Most healthcare orgs are collecting SDOH data, but poor standardization limits its utility

Identifying and understanding the social determinants of health (SDOH) and their impact on patient outcomes is crucial for healthcare organizations looking to succeed in an increasingly consumer-driven, value-based environment. 

However, the quest for these datasets hasn’t been easy. SDOH data comes from a wide variety of sources, most of which vary in their completeness and haven’t necessarily been designed to be aggregated and analyzed for use in the healthcare setting. Patients are often reluctant to fill in the gaps, especially when they are being asked about sensitive topics such as financial security and the quality of their interpersonal relationships. 

And even when usable data is available, organizations struggle to integrate these insights into their existing systems and care processes to empower personalized, meaningful action on a patient’s behalf. 

A new survey from AHIMA and NORC at the University of Chicago illustrates just how challenging it has been to get a handle on SDOH data so far – and to do anything meaningful with the information once it has been gathered.  

Variable collection rates and poor integration of key SDOH data elements 

More than 2600 AHIMA members participated in the poll, which found that nearly 8 in 10 healthcare organizations are collecting SDOH data in some form or fashion. Among those that are gathering the data, approximately 70 percent are doing so electronically through the EHR. 

But their ability to touch on the different domains under the SDOH umbrella varies significantly. Of those who collect any data, only 28 percent collect insights on transportation needs, while just 36 percent ask about food security, both of which are considered major barriers to the affordability and access of care. 

The report suggests that healthcare organizations may not have standardized mechanisms for collecting these elements, or may lack the financial incentive to do so.  

Even when data is inputted electronically, it doesn’t always make it into a patient’s electronic record in an accessible, actionable way. The report distinguishes data collection from data integration, defined as “the incorporation of SDOH data elements into the EHR regardless of whether the data is collected manually or through automation.” 

This non-integrated data may not be adequately included in individual health records, research databases, or population health management platforms to directly inform clinical decision-making. 

The gaps between collection rates and accessibility rates are significant. More than 90 percent of organizations ask their patients about mental health and health behaviors, for example, but just 60 percent consider the information integrated into the EHR.  The stats are even worse for other SDOH factors: just 48 percent have integrated data on housing security, and only 42 percent consider their food insecurity and transportation data to be integrated. 

Organizational, educational challenges affect SDOH data collection and use 

Respondents noted that they experience more than just technical challenges when working with SDOH information. 

When asked about their top barriers around collecting data, 93 percent flagged a lack of staff education and 87 percent pointed to the absence of organizational policy. Just over 40 percent said they do not have the ability to take action on the SDOH issues they identify, reducing the incentive to ask about these concerns. 

For those that do gather data, coding it correctly is another concern. The vast majority of respondents rely on ICD-10 codes to standardize their SDOH data, but 83 percent feel that their staff is insufficiently trained to do so. More than three-quarters (78 percent) say it’s too difficult to find SDOH information within the patient’s record in order to codify it appropriately for research or billing purposes. 

Only 21 percent said there aren’t applicable ICD-10 codes available for the social determinant in question, meaning that most respondents believe it is possible to standardize these key elements if they are accessible to experienced coders. 

Recommendations for improving the utilization of SDOH data 

A combination of broader policy changes and individual organizational actions will be necessary to improve data collection and utilization, AHIMA and NORC explain.  

The report suggests that CMS work with other standards-setting organizations to create a shared set of clinically validated definitions for domains that should be routinely collected.  CMS and other payers may wish to create more tangible incentives for providers to gather SDOH data and to design interventions that make use of the information collected from patients. 

As part of this process, stakeholders should invest in staff training and organizational policies that enable and empower front-line clinicians to have personalized, culturally sensitive conversations with patients about their socioeconomic needs. The industry should also develop technical support pipelines to promote accurate and complete coding of SDOH elements that can be more easily integrated into population health management interventions. 

Lastly, healthcare organizations should develop closer ties with community-based organizations so that providers can quickly and seamlessly refer patients to relevant services. These relationships should prioritize the use of closed-loop referrals, during which providers can get notified of whether or not their patient has taken advantage of the referral.   

By improving staff training, bolstering technical connections, and expanding community-based relationships, healthcare organizations can collect more robust and comprehensive SDOH data and use this important information more effectively to make a difference for patients experiencing non-clinical challenges in their communities. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.