$4.4 million grant drives forward standardization of social determinants of health data in EHRs

LOINC^® and Health Data Standards at Regenstrief Institute has received a $4.4 million grant from the Regenstrief Foundation to support expansion of work on a global initiative to categorize and standardize social determinants of health (SDOH) information into electronic health records (EHRs), an ambitious project to integrate social needs data into clinical care to more effectively address health inequities.

The unequal distribution of income, food, safety and access to healthcare are recognized as root causes of health disparities. But, currently, data on these factors are rarely well documented within a patient's EHR. When this information is captured, it appears in varied, non-standardized terminologies, disconnected from clinical data and is at best cumbersome and at worst impossible to use.

The new four-year project, supported by the Regenstrief Foundation, will be led by LOINC and Health Data Standards at Regenstrief and Health Level Seven^® (HL7^®) International's Gravity Project, which has been named in a White House report, The U.S. Playbook to Address Social Determinants of Health, as the recognized source for nationally required SDOH data elements.

The foresight encompassed in this funding means Regenstrief, through its LOINC and Health Data Standards program, can now come to the table with partners such as The Office of the National Coordinator for Health Information Technology (ONC) and the Gravity Project of HL7 International to continue to expand the strategic implementation of social determinants of health data in electronic health records. We've worked on SDOH projects with the Gravity team, but this support allows for us to expand our collaboration and participation in a more comprehensive approach."

Marjorie Rallins, DPM, M.S., executive director of LOINC and Health Data Standards

"Social determinants of health are foundational causes of poor health outcomes," said D. Craig Brater, M.D., president of the Regenstrief Foundation. "Health inequity is pervasive. Standardizing social risk factors data in EHRs and integrating this information into clinical care is an important step toward meeting health disparity challenges. Regenstrief Institute is internationally known for setting health data standards and is an ideal leadership partner for this initiative."

The Gravity, LOINC and Health Data Standards team will create, identify and build a critical mass of standardized SDOH data elements to benefit patients, clinicians and researchers. This work will enable clinicians to monitor, evaluate and address patients' social and clinical needs comprehensively, positively impacting individual patients as well as supporting efforts by healthcare systems and government agencies to track health inequities at the population level. It will also benefit research into health disparities, supporting studies to evaluate the impact of interventions on inequities in healthcare access, care delivery and patient outcomes.

"As a multistakeholder collaborative, Gravity has successfully introduced a nationally recognized set of open-source, standards-based terminologies to support care across 19 social risk domains," said Vanessa Candelora, Gravity Project program manager. "Gravity is excited to collaborate with the LOINC and Health Data Standards team to continue the drive toward a world where health and social care organizations readily share the information needed to effectively meet the social needs of individuals and advance health equity and improve health outcomes in communities by using standard terminology and technology."

The initiative will focus on data standards for a number of critical social risk domains, which may include some or all of the following:

• neighborhood safety
• access to green space
• food access
• adverse childhood experiences/toxic stress
• weathering
• minority strain
• immigration status
• history of incarceration

Other domains are in the planning phases.

"Where each of us lives, how much money we make, the quality of food we eat and the green space near our homes are just a few of the factors that significantly affect our health and longevity," said Rachel Patzer, PhD, MPH, president and chief executive officer of the Regenstrief Institute. "Collecting this important health information in a standardized, accessible format in electronic health records will enable clinicians to better access and effectively use these data to support equitable treatment decisions, as well as improve their ability to address the fundamental drivers of health that impact our communities outside of the health system. We are most grateful for the Regenstrief Foundation's vision to enable systematic integration of social risk data to improve the health of patients and populations."

Health equity the impetus for Sam Regenstrief's vision

A further quote from Dr. Brater: "As a maker of appliances, Sam Regenstrief was dedicated to quality control and standards. He understood the same principles should be applied to health data, ergo the creation of the LOINC program nearly 30 years ago. Sam was also ahead of his time in advocating for what we call today, health equity. As such, facilitating LOINC's ability to develop standards for social determinants of health and therein enabling better research into causes of and solutions to these vexing issues is precisely where he would want to have impact."