Health information technology is defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing and use of health care information, data and knowledge for communication and decision making”.1 Different forms of health information technology (HIT) include the electronic health record, electronic prescribing, clinical decision support, telehealth, patient portal as well as consumer health IT applications.
Health IT offers a unique opportunity to teach learners about social determinants of health and how these determinants affect patients. As students and trainees engage in experiential learning in the practice setting, they see first-hand the impact of social determinants of health and learn how to identify and address these issues.
In exploring how to incorporate health IT in teaching and addressing social determinants of health, we should consider these questions:
· Which specific social determinants of health related issue can be uniquely addressed using health information technology?
· Which tools currently exist?
· Can we identify opportunities and gaps in patient care?
· What are the barriers to incorporating health IT into our practice?
One of the ways we can optimize health-IT to reduce health disparities is in screening for social determinants of health. There are tools available which we can either embed within the electronic health record or use as a stand-alone form which patients can complete online before their visit. One of such tools is the protocol for responding to and assessing patients’ assets, risks and experiences (PRAPARE).2
PRAPARE is a standardized patient social risk assessment tool developed by the National Association of Community Health Centers and its partners which can be used to identify and address patient’s social needs as they present for care. PRAPARE core measures include: race, ethnicity, migrant status, veteran status, language, housing status and stability, neighborhood, education, employment, insurance, income, material security, transportation, social integration and support, and stress.
Health Leads (www.healthleadsusa.org) is another tool used in screening for social needs. The domains screened are divided into essential and optional social need domains. Essential social need domains include food insecurity, housing instability, financial resource strain, transportation, exposure to violence, socio-demographic information. Optional social need domains include childcare, education, employment, health behaviors, social isolation and supports, and behavioral/mental health.
Ideally, the workflow in clinical practice should include connecting patients to resources if screening reveals they have social needs. Some of the tools available to link patient to community resources include NowPow (www.nowpow.com), Purple Binder (www.purplebinder.com), GoodRx (www.goodrx.com), Needy Meds (www.needymeds.com) to name a few.
Health IT also encompasses consumer health applications and clinical decision support tools. Commercial health applications which can be either mobile or online can be downloaded by patients to track their exercise, eating habits, monitor prescriptions and manage appointments.
Clinical decision support tools are usually embedded within the electronic health record and can be used in teaching learners about addressing social determinants of health and reducing health disparities. Alerts and reminders, as well as guided clinical work flows provide recommendations and guidelines that learners can view and discuss with their preceptors and also with patients.
While the benefits of health IT are evident, it is important to acknowledge that there are challenges to utilizing Health IT, some of which are financial resources to invest in the needed infrastructure and its maintenance, language barriers for non-English speaking patients and patients’ low health literacy.
As educators passionate about teaching social determinants of health, health information technology is a powerful tool in our toolkit. With new applications and tools being developed daily, we might struggle to remain current. Sharing resources, tools and tips is a benefit of being part of a community of practice such as this. We would love to hear from you. How do you use health information technology to teach and/or address social determinants of health? What tools do you use in your clinical or teaching practice? What challenges have you faced in doing this, and how have you overcome those challenges? Share your thoughts in the comments section below.
*Some of this material was presented at a workshop on Health IT at the 2018 National SGIM conference by Mobola Campbell-Yesufu, Aashish Didwania, Allie Goodwin and Quentin Youmans.
References
1. Health IT Glossary https://www.healthit.gov/unintended-consequences/content/glossary.html#h Accessed October 15, 2018
2. PRAPERE Implementation and Action Toolkit http://www.nachc.org/research-and-data/prapare/toolkit/ Accessed October 15, 2018
-Mobola Campbell, MD