By Janet Campbell (Epic), Chair, SDOH & Health Equity Task Force

Recognizing an important opportunity for the EHR Association to be a proactive leader in the burgeoning and increasingly critical field of social determinants of health (SDOH) and health equity, the Association has kicked off its recently established SDOH & Health Equity Task Force. 

EHRs have revolutionized the healthcare industry and even how care is delivered. But the practice of addressing social risks and delivering care equitably varies widely across organizations. Thus the role of the EHR  – and therefore the role of health IT developers – remains largely undefined. The potential for EHRs to advance SDOH and health equity is significant, including the proactive collection of demographic and determinant data, segmenting quality reports to uncover disparities, and facilitating prompt closed-loop community-based organization (CBO) referrals. 

In the kick-off meeting for the Task Force, Bill Hayes, MD, Vice Chair of the EHRA Executive Committee and Chief Medical Officer with CPSI, noted: “Over my years in practice, I came to realize that, as a physician, I could put together what I thought was hopefully the best and highest-quality plan of care for a patient. But there were so many things out of my control – affordability, access, socioeconomic status – that the plan may or may not ever come to fruition in the ways I expected, and the outcome for the patient would never be quite as good as it could be if those factors were addressed. So this is an extremely important topic from a practical and medical practice standpoint, especially in terms of accessing SDOH through EHRs”

When patient outcomes vary along demographic lines – race, ethnicity, gender, sexual orientation, language spoken, and other factors – in unexplainable ways, we call these health disparities. Accurate and consistent collection of these demographic factors in the EHR, ideally by patients themselves, can fuel efforts downstream to uncover and address inequity. For example, EHR dashboards that track the quality of care delivery (maternal mortality, hospital-acquired infections, readmission rates, etc.) could be additionally stratified along patient demographics to highlight emergent disparities.

Social determinants of health are the various environmental conditions that impact an individual’s health and well-being, such as socioeconomic status, access to education and employment, and living conditions – factors that often have a greater impact on health outcomes than medical treatment alone. By incorporating the collection of SDOH data (housing data, food insecurity, access to transportation, etc.) within EHRs, healthcare providers can have a more complete understanding of a patient’s overall health and well-being. Electronic, standards-based connections to CBOs could support addressing these determinants promptly, and extrapolating to their patient population as a whole can help organizations address at-risk communities more broadly.

However, the collection and use of demographic and SDOH data in EHRs face several challenges, including patient privacy concerns and the need for standardized data collection methods and standardized data representation. Moreover, many healthcare providers may not have the resources, training, or time to effectively address SDOH in their patients.

Despite these challenges, the integration of accurate demographic and social determinants into EHRs has the potential to greatly improve health outcomes and reduce disparities in healthcare. As the healthcare industry continues to adopt and integrate EHRs into clinical practice, it is important to prioritize their role in the collection and use of demographic and SDOH data to address health equity and improve the overall health of all individuals – and EHRA’s SDOH and Health Equity Task Force will be ensuring health IT developers have a voice in making that happen.