5 Takeaways from the ONC SDOH Learning Forum

The agency's latest information exchange series addressed SDOH technical infrastructure and interoperability.

The website for the learning forum from the Office of the National Coordinator for Health Information Technology (ONC) features its past and future events, including the most recent on Social Determinants of Health (SDOH) Technical Infrastructure and Interoperability. The following are five takeaways from that webinar.

1. The ONC forum spans five topics relevant to payers and all healthcare stakeholders
    

From the ONC website, the topics include:

• Governance
   
• Technical infrastructure
   
• Interoperability
   
• Financing
   
• Policy considerations

The ONC has provided a primer summarizing this scope.

2. ONC speakers noted the inclusion of SDOH in USCDI
    

The ONC's United States Core Data for Interoperability (USCDI) included new SDOH data classes and elements as part of a version two, July 2021 release. Per the release document, the USCDI "is a standardized set of health data classes and constituent data elements for national, interoperable health information exchange."

At the forum, ONC speakers highlighted the importance of the addition of SDOH assessments, problems, goals, and interventions in addition to data on race, ethnicity, and language, sexual orientation, and gender identify.

3. Speakers highlighted the medical-social fragmentation challenge
    

During the webinar, Paul Sorenson, director of the St. Louis Regional Data Alliance, noted that SDOH infrastructure and interoperability do not involve "a simple pairing of sectors." Examples include disparate funding sources, intervention approaches, system and tech integration maturity, and even how data is considered—as part of "robust communities of practice in healthcare" versus data as a "burden/afterthought" in the social sector.

4. What interoperability and infrastructure questions should be asked
    

The ONC highlighted six areas that organizations should address before SDOH-related software decisions are made:

• Assessments to understand existing landscape
   
• Hardware and software that can be funded, scaled, and targeted appropriately
   
• Health IT standards applicable to community need
   
• Interoperability as a key consideration
   
• Infrastructure, data standard, and capacity needs
   
• Security and privacy requirements

5. Field insights from Missouri, Michigan, and the Gravity Project
    

The ONC webinar featured three initiatives with a common message: the importance of both customizing and generalizing SDOH interoperability. Efforts must balance individualization (programs, populations, priorities) with silo-proofing—and ensure that interoperability applies not only to data and technology but collaborator thinking.

The three initiatives were:

• Missouri Aging Services Data Collaborative – Has built a "shared data infrastructure and support strong data actors that use quality data to improve people's lives."
  
  To his previous comments, Paul Sorenson added that by using open-data interoperability standards, the state's aging services can be a launching off pointlinking affiliated state agencies, home and community-based service providers, referral platforms, and hospital associations.
   
• United Way of Southeastern Michigan – Launched with a food security demonstration in September 2021.
  
  Senior director of Health and Basic Needs Sara Gold noted the lessons learned from "sitting in the middle of multiple, competing challenges … Where do we start? And moving from paralysis and endless questions to action."
  
  Bob Kreha, a technical consult for the project, added that "in interoperability workflow, you have to anticipate that something is going to get stuck." Kreha emphasized the "never-ending permutations" that can occur with implementation and that "looking very hard at centering partner voices as well as resources and funding" is essential.
   
• Gravity Project – Continues to advance "consensus-driven data standards to support the collection, use, and exchange" of SDOH data. Gravity's contributions have appeared in USCDI version two and CMS' fiscal year 2023 rules relating to inpatient prospective payment, Medicare Advantage, and Part D drug plans.
  
  Aaron Seib, who serves on Gravity's Executive and Governance and Finance Committees, notes: "It's really about implementation at scale for the best outcomes … The biggest message is getting engaged with social services partners."