Tips to Integrate Social Determinants of Health Data into the EHR

The Gravity Project, a community-led HL7 Fast Healthcare Interoperability Resources (FHIR) Accelerator, published an implementation and recommendation guide for social determinants of health (SDOH) data and terminology, with a focus on food insecurity, housing instability and quality, and transportation access.

Research shows that identifying and implementing a patient’s SDOH data into the EHR is crucial to finding answers to significant health issues. Studies show this data accounts for 80 to 90 percent of individuals’ health.

Once identified, SDOH data can create opportunities to offer social services and interventions for high-risk individuals.

Health systems across the country are attempting to implement SDOH data into patient health records. Yet, most health systems face issues, such as interoperability, when trying to implement SDOH into their respective EHRs, meaning there isn’t an abundance of information about what healthcare can do with SDOH data.

With this publication, The Gravity Project developed data elements and standards to gather, exchange, and utilize SDOH data across screening, diagnosis, planning, and intervention platforms.

Founded by the University of California San Francisco (UCSF) Social Interventions Research and Evaluation Network (SIREN) in 2018, Gravity Project consists of over 1,000 healthcare stakeholders. These stakeholders include academic and federal food insecurity experts, community-based organizations, payers, patients, providers, and health IT vendors.

The spread of COVID-19 highlighted the importance of SDOH data collection and integration, making it an area of extreme focus for providers and laboratories.

COVID-19 data from OCHIN, an Oregon-based nonprofit health information network, reported Black patients were 2.5 times more likely than White patients to have a COVID-19 diagnosis observed in the EHR. Additionally, Hispanic patients were two times as likely as Caucasian patients to have a COVID-19 diagnosis listed.

The researchers also noted homeless, or those in housing were almost two times more likely to test COVID-19 positive.

“The Gravity Project’s work to document and integrate social risk in clinical care has never been more urgent than now,” said Tom Giannulli, chief medical information officer of the American Medical Association (AMA).

“With COVID-19, doctors see the intersection of social determinants and health status daily. The AMA is proud to contribute our expertise and to sponsor Gravity’s critical work.”

Gravity Project aims to expand the way healthcare cares for all individual and community needs by capturing and exchanging SDOH data.

Regenstrief Institute, the ICD-10 Coordination and Maintenance Committee, and SNOMED International will help Gravity Project translate consensus data recommendations on food insecurity into code for integration.

Gravity Project noted Regenstrief’s COVID-19 standardized codes for laboratory testing and clinical observations to the Logical Observation Identifiers Names and Codes (LOINC) dataset as the gold standard of data integration.

Looking forward as a separate HL7 FHIR Accelerator project, Gravity Project is gathering the healthcare community’s consensus on data elements and developing a FHIR Implementation Guide for health IT professionals to use as a guide for 2021 implementations.

By the time the healthcare sector launches The Office of the National Coordinator for Health Information Technology’s (ONC) and Centers for Medicare & Medicaid Services’ (CMS) interoperability rules in January 2021, Gravity Project will have data ready for integration on food, housing, and transportation.

“Highmark remains focused on the health and vitality of the communities we serve,” Deborah Donovan, executive committee member of The Gravity Project and vice president of Social Determinants of Health Strategy and Operations at Highmark.

“The Gravity Project’s development of data standards and exchange of SDOH data will be critical to our ability to understand the social needs of our members, patients and communities, and make decisions that best support our customers.”