Subscribe to RSS
Social and Health Information Platform: Piloting a Standards-Based, Digital Platform Linking Social Determinants of Health Data into Clinical Workflows for Community-Wide UseFunding The SHIP development was funded by the Michael and Susan Dell Foundation through a multi-year grant to the University of Texas at Austin. We are also grateful to our collaborators and co-designers at Lone Star Circle of Care, People's Community Clinic, findhelp, Connxus, the United Way of Greater Austin's Navigation Center team, and many others in the community that helped lay the groundwork for SHIP and Model Community through decades of arduous cross-sector work.
Background Social determinants of health (SDoH)[a] are increasingly recognized as a main contributor to clinical health outcomes, but the technologies and workflows within clinics make it difficult for health care providers to address SDoH needs during routine clinical visits.
Objectives Our objectives were to pilot a digital platform that matches, links, and visualizes patient-level information and community-level deidentified data from across sectors; establish a technical infrastructure that is scalable, generalizable, and interoperable with new datasets or technologies; employ user-centered codesign principles to refine the platform's visualizations, dashboards, and alerts with community health workers, clinicians, and clinic administrators.
Methods We used privacy-preserving record linkage (PPRL) tools to ensure that all identifiable patient data were encrypted, only matched and displayed with consent, and never accessed or stored by the data intermediary. We used limited data sets (LDS) to share nonidentifiable patient data with the data intermediary through a health information exchange (HIE) to take advantage of existing partner agreements, technical infrastructure, and community clinical data.
Results The platform was successfully piloted in two Federally Qualified Health Clinics by 26 clinic staff. SDoH and demographic data from findhelp were successfully linked, matched, and displayed with clinical and demographic data from the HIE, Connxus. Pilot users tested the platform using real-patient data, guiding the refinement of the social and health information platform's visualizations and alerts. Users emphasized the importance of visuals and alerts that gave quick insights into individual patient SDoH needs, survey responses, and clinic-level trends in SDoH service referrals.
Conclusion This pilot shows the importance of PPRL, LDS, and HIE-based data intermediaries in sharing data across sectors and service providers for scalable patient-level care coordination and community-level insights. Clinic staff are integral in designing, developing, and adopting health technologies that will enhance their ability to address SDoH needs within existing workflows without adding undue burdens or additional stress.
Keywordssocial determinants of health - digital platform - health information platform - population health - health information exchange
Protection of Human Subjects
This study was performed in compliance with federal regulations regarding personally identifiable health information, the University of Texas at Austin's Information Security Office (ISO) testing and review policies, and the University of Texas at Austin's Institutional Review Board (IRB) for Human Subjects Research (Protocol Number 2020–04–0067).
a Also known as “social drivers of health” or “non-medical drivers of health (NDoH).”
Received: 20 March 2023
Accepted: 21 July 2023
Article published online:
08 November 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
1 Healthy People 20230. Healthy People 2030 Framework. Office of Disease Prevention and Health Promotion. Accessed August 08, 2023 at: https://health.gov/healthypeople/about/healthy-people-2030-framework
Constitution of the World Health Organization.
World Health Organization. Accessed August 08, 2023 at: https://www.who.int/about/governance/constitution
- 3 Magnan S. Social Determinants of Health 101 For Health Care: Five Plus Five. NAM Perspectives. Discussion Paper. Washington, DC: National Academy of Medicine; 2017. DOI: 10.31478/201710c
- 4 Hood CM, Gennuso KP, Swain GR, Catlin BB. County health rankings: relationships between determinant factors and health outcomes. Am J Prev Med 2016; 50 (02) 129-135
- 5 Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K. eds. Health Behavior and Health Education. 4th ed.. San Francisco: John Wiley & Sons; 2008: 465-485
- 6 Chen M, Tan X, Padman R. Social determinants of health in electronic health records and their impact on analysis and risk prediction:a systematic review. J Am Med Inform Assoc 2020; 27 (11) 1764-1773
- 7 Solomon LS, Kanter MH. Health care steps up to social determinants of health: current context. Perm J 2018; 22: 18-139
Assistant Secretary for Public Affairs (ASPA).
HHS offers states flexibility to better address Medicaid enrollees' needs. HHS.gov. Accessed August 08, 2023 at: https://www.hhs.gov/about/news/2023/01/04/hhs-offers-states-flexibility-to-better-address-medicaid-enrollees-needs.html Published January 4, 2023.
HHS Offers States Flexibility to Better Address Medicaid Enrollees' Needs.
CMS. Accessed August 08, 2023 at: https://www.cms.gov/newsroom/press-releases/hhs-offers-states-flexibility-better-address-medicaid-enrollees-needs Published January 4, 2023
- 10 Gold R, Bunce A, Cowburn S. et al. Adoption of social determinants of health EHR tools by community health centers. Ann Fam Med 2018; 16 (05) 399-407
- 11 Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. PMID: 25057539.
- 12 Gruß I, Bunce A, Davis J, Dambrun K, Cottrell E, Gold R. Initiating and implementing social determinants of health data collection in community health centers. Popul Health Manag 2021; 24 (01) 52-58
- 13 National Academies of Sciences, Engineering, and Medicine. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press; 2019. https://doi.org/10.17226/25467
- 14 Crawford A, Serhal E. Digital health equity and COVID-19: the innovation curve cannot reinforce the social gradient of health. J Med Internet Res 2020; 22 (06) e19361
- 15 Rosenbloom ST, Denny JC, Xu H, Lorenzi N, Stead WW, Johnson KB. Data from clinical notes: a perspective on the tension between structure and flexible documentation. J Am Med Inform Assoc 2011; 18 (02) 181-186
- 16 Freij M, Dullabh P, Lewis S, Smith SR, Hovey L, Dhopeshwarkar R. Incorporating social determinants of health in electronic health records: qualitative study of current practices among top vendors. JMIR Med Inform 2019; 7 (02) e13849
- 17 Cantor MN, Thorpe L. Integrating data on social determinants of health into electronic health records. Health Aff (Millwood) 2018; 37 (04) 585-590
- 18 Rousseau JF, Oliveira E, Tierney WM, Khurshid A. Methods for development and application of data standards in an ontology-driven information model for measuring, managing, and computing social determinants of health for individuals, households, and communities evaluated through an example of asthma. J Biomed Inform 2022; 136: 104241
- 19 Tomar D, Bhati JP, Tomar P, Kaur G. Chapter 2 – Migration of healthcare relational database to NoSQL cloud database for healthcare analytics and management. ScienceDirect Published January 1, 2019. Accessed September 25, 2023 at: https://www.sciencedirect.com/science/article/abs/pii/B9780128153680000026
- 20 Bakken S. Can informatics innovation help mitigate clinician burnout?. J Am Med Inform Assoc 2019; 26 (02) 93-94
- 21 Glasgow RE, Harden SM, Gaglio B. et al. Re-aim planning and evaluation framework: adapting to new science and practice with a 20-Year review. Front Public Health 2019; 7: 64
- 22 Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: a systematic review of use over time. Am J Public Health 2013; 103 (06) e38-e46
23 What is a Limited Data Set Under HIPAA? HIPAA J 2023. Accessed August 08, 2023 at: https://www.hipaajournal.com/limited-data-set-under-hipaa/
- 24 Kiernan D, Carton T, Toh S. et al. Establishing a framework for privacy-preserving record linkage among electronic health record and administrative claims databases within PCORnet®, the National Patient-Centered Clinical Research Network. BMC Res Notes 2022; 15 (01) 337
- 25 Vatsalan D, Sehili Z, Christen P, Rahm E. Privacy-preserving record linkage for big data: current approaches and research challenges. Handbook of Big Data Technologies 2017; 851-895 DOI: 10.1007/978-3-319-49340-4_25.
- 26 Dabbs ADV, Myers BA, Mc Curry KR. et al. User-centered design and interactive health technologies for patients. CIN: computers, informatics. Nursing. 2009; 27 (03) 175-183
27 The Open Eligibility Project. findhelp. Accessed August 08, 2023 at: https://support.findhelp.com/hc/en-us/articles/4404055283227-The-Open-Eligibility-Project Published January 10, 2023
The Gravity Project. HITAC Interoperability Standards Priorities Task Force 2021 Presentation. Accessed August 08, 2023 at: https://www.healthit.gov/sites/default/files/facas/2021-04-08_Gravity_Project_Presentation.pdf Published April 8, 2021