Social Health IT How Digital Tech Can Boost the Social Determinants of Health

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Social Health IT How Digital Tech Can Boost the Social Determinants of Health HIMSS Joint Interoperability & HIE, Nursing Informatics and Connected

1 Social Health IT How Digital Tech Can Boost the Social Determinants of Health HIMSS Joint Interoperability & HIE, Nursing Informatics and Connected Health Community Roundtable September 27, 2017 Jane Sarasohn-Kahn, MA (Econ.), MHSA Health Economist, Advisor, Trend Weaver THINK-Health and Health Populi blog

2 Social Health IT How Digital Tech Can Boost the Social Determinants of Health My lightbulb moment, a memory: July 23, 1967 The state of health inequity in America The role of social determinants of health (SDOH) The evidence: some examples of health tech & SDOH Call-to-action: We are all part of the health/care ecosystem Q&A 2

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8 Source: Social Determinants of Health Cultural Competence Is Not Enough, DL Powell, Creative Nursing, Vol. 22, No. 1,

9 Percent of Men and Women Who Have Been Told They Have Diabetes by Race/Ethnicity, US, 2014 Source: IWPR analysis of Behavior Risk Surveillance System microdata, Institute for Women s Policy Research,

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11 Infant Mortality Rates, By Race and Hispanic Origin of Mother United States, SOURCE: NCHS, National Vital Statistics System. 11

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13 Immigrant Status Is A SDOH 13

14 Zip code is more important than genetic code. Robert Wood Johnson Foundation, 2009 Commission to Build a Healthier America 14

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16 Growing Embrace of the Triple Aim in Health Care Operational Beacon for U.S. Health Care Public and private payors driving toward the Triple Aim in health plan designs. Source: Institute for Healthcare Improvement, Why the Triple Aim? 16

17 Source: American State and Territorial Health Officials 17

18 SDOH + Health IT Isn t Easy Some Barriers Lack of knowledge and consensus, absence of standards or tools Best practice still evolving Health care social services Lack of multi-sector collaboration who does what? Rigid technology systems: various platforms to use EHRs, cloudbased tech, apps Sharing data across sectors is a major challenge. But this must be done. Source: RWJF, Using Social Determinants of Health Data to Improve Health Care and Health: A Learning Report, May 2,

19 Source: Population health providers still struggling to build community connections, Modern Healthcare, Power Panel Survey Q32017, 16 September

20 Source: Population health providers still struggling to build community connections, Modern Healthcare, Power Panel Survey Q32017, 16 September

21 Source: Population health providers still struggling to build community connections, Modern Healthcare, Power Panel Survey Q32017, 16 September

22 Food As SDOH Heat map of top risk factors that contribute to the burden of NCDs 22

Food As SDOH Amazon and Grocers Working With USDA On SNAP Testing viability of enabling participants in SNAP to use benefits to purchase groceries online Goal: to enable people in food deserts

23 Food As SDOH Amazon and Grocers Working With USDA On SNAP Testing viability of enabling participants in SNAP to use benefits to purchase groceries online Goal: to enable people in food deserts without purchasing options to gain access to more nutritious food choices To bring benefits of online market to lowincome Americans participating in SNAP Amazon, HyVee and Safeway among retailers in USDA online pilot 23

24 Food as SDOH PCPs would first hire dietitians 24

25 Transportation As SDOH Ride With Uber & Lyft To Health Provider 25

26 Education -> Health Literacy As SDOH Medication Adherence Wireless Inside 26

27 Broadband Connectivity As SDOH Without Access Rural Source: Annual Broadband Report, FCC, January

Address Multiple SDOHs Via Platforms 1-stop shop to address

for food pantries, substance abuse treatment, housing, parks,

28 Address Multiple SDOHs Via Platforms 1-stop shop to address SDOH, Yelp! for social services Healthcare is local Purple, over-stuffed, coffee-stained 3-ring binder Transformed into referral platform for food pantries, substance abuse treatment, housing, parks, jobs, education ER setting: 60% rate in acute care costs for frequent fliers RCT on clinical effects of patient navigators 28

29 + Community Cloud SDOH Cloud-based system enables Health Leads to Collect data Search database Manage cases Integration support for screening and referrals 29

30 City Health Dashboard NYC RWJF grant to NYU School of Medicine with NYU Wagner Graduate School of Public Service and the National Resource Network Developed city health dashboard using standardized, city-level data to inform community health improvements Scale to a national resource 30

Fighting SDOH With FHIR Green Circle Health winner of ONC Phase 2 Consumer Health Data Aggregator Challenge Uses FHIR & APIs to import patient data into platform Family

31 Fighting SDOH With FHIR Green Circle Health winner of ONC Phase 2 Consumer Health Data Aggregator Challenge Uses FHIR & APIs to import patient data into platform Family health dashboard: personal data, medical device data, remote monitoring, reminders Note use of Dr. Mom will manage it now recognizing role of family Chief Health Officer 31

Cognitive Computing And SDOH Intermountain Healthcare, AI & NLP Focus on adolescents with T1D Rx & tx adherence and condition tracking AI can ID behavior patterns, predict

32 Cognitive Computing And SDOH Intermountain Healthcare, AI & NLP Focus on adolescents with T1D Rx & tx adherence and condition tracking AI can ID behavior patterns, predict choices, coach & boost patient decision making Structured + unstructured data in EHRs, claims, social media, wearable tech, RHM adherence, lifestyle choices, outcomes, < costs, > QoL 32

Let s Add Community Vital Signs To EHRs Providers begin with vital signs biometric markers in clinical Providers should add community vital signs aggregated measures of SDOH Constructed from

33 Let s Add Community Vital Signs To EHRs Providers begin with vital signs biometric markers in clinical Providers should add community vital signs aggregated measures of SDOH Constructed from community-level geocoded data from public sources, eg., US Census, community surveys GIS as proxies for SDOH Source: Bazemore AW, et al. Community Vital signs : incorporating geocoded social determinants into electronic records to promote patient and population health. AMIA, 10 July,

Hospital care Community and social care Social support networks Cloud-based, open API

34 AI For SDOH At Scale HINT: Scale matters ProACT: EU-funded project (Jan 16-July 19) Focus: EU s 50 mm patients self-manage chronic disease Integrating 4 modes: Homecare Hospital care Community and social care Social support networks Cloud-based, open API with home based sensors and wearable tech to track and provide personalized feedback to patients. 34

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36 Source: Population health providers still struggling to build community connections, Modern Healthcare, Power Panel Survey Q32017, 16 September

37 A Major Message for Stakeholders Large Retail, Healthcare Providers, & Digital Companies Equally Trusted to Manage Health 37

38 can do health The social determinants are going to be as much a part of regular health care as treating blood pressure. Dr. Robert Corey Waller, Camden Coalition of Healthcare Providers 38

39 Q&A Jane Sarasohn-Kahn, MA (Econ.), MHSA Health Economist, Advisor, Trend Weaver Twitter 39

Social Health IT How Digital Tech Can Boost the Social Determinants of Health

Social Health IT How Digital Tech Can Boost the Social Determinants of Health Session #69, 21 February 2017 Jane Sarasohn-Kahn, MA (Econ.), MHSA Health Economist, Advisor, Trend Weaver THINK-Health and