How trust drives social determinant data analytics

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Navigating social factors well beyond the healthcare provider’s control have always been key to providing quality care. With the shift to value-based care driven by population health and precision medicine, the ability to factor in social determinants has become more important than ever.  Fortunately, technology has made analyzing that kind of information much easier.

Unfortunately, the wild card has nothing to do with technology. It revolves around the trust that healthcare providers establish with patients and members of their local communities. This goes back to the principle that you can’t analyze data that you’re unable to gather. In a field so incredibly personal as healthcare, much of that information resides as unstructured data that only the patient can provide.

New population health platforms have made it easy to gather some of the more critical public domain demographic data on the communities or regions where patient populations reside. Areas in the United States where families have been employed by the coal mining industry will obviously have social and professional health determinants that someone in a city would not experience.

However, as populations get more complex and anxiety about privacy in the healthcare industry increases, mistrust also increases. Add to this the increase in immigrants who in some cases are concerned about their legal status in the country, and you have a real problem in gathering adequate data.

I had the opportunity to interview a healthcare executive who heads one of the larger systems for Hispanic communities in the Southwest about cross-cultural factors in gathering social determinant data. I was told that his patients spend a fraction of the time in their walk-in clinics than they spend in facilities in other less diverse communities. When asked why, he said that many of these patients give personal information only on a “need to know basis” for fear that any cookie crumbs could be used to deport them.

On the other side, physicians and their assistants are under pressure to increase the efficiency of patient visits while still gathering as much historical data as possible when conducting a patient’s health inventory.

Research confirms that the barriers perceived by front-line clinicians related to data gathering include:

  • Include insufficient training in social history taking
  • Uncertainty about how to address these issues in clinical practice
  • A lack of knowledge of local referral resources

This is why it’s no surprise that recent research from Deloitte shows that that less than one-third of hospitals are integrating social needs and determinants into the electronic health records (EHRs) for most of their target population.

This tells us that the most reliable way to establish the trust required to gather social determinant data and provide the critical insights necessary for analytics platforms is through a concerted training program that balances time constraints with patient-engagement comfort levels.

Whether this patient-generated data is most easily collected face-to-face versus through digital input from the patient is one of the burning questions in patient-engagement transformation. Can the patient trust the human more than the technology? Am I more likely to be honest about my health history online than I am when staring a practitioner in the eye?

Many of us who have been asked in a face-to-face annual checkup by our GP how much alcohol we drink during a typical week, know the dilemma of honesty with the human data collector.

Finally, even after establishing trust to gather the data, the EHR system where it resides becomes the last obstacle. Some of these platforms have still not been programmed for social determinants, whether from clinicians or patients. Even on the EHR systems that have established a standard social determinant vocabulary, there is a final and age-old interoperability trust issue in having these valuable data points travel reliably and securely across platforms and devices.

Comments

  1. Barbra McGann says:

    Bottom line: Social determinant data is critical to effective – and increasingly proactive – health and care management but we often overlook the human behaviors we need to address to collect and manage that data… behaviors driven by trust (or lack thereof) on how the data is collected, used, whether or not it is accurate, current, accessible, etc. Therefore, to be truly impactful with value-based care we need to combine training and change management with systems development and use.

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