Bridging the SDOH data gap: The transformative role of health information exchanges

As social determinants of health gain traction, HIEs rise to the challenge, improving interoperability and becoming pivotal conduits for essential health and social data.

This article is part of the June 2023 COVERstory.

With more evidence showing that social determinants of health impact healthcare outcomes, there’s growing potential for health information exchanges to play a critical role in collecting relevant social information and disseminating to entities that can act on it. 

As HIEs expand capabilities and increasingly use standardized transactions and exchange formats, they have the potential to help coordinate cross-agency projects with the capacity to support population-specific outcomes. 

In fact, some foresee the potential for HIEs to morph into health data utilities (HDUs), which will exchange a broad array of health data as well as offer analytics and other advanced tools that will support efforts to meet social needs and value-based care initiatives. 

Enhanced interoperability 

HIEs and HDUs can break down the barriers that exist between data of public, community and clinical organizations, which exist in separate silos, contends Marc Rabner, recently named as the inaugural chief medical officer of CRISP Shared Services, a Baltimore-based nonprofit that provides technology to six HIEs across the nation. 

Healthcare organizations are making forays into SDOH-focused projects, but these early experiences show that complex programs require easy exchange of data, and Rabner believes that HIEs can play key roles in bridging public and private sector agencies to achieve enhanced interoperability, while providing a foundation of governance and privacy. 

Rabner joined CRISP as a clinical advisor three years ago, and saw the opportunity for HIEs to have an impact on SDOH. “There was a lot of talk about SDOH when I joined, but not a lot of data sharing,” he says, noting that there was more appetite for this discussion in Maryland because the state has a total cost of care model, and thus “they were more willing to talk about going upstream, getting in the weeds on sharing data, both at the clinical level and community level.” 

He sees two general data sharing challenges that HIEs can address. One is just facilitating the screening for social needs, and then following through and enabling efficient interventions. “It’s a challenge for hospitals, health systems and primary care physician offices to screen for social needs at scale; that’s changing with some recent regulatory requirements, but it hasn’t been a typical part of the workflow for most hospitals and health systems,” he notes. “As we move to a value-based care model, it has become more crucial.” 

Developing standards that can be used across the ecosystem will be important, says Rabner, who worked on the technical committee for The Gravity Project, which is looking to develop FHIR-based standards to facilitate data exchange for SDOH-related information. “There is a standards problem – standards are just not routinely applied,” he says. “Everyone is using a different ‘screen,’ and it’s hard to compare apples to oranges when you’re talking about analytics and drawing conclusions of populations.” 

While progress is being made on Gravity Project-developed standards, “I’m not seeing those standards adopted quickly. There’s some room for improvement there. I will be interested to see what federal requirements (from CMS and NCQA) will do for adoption. It’s not happening at the grass-roots level, and I don’t know what will turn the table on that.” 

Where HIEs can fit in 

Information exchanges can help fill these gaps, he contends because they can be agnostic, working with the variety of systems now in use across the ecosystem. 

“Once standards are more routinely applied, we can map to those later,” he says. “We need to move data between organizations to facilitate social need interventions – there’s a growing space of SDOH technology that makes it easier for healthcare entities to make referrals.” 

An expanded role for HIEs can especially aid bandwidth-strapped community-based organizations, which have limited money and resources for technology investment. 

“I do see healthcare community-based organizations using the HIEs to both receive referrals and close the loop on the referrals they’ve received,” he concludes. “We have a big challenge in CBOs – they’re typically grant funded, using older IT systems and there’s been no focus on interoperability by CBOs. We’re not seeing the ability to share the data because of those IT systems or because of a lack of IT expertise to make those connections and share the data.” 

Rabner predicts an evolution among HIEs to “move health data appropriately across organizations and sectors, with HIEs getting the right data to the right place at the right time.” That can help bring efficiency and resolution to social needs that impact health, he contends. “Healthcare organizations have problems intervening with social needs during a short patient visit, to be able to address patient social needs at scale. CBOs have the expertise, but struggle with capacity. HIEs and health data utilities can put the information into the right hands to solve both needs.” 

He illustrates how this can work by pointing to a use case involving Maryland’s Department of Health, which aims to provide assistance to Medicaid patients who frequently present at emergency departments with severe asthma. But patients and their families don’t know about the program, the health department doesn’t always know about ED visits, and emergency care providers aren’t always aware of patients with frequent visits. This is a role that an HIE or HDU can fill, he believes. 

“An HIE can sit at the middle as a trusted third party in the middle of various stakeholders,” he says. “SDOH data lives in a lot of different places, from community programs like SNAP and TANF, with providers, payers and CBOs. To be able to sit in the middle and provide the data governance and technology, to find the right use cases and share the information is where HIEs can excel.”

Return to the June 2023 COVERstory.

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