Feds: “Health Equity by Design” Key to Health IT, Interoperability

Health IT developers should consider the collection of social determinants of health (SDOH) data as a core feature of health IT design to pursue health equity, ONC lead Micky Tripathi, PhD, MPP, said in a media availability earlier this month.

SDOH data exchange gives providers a more well-rounded view of what conditions may be impacting patient health and wellbeing, allowing for targeted intervention.

However, the healthcare industry lacks the interoperability infrastructure to share SDOH data in a systematic way. COVID-19 highlighted these infrastructure flaws.

“We have a situation today where we are not able to get the kinds of data we need on specific communities and what's been happening to them during the pandemic because we don't have the core constructs of health equity to share that data in a systematic way across public health systems,” Tripathi said. “As one health equity expert told us, ‘If you're not counted, you don't count,’” Tripathi said.

“The idea of health equity by design is a core construct that we need to inculcate in the entire industry,” Tripathi continued. “It’s not about compliance. It’s about the spirit of what we are trying to accomplish.”

Tripathi said ONC has begun examining which levers it can pull to support health equity efforts. This includes rethinking programs from a health equity perspective.

He noted that the ONC is looking to ensure race, ethnicity, and language (REL), sexual orientation and gender identity (SO/GI), and social determinants of health data can be documented in EHR systems at the point of care.

“We've begun the process of saying SDOH and SO/GI data and very detailed race, ethnicity, and language data is required to be available or capturable in EHR systems with the USCDI version two,” Tripathi explained.

However, he noted that while ONC has the authority to ensure EHR systems can capture SDOH data, the agency does not have the power to mandate providers to collect that data.

“From an ONC perspective, we can certify systems to say that they're required to have a place to put that data, but we have no authority to motivate the providers and the users of those systems to actually ask the patients or provide mechanisms for patients to provide that data and populate those fields,” he explained. “That's the other part the equation.”

To address this, ONC is working with other federal agencies to determine how they may require that the functions mandated in EHR systems are used.

“There's a wide variety of ways that we could do that through programmatic mechanisms and grants that other agencies have,” Tripathi said.

For instance, federal agencies might require healthcare stakeholders leverage USCDI and populate SDOH data fields, he said.

Crafting the right strategy for implementing SDOH data collection requirements is in addition to the patient-provider communication skills that are needed for the job. Asking a patient about social determinants of health requires serious trust between her and her clinician, as many individuals find SDOH information to be sensitive and personal.

That consideration, although critical, likely falls out of ONC’s purview, adding yet another foil to the health equity in health IT mission Tripathi elucidated.