The ability of digital health innovation to help the disenfranchised and those underserved by the existing health care system may seem a stretch. After all, it seems a long way from the high-tech world of digital start-ups to the realities faced by those living in poverty or on the street.
In fact, important work is being done to bridge this gap and those providing primary care are at the front lines of determining how health technology can be used more effectively to address the social determinants of health – factors such as income, housing, education.
These social determinants have long been known to have a greater impact on individual and population health than interventions offered through the health care system itself. The phrase “social determinants of health” has recently been elevated to iconic status joining phrases such as “patient-centred” and “value-based care”, in the pantheon of desirable traits/overused terms for an effective modern health care system.
Innovative health care companies are involved in the trying to address the issue. A recent article by Jessica Baker of Healthbox discussed how in the US “technology has made it easier for health systems and payers alike to develop targeted social interventions that can make a great impact on the health of the populations they serve.” Baker also detailed specific initiatives from organisations such as the National Quality Forum and the Aetna Foundation to reduce health disparities.
One of the most obvious areas in which digital health can help address the social determinants of health is through enhanced data collection and analysis facilitated by electronic medical records (EMRs). The axiom “what you can’t measure you can’t manage” can be applied in this context as identifying those who are disadvantaged is a critical step in addressing their health concerns. Several Canadian researchers are working in this area.
A 2015 paper published by the College of Family Physicians of Canada notes that the EMR can be invaluable at the community-level to help primary care providers collect data on patients’ social determinants. “These data can then be anonymised and aggregated into community-level statistics for use in continuous quality improvement activities,” the report states.
A major Canadian study has been launched under the direction of Dr. Andrew Pinto to develop and validate a tool to collect individuals’ social determinants of health data to identify health inequity. Known as the SPARK (Screening for Poverty And Related social determinants and intervening to improve Knowledge of and links to resources) study, the project will recruit and follow an estimated 1540 people in five provinces and builds on earlier work that used tablets to collect data and enter it into the EMR. Other primary care researchers such as Dr. Tara Kiran are also using technology to facilitate research in this same area.
On a smaller scale, a Canadian project involving a research group at Dalhousie medical school, the technology company Innovatia and others is poised to launch a study to develop a Vulnerability Index to help assess a patient’s social circumstances and grade their social determinants of health through a questionnaire given using a mobile app. The aim is to help the physician quickly identify issues of concern and refer the patient to appropriate community resources.
Asked how EMRs can improve how physicians take the social determinants of health into consideration, Dr. Eric Cadesky, president of Doctors BC responds: “(There are) so many levels to this, from population heat-mapping to see where particular care is needed and given (or not) to bedside information and resources. Ultimately it is about data quality, ownership and usability.”
Partnering with patients to improve health is just as, if not more, important with the disenfranchised as it with those who may be more health literate and have full access to the digital tools available to address their health concerns. Using digital technology to reach the disenfranchised and underserved is still in its infancy.
An environmental scan of best practices in reaching underserved groups published by the Canadian Partnership Against Cancer and the Propel Centre for Population Health Impact concluded that “while certain technologies can support deliberative public engagement processes, their use with underserved groups requires careful consideration”. For example, the report said, “Online platforms (e.g., surveys, discussion boards) are particularly problematic when language and internet access are known challenges for particular target groups.”
So, while it clear that even the best EMR is not going to eradicate poverty or homelessness, innovative approaches using digital health can and will continue to help clinicians make gains in acknowledging and addressing the social determinants of health.
As part of the “Enabling the Shift to Community-based Care” stream at the HIMSS & Health 2.0 European Conference, a session on integrating health and social care will be held on June 13 from 10:45 am to 12:15 pm featuring Prof. Kevin Fenton, Strategic Director, Place and Wellbeing Department at London Borough Of Southwark, UK, Masood Nasir, CCIO at NHS Birmingham and Solihull Clinical Commissioning Groups, UK, and John Rayner, Regional Director – Europe And Latin America at HIMSS Analytics.
Health Writer and Social Media Commentator