From 3M Health Information Systems
Part 2: A view of SDoH through the eyes of a social worker
In part one, I sat down with Amanda Steffon to talk about gaps and opportunities related to social determinants of health (SDoH). For the second part of the interview, we discuss gaps in SDoH data collection and top priorities for SDoH in the future.
Precious: As a social worker and with your experience handling SDoH data, what are your thoughts on opportunities and gaps related to the collection and use of SDoH?
Amanda: I would say we haven’t collected as much data as we could. We can increase data collection by ensuring that SDoH are documented, available and extracted. Gathering data from vulnerable populations is still a challenge. There are portions of our population that are often unreachable or harder to get to. I do think we are headed in the right direction. We have realized where we previously missed opportunities to collect data and are working to correct this.
Much of the data we do have is free flowing information not being leveraged in an impactful way. We need to dig a lot deeper into the data we’re gathering. For instance, a person comes into a health care facility, and their physician finds out that the person is experiencing food insecurity. It is not enough for us to simply report that someone has food insecurity. Without specificity, what do we do with this information? Why are they suffering from food insecurity? Is it an economic deficit? Is the local grocery store miles away from their house, making it difficult to access because they do not have transportation? Knowing why something is happening makes it possible to develop solutions.
If it is an economic issue, you can be linked to specific resources to help you meet that need. From there we need to find out if we are collecting the appropriate data from community resources. Do we know if the person has connected with their local food bank? Is there data on that follow up, and how is that data being used? Without specific data and drawing the connections, we aren’t getting the complete picture of the person, from identifying the problem to the outcome. Just capturing that a person experiences food insecurity, I wouldn’t say it is meaningless, but it isn’t necessarily as meaningful as it could be.
Precious: Doesn’t free text make it more challenging to standardize that information?
Amanda: It is a challenge, but why shy away from a good challenge? Free text notes draw a more comprehensive picture of the patient and bring the person into our documentation. When I read a patient chart, there are always progress notes that stand out where you can tell that the provider interfacing with the patient truly knows that person and captured that information. When you can build a relationship and talk with people, they end up giving you a lot more information than you could ever extract from an assessment or questionnaire. As a fundamental approach of social work, we rarely ask close-ended questions, because people provide very narrow answers to very narrow questions.
Standardizing the data in free text is far more challenging than working with discrete, predefined assessments, but the information we gain from free text is invaluable. It is important for me to acknowledge that we can use tools such as questionnaires for data and that they have their purpose. It just shouldn’t be a substitution for what we can gain from knowing our patients and their stories.
Precious: Wrapping up this interview, if you had to list your top three priorities for SDoH, what would they be and why?
- More data and more data where it exists – I think priority number one for health care would be data, not just gathering some data, but all the data, in all the places where it exists. There has been a push for encoding from ancillary notes, with the recognition that information does exist outside of provider notes and should be leveraged. However, we have been slow to implement processes to extract and use that information; look at how long it has taken to use ancillary notes to support coding. The same goes for community data. There is acknowledgment of the importance of gathering that data and how vital it is for us. I just don’t think that we’re there yet.
- How do we assess barriers? – It’s one thing to indicate that I have a finding of food insecurity, chronic unemployment, poverty or homelessness. That information is of little use if you aren’t identifying the barriers that person is facing and what has caused them to experience these things. So, priority number two would be taking that extra step by identifying causative factors and barriers, and then refer to the appropriate resources and support. Why is that person facing homelessness, and what can be done about it is far more useful than just stating that a person is homeless.
- Acknowledgment that SDoH are not just the responsibility of health care – Health care is only one arena. We need to see more collaboration across federal, state and local government programs. Identify the systems in which we have created and perpetuated these disparities and inequalities. The H in SDoH could lead a person to think that this is only a health care issue and needs to be dealt with in health care, but that’s just not the case. It needs to be managed on a much larger scale across many systems and people. It’s not just health care’s burden but everyone’s burden.
So much more could be said about SDoH. Acknowledgment and recognition of SDoH is a step forward, but to keep the momentum going takes determination … and lots of it. It was a pleasure for me to interview Amanda, and we hope you will add your voice to ours on this critically important topic.
Precious Porter, RN, BSN, clinical data analyst at 3M Health Information Systems.
Amanda Steffon, is a project manager for the 3M clinical terminology team.