For over half a century, social determinants of health, or SDOH, have been a subject of discussion. But only recently have health care providers dedicated time to understand these factors and associated data. Medical care accounts for only 20 percent of a person's health outcomes, as estimated by experts. Still, social and behavioral determinants account for most factors influencing improved health outcomes. The plight of normalizing health data collection and exchange could change care models and the health of global communities.
Demand for Data
As the US health care system advances to include value-based care—and places emphasis on population health—uses of SDOH data are on the rise. "Digitization of health care has placed value on using structured and codified data," says Matt Menning, a director at the American Medical Association. It's the demand for a flexible set of SDOH common data elements that can serve today's information needs. A much-anticipated evolution of care models and IT is ahead.
"We're improving the value of health information available to clinicians. Our mission is to promote equity in care and represent our voice in the house of medicine," says Tom Giannulli, MD, leader of the Integrated Health Model Initiative (IHMI), an AMA venture to improve the value of health care information available to clinicians. His goal, in other words, is to adapt to waves of tech advancements in health care and fight to add SDOH to the conversation on data standards. It's that same fervor that not only the AMA, but efforts like Health Level Seven International (HL7) and the Gravity Project are using to improve SDOH capture and representation. All of which are based on enabling broader use of health care data, promoting relevant standards.
"The opportunity to improve population health with SDOH affects both domestic care, on top of international care," adds Giannulli. Consensus-driven action exists between IHMI and other organizations to create free global standards to codify and exchange data. The vision? To make the collection and use of SDOH data in current health IT infrastructures better. "Clinically clear and consistent SDOH definitions will support next-generation systems for population health management and value-based care."
Codes Up Close
Beyond capturing—yes, normalizing—SDOH data can happen. Realistically, code sets that are already implementable into existing workflows is the first step, according to Giannulli. "Most of the codified SDOH data exchange that occurs today involves large payers and is based on administrative and claims infrastructure," he says. Current work flows are prioritized in the AMA's planned action for this year.
Considering the promotion of practical use and adoption of standards, these standards can and should be implemented and used in conjunction with existing health IT infrastructure. Giannulli adds that it's important to curate, refine and expand ICD-10 SDOH terms based on real-world demand and utilization. If broadly adopted, ICD-10 codes for SDOH can enable provider organizations to better track patient needs and identify solutions to improve the health of their communities.
Just as ICD require a shift in terminology, CPT will require better coding rules on how to document SDOH assessments in the evaluation and management of patients. An emphasis will be placed on the value of collaboration among industry partners, says Matt Menning, engagement director for IHMI. "We can improve awareness and consistent use of existing SDOH standards," he says. AMA partnerships with SNOMED International, HL7 and other members of the global health care community are already driving development of open standards to capture SDOH data to enable better documentation for improved outcomes and administration.
Magnification of SDOH in today's code sets has a strong chance of amending real-world problems. And new, freely available, open SDOH data standards will improve the value and semantic interoperability of health care data. As Giannulli and Menning note, the AMA is looking toward the future state of health care interoperability and the role that improved data liquidity and portability standards will play in facilitating advances in care delivery, analytics and applications of augmented intelligence.
Organizations looking to assist the AMA with this effort can take several approaches, like learning how to use SDOH in practice, improving consistent capture of terms or participating in consensus communities to move standardization proposals forward.