AHIMA Survey IDs Technology Challenges to Collecting, Using SDOH

A new survey commissioned by AHIMA finds that nearly 80% of healthcare organizations are collecting data on social determinants of health, but they're having problems gathering and analyzing the right data, finding trained personnel to do the work and putting that data to use to improve clinical outcomes.

Roughly eight of every 10 healthcare organizations are collecting data on social determinants of health (SDOH), but technology problems are keeping them from using that data to effectively improve clinical outcomes.

That's the takeaway from a new survey commissioned by the American Health Information Management Association (AHIMA) and conducted by NORC at the University of Chicago. The survey, of 2,600 AHIMA members and others, found that providers are facing difficulties standardizing and integrating data, including a lack of training on how to collect, code and use the information. They also are struggling to use the data they have.

“The effective collection, coding, and use of SDOH data are vital to improving health and healthcare outcomes,” Wylecia Wiggs Harris, PhD, CAE, AHIMA's chief executive officer, said in a press release issued by the agency. “Health information professionals play a pivotal role in how SDOH data is collected, shared, and ultimately used to improve health and healthcare outcomes. We look forward to collaborating with policymakers, providers, and key stakeholders to advance comprehensive solutions to address the challenges illuminated by this survey.”

The US Department of Health and Human Services defines SDOH as "the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks." This includes home and family, education, work, travel, and digital literacy, among other factors.

Healthcare organizations have been increasingly focusing on SDOH as they shift to value-based care and the concept of treating the "whole patient" on his or her lifelong healthcare journey. That means taking into account and addressing all the factors that affect a patient's health and wellness through programs and partnerships.

But according to the AHIMA survey, that isn't easy. According to researchers, less than 2% of the claims data of Medicaid and Medicare enrollees includes SDOH.

"Despite the increased attention and emphasis on SDOH, there are real challenges to addressing individual social needs, especially within the healthcare system," a white paper issued with the survey points out. "Historically, the healthcare system has not been oriented to address these issues and significant changes are needed to enable healthcare providers to affect health outcomes through the use of this data. While a multitude of changes are needed, a focus on the documentation of these needs and translating those needs into coded data for actionable use is foundational."

According to the survey, some 78% of respondents collect SDOH data, and 71% of them gather it through the EHR, but they prioritize different elements. Only 44% track housing insecurity, 38% eye economic stability, 36% look at food insecurity, 28& look at transportation, and 17% track education.

"These findings suggest that these variables might not have structured fields in the organization’s ’s EHR that would facilitate collection," the white paper notes.

Among other issues, the survey found that while health systems are collecting the data, they aren't necessarily integrating it in to the EHR.

"The fact that the data may be incomplete, unstructured, and/or buried in inconsistent fields -- such as health concerns, goals, social history, etc.— may limit the integration of this information into the EHR," the study reported. "Broader collaboration among key stakeholders across the health care sector is a critical step to improved collection of SDOH data and ultimately using this data to improve health outcomes. Policy can serve as a crucial lever to advance collaboration between stakeholders with the ultimate goal of improving the collection, coding, and use of clinically-relevant SDOH data to improve health outcomes."

To that end, AHIMA is recommending that HHS lay out what SDOH data healthcare organizations should be collecting, and perhaps offer financial incentives for prioritizing that data.

In addition, the organization recommends that the federal government offer financial and technical support to train healthcare providers on how to collect, code, and use SDOH data, including "a focus on cultural competency coupled with the recognition that different care settings may require different approaches."

Finally, AHIMA is recommending that the federal government provide funding, technical resources, and infrastructure to help providers use that data in coordination with other organizations.

"Many of the solutions to addressing SDOH needs rely on collaboration between the health and social services sectors," the white paper concludes. "This type of cooperation is happening in pockets at the local level. Many providers are reticent to ask their patients about their SDOH needs without first having the community-based support system to which they can refer the patient so that these needs can be met. Federal incentives are needed for states to create better alignment—across coordinating agencies to improve coordination, collection, and, ultimately, impact."