One of the biggest themes of this year’s HiMSS conference was the importance of identifying and addressing patients’ social determinants of health. With the rising importance of delivering value-based care, addressing social determinants and facilitating a patient’s role in their healthcare journey is something both payers and health systems cannot ignore. The topic discussed by many attendees and speakers was how better patient enablement needs to be achieved while supporting compassionate care and smarter, not harder, workflows.

Social Determinants and the US Healthcare System
The healthcare system in the United States has been changing rapidly. Health systems, payors, and individual communities have committed to easy access, high quality, no harm, low-cost clinical care. The needle is moving towards improved outcomes and better value, but it has become increasingly apparent that for these efforts to meet our country’s overall goals we need to work together, re-think our approach, and expand our focus beyond what happens in and immediately after an acute episode.

The most notable effects of the Affordable Care Act were ensuring all Americans could afford health insurance. It also provided mandates for health care providers to have easy access to a patient’s medical information and for patients to have ease of access to their own health information. However, a person’s health is not just defined by clinical care. In fact, research suggests that the largest contributor to a person’s health is social determinants at 50%, whereas clinical care contributes only 20%.
Healthy People 2020 defines social determinants of health as conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.” In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live.

Work Smarter, Not Harder to Address Social Determinants
Clinicians, including nurses, providers, and support teams, have always been committed to high touch, quality care. Even today, technology can be perceived as a barrier to providing this care, especially with poorly design EMR systems and the frustrations of vendors seen as simply providing vaporware. Although there can be barriers with technology, there has always been some sort of perceived barrier to providing compassionate care. Nearly twenty-five years ago, clinicians did not want to refer to patients as customers or to see healthcare as a business. When Meaningful Use required ease of access to health information, clinicians were not eager to see a computer screen placed between the patient and themselves. The key is making the technology a value-add instead of a distraction or obstacle.

When it comes to addressing SDOH, providers need to leverage technology to collect relevant information on a regular basis and using this data to support patients in their wellness journey. Gathering information is the first part of this journey and even here there are many questions. Who should be asking patients questions? Does a clinician need to be the one to ask? Could gathering self-reported data be more successful and promote patients being more open to answering?

The second challenge is closing the loop between care and services. When the data is collected, it needs to be used or there is a risk of losing the trusting relationship. There are community-based organizations that need and want referrals to assist the members of the community. If the health care team has the information the right thing to do is to share it and ensure that the loop is closed for their patients.

The third challenge is implementing the necessary relationships between the patient, provider, payer, and community-based organizations. The relationships need to not only protect Patient Health Information (PHI) and Patient I Information (PII), but also need to be properly enabled, tracked, and optimized. This optimization piece is so critical because it is what will drive long-term success. This can be done with robust analytical capabilities to identify trends that can make an impact on both individual patients and the community as a whole. Human beings are not always willing to ask for help. They do not always send up the distress signal or the white flag. But a patient’s data can do it for them.

How Healthcare IT Will Address Social Determinants
Seeing how many conversations were fueled by Social Determinants of Health indicates how much possibility exists for the future of healthcare. The future is certainly exciting as the possibilities to leverage both old and emerging technologies to increase patient care seem to be ever increasing. Her,e at CipherHealth we are thrilled to see how our clients are begging to collect this data both inside and outside of healthcare facilities.

As payers and providers find new ways of incentivizing care, the importance of addressing SDOH will become more and more important. To learn more about how to impact Social Determinants of Health, I invite you to explore these resources:



Kimmie Krakowski, MSN, RN, CENP, CAHIMS, is CipherHealth’s Chief Nursing Information Officer. Recently, she co-authored An Introduction to Nursing Informatics, Evolution, and Innovation, 2nd Edition: Evolution and Innovation and can be seen here at her book signing at HiMSS 2019.

Kimmie Krakowski, MSN, RN, CENP, CAHIMS is the Chief Nursing Information Officer at CipherHealth. Prior to her current role at CipherHealth, Krakowski served as the Associate Chief Nursing Information Officer, Senior Director of Informatics and Innovation at Inova Health System. Krakowski recently published Exploration of Portal Activation by Patients in a Healthcare System and co-authored An Introduction to Nursing Informatics, Evolution, and Innovation and An Introduction to Nursing Informatics, Evolution, and Innovation, 2nd Edition (available in November 2018). Krakowski is also featured in Build an A Team by Whitney Johnson.