR using patient experience metrics, the hospital partnered with the EHR vendor to implement a health equity dashboard.

The EHR integration aggregates SDOH data collected through patient registration and integrates the information in a customizable digital format for clinical data analytics.

“At this point, we have a really good health equity dashboard that has given us a lot of data,” Moin said. “Now we're going to make sense of the data.”

Moin explained that analyzing the data based on all-comers in the hospital versus its Hispanic population has led to some important insights.

For instance, the hospital learned that about two-thirds of patients preferred English as their language, and two-thirds did not require an interpreter, which seems to match up.

However, upon further analysis, the organization found that among its Hispanic population, two-thirds say that Spanish is their preferred language, and only half of them are getting an interpreter if their hospital stay became complex or involved a complication. 

“That is something that we want to address,” Moin said. “Those two-thirds should be getting an interpreter.”

The dashboard has also helped the hospital gather hospital acquired complication data in relation to SDOH.

“From a health equity point of view, hospital acquired complication data is pointless until we were able to incorporate that into demographics, which is what we did with the dashboard,” Moin explained. “We can break up different complications and see, is there a complication that occurs more commonly amongst our Hispanic population versus all-comers.”

The dashboard also aggregates mortality data, which drove a lot of the discussion around COVID-19, Moin said.

In the last year, COVID-19 has been the number-one diagnosis among the general population, followed by sepsis, hypertensive heart disease, and ST elevations.

“End-users can compare all-comers to the Hispanic population with all our different units, whether that's medicine, the ICU, different floors, telemetry, OB/GYN, or pediatric,” Moin explained. “This is where the data goes really deep into helping individual units or providers understand how things are going.”

Christina Wolf, RN, director of population health and community development at LGH, said that the hospital plans to add more social determinant of health data points once the hospital starts screening every admitted patient, which is in the organization’s plan.

Wolf noted that Mass Health has asked all hospitals to “step up” discharge planning for those who are homeless.

LGH is halfway to identifying all its homeless population through the dashboard, Wolf said. Ultimately, this will allow the hospital to track this vulnerable population in terms of discharge disposition, readmission, length of stay, and more.

Wolf noted that the dashboard gives the organization a way to measure health inequities, which is key to improving health outcomes.

“We can't improve what we can't measure,” she said. “For me, that's what the whole genesis of this was.”