How to Add Social Determinants Collection to Healthcare Software

Healthcare providers hadn’t been concerned with social determinants of health until the pandemic. It became clear then that these same determinants largely influence the health status of patients and their health choices. So how do you add these social determinants collection to healthcare software? Let's study the question.

Adding SDOH: preparatory measures

So you’ve decided to collect social determinants in your clinic. To begin with, you have to answer two paramount questions:

• How to collect the data?

As a rule, it concerns choosing between paper and electronic questionnaires.

Every data sourcing method has its pros and cons. For example, paper questionnaires are a more flexible option, because the provider’s employees can decide when to run an SDOH screening survey and choose where to locate survey boxes. Besides, paper screening is far more budget-friendly. On the other hand, paper screenings involve manual processing of the collected data, which is time-consuming and error-prone. Besides, manual data processing can become yet “another brick in the wall” of clinicians’ burnout.

As for digital SDOH collection, providers’ trusted vendors or an in-house IT team typically build SDOH surveys into their EHR system as an opt-in screen. MercyOne, a healthcare network from Iowa, followed this approach, allowing their patients to stay in control of their data and respond to the survey questions whenever they see fit. As a result, providers and patients build a good rapport and ensure new social needs, if any, are automatically reported to the provider. At the same time, this solution is significantly more expensive.

• Which determinant to focus on?

It’s better to focus your efforts on social challenges relevant to your community that your organization can solve swiftly and effectively by turning to your existing partnerships. For example, a clinic’s key patient population can comprise elderly patients or patients with disabilities. If a healthcare provider has a carrier partner that enables the transportation service, they can study the demand for the service among the patients. In this case, SDOH screening may help set up a patient transportation service for non-urgent situations.

According to the American Journal of Public Health publication from May 2020, the absence of non-urgent transportation to the point of care made about 6 mln persons delay their visits. Given that a large part of those patients could be disadvantaged chronic condition patients, a no-show for them could result in relapses and increased costs for providers. On the contrary, non-emergency transportation (NEMT) service can help providers save up to $537 million annually, a 2019 survey reports.

Collecting SDOH: feasible ways

So you’ve decided on how to collect SDOH and chosen the social issue to resolve. Now it’s time to proceed with collecting data. Providers typically have three data collection options to select from.

Determinants screening on-premises

This is the most common approach and it implies clinicians and/or nurses offering patients to participate in the survey at the hospital’s registry before, after, or right at the appointment.

Face-to-face discussions

While some patients tend to avoid face-to-face discussion about their SDOH-related issues, others can feel comfortable discussing the topic. Such an approach, by the way, is quite popular among young adults, as, according to a study from the University of Michigan, 51% of younger patients are willing to discuss their social determinants in person.Moreover, young adults do not only feel free to talk about the difficulties they experience, but also welcome straightforward solutions to their social needs offered by their doctors explicitly. So, in case this patient population is the core of your clinic, you can collect data via friendly chats during the appointments.

Tech-based interviews

Some providers have already managed to introduce a broad network of digital patient engagement solutions, which enables them to set up SDOH gathering efforts via channels preferred by their patients. For instance, they can design and send a mobile survey featuring social needs and related challenges.

When the challenges are uncovered, the provider can assist with solving the challenges by connecting the patient with the needed service, so that the patient could make decisions regarding overcoming their social issues. The provider can then offer follow-up interviews to see if the proposed solution was helpful and efficient for the patient.

Points to remember

Although interviews for collecting social determinats data are aimed to benefit the patient, they may touch on very personal topics that patients do not want to discuss. Therefore, to successfully complete such a task, it is necessary to inform patients that:

• The survey is voluntary

• Some questions can be skipped even if they’ve agreed to participate

• The interview can be interrupted at any time

This is especially true for children's hospitals. While doctors need to know the conditions a child lives in to come up with the most effective treatment, parents may feel uncomfortable when asked about the food situation or housing conditions of the family. They may fear the hospital may call child protective services in case a clinician considers the conditions substandard. Such situations fuel the lack of trust from the patient side.

For this matter, providers should offer their clinicians communication training. During the sessions, clinicians and nurses can learn to build rapport by relying on the following step-by-step guide:

1. Explaining the importance of social determinants and why the doctor needs to gather them
2. Expanding on social issues the provider can help resolve promptly
3. Reassuring the patient that the issue can be solved
4. Repeatedly stressing that the participation is voluntary

For those who opted for gathering data via on-premises paper screening or face-to-face talk, it’s vital to remember that data still needs to be entered into EHRs, or otherwise, it can’t help improve the quality of services for patients. To do this competently, providers could turn to a coding specialist who will classify social determinants according to ICD-10-CM Official Guidelines faster and more accurately than medical staff.

Conclusion

No matter how you look at it, social factors have a serious impact on both a person’s health and the decisions they make regarding their health. Luckily, there is a clear-cut strategy for adding social determinants into healthcare software.

First of all, providers need to choose the suitable poll type (manual or electronic) and the key determinant to focus on. It’s also important to concentrate on determinants providers need to address.

As for the data gathering, providers have three methods to choose from. At this point, it’s better to rely on patient population specifics, available funding, and the existing patient engagement solutions. Collecting and analyzing SDOH data can help providers mitigate some of the social challenges their patients face and help improve their health status while reducing their own operational costs.

Inga Shugalo is a Healthcare Industry Analyst at Itransition, a Software Development Company headquartered in Denver, Colorado. She focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them.