Blog from September, 2020

Christopher Jason


Gathering and integrating social determinants of health (SDOH) data are becoming more common, but the study of social informatics could help ease the integration process.


Social informatics could be the answer to some of healthcare’s social determinants of health (SDOH) data problems, according to an article published in the Journal of the American Medical Informatics Association (JAMIA).  

The rise of value-based reimbursement has led the medical field to increasingly recognize the importance of meeting not only patients’ clinical needs, but also their social needs. As social services and SDOH programming crop up in practices and hospitals nationwide, providers need the SDOH data itself to determine how to best refer patients to services.

But current health IT and data processing systems aren’t quite equipped to do that. Interoperability and integration from multiple data sources hamstring efforts to understand the full scope of SDOH and create appropriate social services recommendations to patients.

The burgeoning field of social informatics may be the answer to that, as well as federal calls for better use of SDOH data, like those from the Office of the National Coordinator for Health Information Technology (ONC).

“This new domain—which we term social informatics—studies the application of information technologies to capture and apply social data in conjunction with health data to improve clinical care and advance individual and population health,” explained the study authors.

“Social informatics uses SDOH-relevant data from informatics resources, such as EHRs, claims data, and mHealth data, to inform research, enhance patient care, and facilitate rapidly growing activities at the intersection of SDOH and medical care.”

According to the study authors, who hail from the University of California, San Francisco, social informatics complements the pre-existing subfields of health informatics, such as clinical informatics, translational bioinformatics, clinical research informatics, and public health informatics.

Researchers suggested the study of social informatics could address common SDOH integration issues, which range from data sources, interoperability, methodologies, and ethics.

DATA SOURCES AND INTEROPERABILITY

Although clinicians can gather social data during patient visits, social data is also accessible through local and national government datasets and community-based organizations.

But EHRs do not make social data easily accessible and integration is a common issue. With more social data becoming increasingly available, researchers said there would be new opportunities to incorporate data into the EHR and integrate social care interventions that identify risks.

In order to meet that moment, informaticists need to be agile and keep up with changes in social circumstances, like a patient’s home address.

“Linking only to home address may also omit relevant information in the case that a patient lives and works in different neighborhoods,” explained the researchers. “Thus, there is a need for new approaches to representing geography-based measures in EHRs beyond interoperability solutions that have primarily been designed to connect patient-level data that exist in 2 places.”

Furthermore, most health systems typically face massive interoperability issues when implementing SDOH into their respective EHRs, and new interoperability platforms need further development, said the researchers.

METHODOLOGIES

Outside of those two challenges, social informatics can address and further expand methodologies. Incorporating social data into the EHR can enhance clinical decision making.

“As one example, structured data elements that capture patients’ transportation needs can facilitate patient-level interventions related to providing transportation assistance,” explained researchers. “These clinical decision–related applications distinguish social informatics from public health informatics, which is less focused on clinical care delivery at the individual level.”

However, EHRs don’t currently provide clinical decision support in the context of a unique patient’s SDOH.

For example, researchers could develop an EHR alert to prevent a clinician from prescribing refrigerated medications for a patient residing in a homeless shelter.

While there are clinical decision support (CDS) tools, there are no social care CDS tools.

ETHICS

Social informatics also will need to assure the ethical acquisition, use, and exchange of social data and guard against unintended consequences of creating, storing, and applying social data. Studying social informatics could address how long social data remains within the EHR and that the information is secure.

Overall, social informatics is a crucial subhead of health informatics. But for proper integration, it will demand new data sources, interoperability, policies, practice tools, regulations, and a commitment to security.

“We hope that communities of practice and research will help to both establish and nurture this rapidly evolving field,” wrote the study authors.

The study authors recommend social informatics expert groups could become a mainstay at the American Medical Informatics Association, the American College of Physicians, or other medical organizations. Also, the ONC could further expand social informatics research to increase its awareness.

Researchers also noted the National Library of Medicine’s (NLM’s) 10-year Strategic Plan, highlighting the importance of implementing social factors into research and developing SDOH data standards.

“To more comprehensively support social informatics, the NLM could expand their SDOH approach to other objectives—particularly those related to informatics applications and knowledge delivery infrastructure— in order to explicitly surface and address the unique needs of social and medical care integration activities,” explained researchers.

The researchers recommend NLM expand its objective of enhanced informatics research training and data science to integrate social data into EHRs.

“Creating this new subfield of informatics is necessary to drive research that informs how to approach the unique interoperability, execution, and ethical challenges involved in incorporating social information into health care,” concluded the study authors.

“Social informatics will be a new tool in the toolbox for better integrating social and medical care in ways that can improve individual and population health and health equity.”



Heather Landi


During the height of the COVID-19 pandemic, as normal hospital workflows were disrupted, providers often struggled to get the critical patient information they needed.

This was particularly true in New York City, which was hard-hit by the pandemic in April and May, where a data-sharing platform proved to be a valuable tool for health systems including NYU Langone Health, Mount Sinai and Northwell Health.

Insurer Healthfirst operates a private health information exchange (HIE) with data points on its 1.4 million members in NYC and Long Island. 

Hospitals have leveraged that HIE to better identify care gaps and improve care for patients while in the midst of an unprecedented outbreak, according to Jay Schechtman, M.D., Healthfirst's chief clinical officer. For instance, physicians often don't have basic information such as whether patients filled their prescriptions. But that can be key to keeping patients out of the hospital. 

"During COVID, if patients don’t fill their medicine they can then have an exacerbation of their condition, such as cardiac disease, which would send them to the hospital," he said.

Hospitals are able to get that pharmacy fill data and medication adherence information through Healthfirst's HIE.

MediSys Health Network operates Jamaica Hospital Medical Center and Flushing Hospital Medical Center, both located in Queens in NYC, which had been the epicenter of the pandemic.

The hospitals were inundated with critically ill patients, said Pauline Marks, executive director of  TJH Medical Services, PC, the physician group of the MediSys Health Network.

"It was great comfort to know that the exchange of information was uninterrupted. Healthfirst was fully supportive and aware of the status and follow-up of our 160,000 members," Marks said.

Through the HIE, Healthfirst sends 35,000 patient care summaries, including claims and care gap data, each month to hospitals in its provider network and federally qualified health centers.

Like most providers in its network, Healthfirst works with MediSys Health Network through a value-based arrangement. That financial model and the collaboration with Healthfirst proved to be valuable from a financial perspective as well.

"Since more then 50% of our organization's revenue come from our value based arrangement with Healthfirst, we benefited from a cash flow perspective," Marks said.

In New York, state officials suspended certain administrative requirements for hospitals, such as inpatient notifications to health plans, to help hospitals shift resources to treat COVID-19 patients. That could've also caused some big problems, though. 

"Without this HIE, we would have been completely blind as to what happened with our members," Schechtman said, noting that the HIE data enables the health plan to follow-up with members to ensure they stay healthy after being discharged from the hospital.

Nearly 1 million of Healthfirst’s members are covered solely by Medicaid, making this data-sharing platform even more critical.

As disadvantaged populations have been disproportionately impacted by the COVID-19 pandemic, having data on Medicaid members enabled Healthfirst to have a real-time view on how the pandemic was affecting that population.

"It allowed us to model out what was happening to our population and to look at certain ZIP codes, areas like Elmhurst and Corona, which are very ethically diverse neighborhoods that were very hard hit," he said. "We used that data to then work with New York City to push out messaging around COVID-19 testing."

Public health officials have acknowledged that the COVID-19 pandemic has exposed a lot of inefficiencies in the healthcare system—with one of the largest being data sharing and access.

Data access is critical both for patients who are navigating care for COVID-19 as well as for the army of contact tracers trying to track the spread of the virus, Centers for Medicare & Medicaid Services Administrator Seema Verma said during a virtual event in July.

For instance, the patients who were in quarantine on cruise ships during the early days of the pandemic would have been in a better position if they had access to their electronic health records and medical data, which would provide details on other medical conditions or medications they take, Verma said.

Schechtman also believes that the COVID-19 pandemic has proven the need for greater interoperability in healthcare.

"You can’t do anything unless you have the right information at the right time to the right people and it has to be actionable information. If we didn’t do the investment in this, we would be struggling right now," he said.





Christopher Jason 


Researchers and government leaders in the St. Louis area will be able to access demographic information and local COVID-19 data in one workflow.


The St. Louis Regional Data Alliance has launched the St. Louis Regional Data Exchange, an online portal that bonds more than 400 regional public data sets incorporating local COVID-19 and demographic data, according to an article published in the University of Missouri – St. Louis Daily.

The University of Missouri – St. Louis (USML) Community Innovation and Action Center will store the data exchange. The university also runs the St. Louis Regional Data Alliance.

“This has been a long time in the making,” Paul Sorenson, director of the St. Louis Regional Data Alliance and interim co-director of the Community Innovation and Action Center, said to the UMSL Daily. “We’re excited to get it off the ground.”

With the database up and running, users have access to demographic data, real estate and land records, information about health and social services, tax information, boundary data, environmental information, COVID-19 data, and more.

The portal gathers the data sets from St. Louis, St. Charles, and Jefferson Counties in Missouri, along with St. Clair and Madison counties in Illinois. It also includes public data from the Metropolitan Saint Louis Transit Agency and East-West Gateway Council of Governments.

“This is a rare collaborative effort across different local governments,” Sorenson continued. “Although the exchange features data that they already share, now it’s easy to find in one place, and we’ve had great buy-in and participation from the institutions we featured on the site. They will continue to publish their own websites, but they’re happy to have their data all in one place.”

Several years ago, leaders at East-West Gateway and Saint Louis University attempted to develop a regional data exchange, called OneSTL. However, creating the data exchange did not go as planned.

“The time wasn’t right, so it didn’t quite get off the ground,” Sorenson said. “When we started the RDA two years ago and decided we wanted to create a portal, we worked very closely with the designers of the original St. Louis Regional Data Exchange to learn what happened and continue to build on it.”

Sorenson said the coalition plans to add additional data from local governments, universities, and nonprofit organizations into the portal.

The group intends to unite the St. Louis Data Commons and the St. Louis Regional Data Exchange, which would allow researchers and government leaders to access increased amounts of data and learn more about local COVID-19 data, social determinants of health, and racial equity. Sorenson said this could launch in the fall.

“It can set the stage for important conversations about what to do next,” Sorenson said. “The data portal is a big bag of data; it used to be scattered all over the floor, and you couldn’t find anything and that wasn’t great.

“Now it’s in one place, organized. But what we want to do next is connect the dots in a more meaningful way. We’re really working now on creating those regional data assets that connect property data across different counties or COVID data from different healthcare systems.”

“The Regional Data Exchange gives us a fantastic foundation to continue to build upon.”

The spread of COVID-19 has spurred the need for increased regional data.

Regenstrief Institute in Indiana and its partners developed a COVID-19 tracking and response EHR data dashboard to provide the state with a more in-depth view of the pandemic within its border.

The dashboard gathers existing patient data throughout Indiana to enhance patient care. Using this data, Indiana’s government is able to learn more about the potential hot spots and surges across the Hoosier state.

With the majority of Indiana’s health systems and laboratories connected, it allows state officials to make predictions about the spread of the coronavirus and identify patterns.





Sara Mageit


Digital innovation is becoming increasingly critical to clinical practice, not just as a workforce management tool, but as a foundation to change the way care is delivered. Healthcare IT News spoke to senior nursing informatics officer for Abu Dhabi Health Services, Hana Abu Sharib and professor in health and human services informatics at the University of Eastern Finland, Dr Kaija Saranto, to find out exactly how nurses and midwives are leading the digital transition.

Nurses and midwives have played a key role in leading the digital and informatics arena to improve patient care, particularly in the COVID environment where the quality of digital care delivery has come to the forefront of healthcare and been under more scrutiny than ever. In September, they will be speaking at the HIMSS & Health 2.0 European Digital Event, in the ‘Nurses 2.0’ session, where they will expand on some of these key issues in greater detail.

“During the pandemic, nurse informatics teams were involved in training for different EMR applications and devices for nurse shifting cross settings (ED-OPD-Inpatient) based on operational needs. They were also very actively involved in building the input forms for nursing and addressing the patient surge during the crisis. From a data perspective, they were validating the reports and dashboard,” explains Abu Sharib.  

Saranto adds: “Recording has been more crucial, and a variety of mobile applications have been tested and partly implemented to control the outbreak of the virus. I assume that both nurses and midwives have worked under a heavy pressure to guarantee safety and continuity of care.” 

With the recent growth of digitalisation, nurses and midwives are continuing to lead the digital transition and using informatics to improve patient care.

Saranto said: “The most important or effective key to success is education. I believe that there still is a lot of nurses who do not have proper knowledge and skills to use health information technology tools. Nursing and midwifery programmes have integrated health informatics into their curricula, but it concerns newcomers in the field and the 40 plus age groups are left behind. Thus, in-service training is badly needed.”

Nurses and midwives recognise the importance of this transition and the value of health informatics education and training, as Abu Sharib commented: "RN level and the nursing informatics speciality roles are adopted by many nurses and they are addressed for many clinical documentation requirements or technology adoption as they have advanced knowledge in that field. Nurse informatics is now classified under nursing as one of the specialities acknowledged by senior management.”

In Finland, technology is helping to bring healthcare to the homes of the ageing population, and nursing has subsequently been pushed to the forefront of this community-based care. Finland recently adopted a national information system called Kanta, which includes electronic prescriptions, a patient data repository and an online system which allows patients to view their health information.

Saranto explains: “The situation in Finland is partly easy, but also complicated when we already have 100% EHR coverage in the country. Thus, moving from electronic to electronic systems creates a lot of challenges around how to convince staff that the new system is better. So, the old way was a step-by-step or phased implementation, and now we have moved to big-bang implementations."

The importance of nurse involvement was also highlighted by Saranto, as a way to optimise cooperation between health professionals: “Whatever the model, I think nurses and midwives should be involved right from the beginning and I would like to stress the importance of cooperation between all expert groups.

“Too often nurses and midwives are invited too late to participate in projects. This often leads to misunderstanding and neglects the relation of information flow and work processes. I believe that participation in the HIT projects will also facilitate health informatics (HI) skills, as the need for education becomes real and is attached to your daily practice.”

When discussing the future of innovation and informatics, Saranto said: “Multidisciplinary education is not an innovation, but it is far too seldom used as a model for basic or advanced HI education, although we have encouraging outcomes.

“I have always found IT as a tool to support practice. I hope that those coming to the healthcare arena also have at least minimal knowledge and skills from the context.

“Often in multidisciplinary groups, concepts and terms can cause severe misunderstanding. For example, when planning interfaces. I believe that this could lead to more efficient implementations and satisfied users.”

Abu Sharib concludes: “My hopes are to build the capacity on nurse informatics designated roles in the nursing workforce, and the improvement of nursing informatics use in the innovation of nursing practice based on process enhancement and improving patient outcome.”