Guest Column | December 11, 2019

Technology Holds The Answers For Solving Social Determinants

By David Wenger, Bridge Connector

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Smartphones have become so impactful in our day-to-day lives that it’s hard to remember life without them. For instance, imagine driving to a city for the first time and trying to navigate the streets without GPS. It serves as a great example of the tremendous power of data – the functionality of Google Maps has made everyone an expert navigator and it made the practice of pulling into a gas station to ask for directions all but obsolete.

In healthcare, IT solutions over the past few decades have had a similar effect for providers navigating the challenges presented by each patient. Particularly, they can help us understand and treat an aspect of patient care that is both challenging and tied directly to outcomes: social determinants of health (SDoH), such as nutrition, housing, transportation, education and employment opportunities.

In the same way our phone shows us when to make a left turn, IT solutions empower healthcare providers and social services with accurate and timely patient data that not only identify SDoH but offer a path to effective intervention that addresses the respective barrier(s) to care. Prior to the proliferation of data integration systems, healthcare was vulnerable to referral loopholes and incomplete patient histories that diminished outcomes and drove up the cost of care. Those loopholes have not been closed entirely, but existing tools have improved cohesion between disparate electronic health records (EHRs), customer relationship management (CRM) platforms and various other systems with key patient data. Utilizing them effectively can play a positive role in improving the patient journey and overall quality of care.

Addressing SDoH will transform our healthcare system and help us to anticipate patient needs and provide more holistic care, which will be particularly impactful for our most complex (expensive) patients. Today, we can attribute more than 50 percent of readmissions, one-third of patient deaths, and up to 80 percent of our overall health outcomes to the effects of SDoH. Additionally, a Waystar survey found 1 in 5 patients have a high risk for socioeconomic-related health problems and nearly 70 percent of patients struggle with at least one hurdle considered to be a SDoH. Fortunately, I believe we have the technology available today to tackle this complex issue and integrate SDoH into clinical software and subsequent care.

Technology Benefit #1: Data Powers Effective Treatment Plans

The most unfortunate byproduct of the many electronic systems we enjoy today is siloed patient data – or patient information that disparate systems cannot share easily. I referenced the GPS on a cell phone because asking providers to create an effective treatment plan without a patient’s complete medical history is akin to driving in a foreign city without a GPS. But integration software that exists today breaks down the numerous silos that restrict the flow of data from patient touch points in EHRs, patient engagement software and CRMs.

Each of those systems holds a different element of the patient story – while an EHR has information like current medications, a patient engagement platform might tell you that the patient missed an appointment because they don’t have a car. Putting every element of the patient story together offers the best chance to create a holistic course of treatment that works.

Technology Benefit #2: Tie Loose Ends After Discharge, Referrals

Every time a hospital discharges a patient, or one provider refers a patient to another provider outside its organization, the patient assumes total responsibility for following through and continuing their care. But people dealing with serious medical issues should never feel alone – they need support from their providers to make sure they receive the care they need. Additionally, following a patient journey often involves more people than just the patient. Those who are very ill or elderly often need family members or friends to receive information for them. It’s imperative that the provider can identify the correct patient advocate and share the information with them easily.

Integrating data from various providers allows the discharging physician, or the physician who made the referral, to see if the patient took the appropriate next step in their care and allows them to follow up as needed. Failing to close the loop on discharges and referrals leads to some of our most vulnerable patients falling through the cracks, resulting in the costly and unnecessary readmissions I referenced above.

Technology Benefit #3: Complex Patients Become Less Complex

Twenty-five to thirty million Americans have a condition that qualifies as a rare disease and over 130 million Americans today manage at least one chronic disease. We classify patients in these groups as “complex” because they often require specialty medications and many are treated by multiple physicians, including specialists, at different facilities. Additionally, complex patients are very expensive — they make up only 5 percent of the population but account for about half of all healthcare spending. If those factors aren’t difficult enough, social determinants can make treating this population nearly impossible.

These patients present the greatest challenge for providers because of their complex patient story. But, tying together every aspect of their journey with collected data – for many of them that means starting at birth – gives providers the best chance to address every aspect of their care. Integrated health data paints the most complete roadmap of every patient’s history and provides the same pathway to a solution as the GPS on a lost driver’s smartphone. Also, creating interoperable data systems in healthcare not only makes the population healthier, it limits readmissions and helps to control costs.

While the shift to electronic health records in the 1990s and 2000s was a significant upgrade over paper charts, it also created a convoluted system of data silos that in many ways made it more difficult to share patient data. The next wave of technology is taking down those silos – not only improving patient care across the board but also allowing providers to see a complete picture of every patient they treat. That means incorporating social determinants into a clinical setting and treating them with clinical precision.

About The Author

David Wenger is Founder & CEO at Bridge Connector, an iPaaS company that delivers data-driven workflow automation for healthcare organizations