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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.”