All In: Data for Community Health recently launched a project showcase webinar series to highlight successes and lessons learned from community projects that are developing data-driven, cross-sector solutions to improve community health. In the first webinar kicking off the series, Karen DeSalvo, MD, MPH, MSc, Former Acting Assistant Secretary for Health and National Coordinator for Health IT, provided opening remarks on the importance of translating efforts to incorporate the social determinants of health from the pilot phase to the way we do business “because people’s lives depend on it.”
Next, Breione St. Claire, Project Director at Essential Access Health and Katie Sendze, Director of Client Services at HealthInfoNet discussed their user-centered applications that incorporate electronic health record (EHR) data and other data sources to improve community health. In case you missed it, below is a recap of the highlights.
With support from the U.S. Department of Health and Human Services, Essential Access Health is designing an EHR template to assist physicians in starting conversations on sexual and reproductive health with adolescents. Using a “design thinking” framework, Essential Access Health interviewed various stakeholder groups, including pediatricians and adolescents, to better understand barriers to productive conversations around a sometimes sensitive health topic. From the interviews, they identified important insights, such as concerns from teens about keeping information confidential from parents and teens’ preference for answering these questions in an electronic format.
Currently in the prototype phase, the intended application will allow adolescents to complete an electronic health assessment in the waiting room or at home. As the teen completes the survey, they will receive educational messaging and links to relevant resources. The provider will then be able to review the completed assessment in a pluggable application within their EMR that will automatically prioritize and highlight items to address.
The application intends to help promote comfortable conversations between providers and adolescent patients and elicit honest responses about sexual and reproductive health. It provides a safe environment where adolescents can answer questions with the assurance of privacy and confidentiality of the information disclosed. Data sources currently being linked include patient-generated responses to the assessment and EMR data, but in the future, other related social determinants of health data could also be captured.
As a grantee for Data Across Sectors for Health (DASH), HealthInfoNet, Maine’s health information exchange, worked in collaboration with community action agencies, the Maine Department of Health and Human Services, and federally qualified health centers to leverage their data integration capacity to address the social determinants of health. After numerous conversations between partners regarding data gaps in the health information exchange and the data sources available, the collaborators decided to aim for wins with the low-hanging fruit: 1) non-emergent transportation services data and 2) behavioral health prior authorization and certification data.
Within the HealthInfoNet platform, nurse care coordinators can access population and individual-level dashboards for risk assessment and management. Using statistical risk model tools built into the health information exchange, they can identify and reach out to high-risk patients to help manage their care. Going forward, the collaborators intend to integrate more social determinants of health data sets, including Homeless Management Information System (HMIS) data and ICD-10 Z codes, which will allow them to address the needs of Maine’s homeless population and issues related to access to healthcare.
Although very different projects, Essential Access Health and HealthInfoNet both shared useful insights about developing user-centered applications to improve health.
1. Collaboration with end users is essential to ensure their needs are met
Both presenters emphasized the importance of collaborating with potential end users prior to and during technological tool development. Essential Access Health used a “design thinking” approach, a method in which after defining a problem, one observes people and forms insights about their current approach and where there are gaps or room for improvement, formulates possible solutions. St. Claire emphasized:
“It’s really important to use participatory based research, whether it be design thinking or some other way in which you are including your target audience in your design process.”
HealthInfoNet chose to convene in-person meetings that included a customer team of care managers that ultimately would be using the system for their work. Each approach allowed the organization to identify the problems their technological solution could address and prioritize solutions to implement. Sendze shared:
“At the end of the day if it’s not useful to the client, no one is going to use it.”
2. Ensure individuals understand confidentiality and privacy rules
Essential Access Health intends to leverage their technology to promote patient privacy. Comprehensive explanations of the privacy rules in the online portal and at the start of the health assessment will help adolescents understand who has access to their health information and how it will be used. St. Claire specified:
“Right up front we are going to provide an explanation of their patient rights so they feel comfortable answering the questionnaire.”
Empowering the consumer to know their privacy rights should help prompt more honest responses to questions. HealthInfoNet acknowledged the importance of informed consent and protecting patient privacy as well. In the near future, when HealthInfoNet integrates community action agencies’ data, they will need to design an opt-in structure to allow individuals to consent to the inclusion of their information in the dataset. Dr. DeSalvo further elaborated in her closing remarks:
“It’s a good reminder about the patient voice and patient privacy concerns…As we gather data outside of the clinical realm, it will be really important to gather experience on how people begin to understand the potential uses of their data.”
3. Consider the interoperability of the technology solution
In her opening remarks, Dr. DeSalvo advised:
“Let’s learn from the lessons of the past and not build a bunch of proprietary analytic tools and data standards. Let’s do this where we are thinking about interoperability on the front end and the public use and public good of the data on the front end.”
Essential Access Health certainly took interoperability into account. They chose an application that can operate within multiple EHR types allowing for adaptability to multiple health systems’ IT infrastructures. HealthInfoNet considers interoperability to their work as well, citing certain Uniform Data System (UDS) social data as a challenge to connect to the HIE.
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