Part 2 in our five week blog series: The New Normal: Covid-19’s Impact on Population Health Information Technology. What we know to be true about this healthcare space has been reinforced and accelerated. We’ll help you to discern the noise from the NOW.

 Part 2 – Introduction

Health data pertaining to Social Determinants of Health (SDOH) is THE key to take action with patient populations for the weeks and months ahead.  Socially contextual outreach facilitated in creative ways is crucial to tamp down the myriad mounting crises on the heels of this pandemic.  For example, text messaging platforms drive higher engagement levels online and virtually.  To meet patients where they are with personalized messaging is a natural stepping stone to build relationship and increase trust.  It can lead to the preventive services and in-person care so greatly needed – great, time-relevant examples here and here.

Healthcare organizations are uniquely positioned to have a message land with a patient in a way that isn’t viewed through a polarizing lens.  As community anchors, we have a responsibility to act upon that paradigm in a respectful way.  We also have a responsibility to hear the struggle (compelling options to do so from Barack Obama, here, & Brene Brown and Ibram X. Kendi, here. Then we have a responsibility to start to do the work to be the change.

SDOH-Indicated Needs

Systemic Racism

Underlying all social determinants of health is the systemic racism that has led to inequity in education, job opportunities, access to social support systems, healthy food, housing, green space, upticks in substance abuse, domestic violence, and on and on and on.  We can no longer gloss over the fact that our need to address social determinants of health in this country is due to social inequities and injustices; they’ve led to disparities in areas that have been found to be as much as a 60-80% predictor of healthcare outcomes. No wonder black and minority populations are taking the brunt of the COVID-19 hit.

#BlackLivesMatter & #BlackintheIvory are winning the day, and rightfully so.  The time has long-passed for healthcare organizations to think critically about what that means for paradigms of care and to make real changes now that last for years to come. 

There are powerful voices of Black, Indigenous, and People of Color (BIPOC) origin within the healthcare community such as here, here, here, here, and here (to name just a few), that I’d encourage you to all to explore and follow.  My piece below comes from a place of being in this space for over a decade, pushing for integration with community-based organizations, and a passion for serving the left behind.  That said, I’m more tuned in now than ever to listen, to learn, and to show up to do my part to push the message and call attention to those doing the same.   This is just a small part of that.

Unemployment Related Job Training

The job losses related to the pandemic have been staggering.  Even as unemployment begins to tick in the right direction, many may begin to find their roles have been made obsolete by the experience of lock down.  Mitigation is desperately needed.

Many healthcare organizations double as education hubs nowadays.  For those who do not, partnerships with community-based organizations allow for ushering patients to where they can most quickly get the information needed to pivot.  Perhaps you can pull together an outdoor job fair; you include your community, education, and government partners, ask attendees to complete an EMR integrated SDOH survey, and steer them to the right booths based on responses. Patients take a step in the right direction and you have the data to continue to help them along with even more relevant outreach. The moral: get creative!

Mental Health Needs

What else is staggering?  How about the increased number of reasons patients may be in need of mental health support at this time?  COVID-19 positive, presumed positive, and even negative patients who reported symptoms of concern, are one place to start.  Their angst during these past several weeks, likely greater than others given the added intensity of quarantine periods, would benefit from a caring call. In fact, during the peak, ground-level monitoring efforts across the country showed that mental health counseling became a HUGE component of outreach to patients.

Consider the time and energy your organization spent to roll-out symptom checkers rapidly via mobile and patient portal formats.  Can you apply such urgency to similar mental health checkers?  Perhaps even target them to populations who have historically indicated challenges in this area and/or who are more susceptible to the impacts of a pandemic? Based on responses, you can develop ongoing outreach programs to do a 30, 60, 90-day check-in, to offer resources and continue to support.

Education – COVID-19

There continues to be a need for education around COVID-19, and it’s coming at us from two directions right now: a need to beat back misconceptions that the hard work is done and another to prevent stigma that may be associated with the virus.

We simply can’t afford delays in understanding, due in some cases to message undermining, with COVID-19.  At this point, most understand that the scientific and healthcare community are learning about this virus on the fly.  We do have a responsibility though, as community anchors, to continue the drumbeat of social distancing and PPE use as long as necessary, as well as to provide guidance on circumstantial-specific risk tolerance as our communities open back up.

 At the same time, we have to combat stigma and misconception about the virus and what it means to the future of our working and community relationships.  It took decades for HIV/AIDS affected communities and their scientific champions to right the ship of misinformation—and that work is still not done.  We need to be out front on COVID-19 to allay fears, to provide correct information to our patient populations, and to reassure that healthcare organizations continue to work hand-in-hand with local, state, and federal health departments and government leaders.  Sound policy and education, consistent across traditional private/public boundaries, rooted in science, and better integrated technologically is what our community members need to avoid the chaos sowed by lack of or misinformation.

Intimate Partner Violence

Reports of domestic violence (DV) are on the upswing across the country no doubt related to added mental strain (see above), job loss, substance abuse, and cramped quarters associated with the pandemic.  More startling, reports of child abuse are down and many fear the reason is due to children being unprotected by teachers, counselors, and DCFS.  Your organization has skilled professionals that understand the social context that leads most often to instances of DV and child abuse – listen to them.  While you’re putting out community messaging on COVID-19 and engaging high risk chronic illness patients, why not spend a bit of time in the area of intimate partner violence and abuse intervention?  Your mothers and children are clamoring for it, even as they are forced to remain silent.

Let that sink in – as a community anchor, your healthcare organization has a responsibility to engage patients on a topic that they may be wholly unable to communicate on.  This is where patient-reported assessments via your portals and appointment check-in applications can be key to elicit the information needed to know who requires support.  Your HIT vendor has built in capability to restrict questions from certain settings and/or users – think patient proxies – in order to shield victims and engender the comfort needed to allow for shining light on painful situations, and then to move towards healing.

Gun Violence

Reports of weapon purchases sky rocketing early in the pandemic were jarring, to say the least. The pressure of the pandemic combined with the uptake of arms would be enough to strongly consider outreach and mitigation driven by social determinants in order to prevent avoidable tragedy. But with a long overdue #BlackLivesMatter movement penetrating the zeitgeist, and an election season coming into full swing on top of the pandemic, we have at our doorstep a potentially very unstable situation in the context of guns in this country.

Impoverished, unemployed, lacking education, and/or mentally inflamed as well as armed, the writing couldn’t be starker.  As cries for de-funding the police permeate, similar calls for increased funding and focus on social work as a strategy to more proactively respond to the needs of our population are growing.  A healthy dose of options focused on gun violence mitigation, supported by health and community organizations through social services professionals, could single-handedly prevent our current environment devolving into something even more destabilizing.

Engagement Avenues

Now that you’ve got the critical subject matter on which to engage your patient populations, it’s time to get talking about solutions to do so. Outdoor job fairs driven by SDOH surveys input on kiosks, mental health symptom checkers distributed via patient portals, social media and/or virtual care plan applications as mediums for education are all great approaches laid out high level above.  The key is to keep in mind (as if you’d forgotten that resources for this type of work are fairly limited right now) that as you stratify the risk within SDOH domains, you’ll want to stratify your tools.

Beyond that, particularly in the areas of sensitivity above, we’re entering into relatively uncharted territory and a scientific approach with iterative changes would serve most organizations well.  Consider an example:

The organization wants to get general education tools to a high-risk population.  The need is such that engaging the patients via text – where they are, on a medium they’re comfortable with – is important.  With a preliminary goal intended to gauge and focus additional outreach based on initial responses, the organization randomizes the highest risk patients and reaches out using this paradigm:

1.     Text message to patient A highlighting availability of resource Z

2.     Text message to patient B highlighting availability of resource Y

3.     Text message to patient C highlighting availability of resource X

As a result of affirmative responses, the organization can begin to engage and intervene.  Based on analysis of responses from those that were not affirmative, they update the outreach paradigm to the most effective approach, while adding in additional variation to continue iteration.  With time, they come to better understand which demographics respond to which resources and hone both their outreach populations and messaging to make sure that the patients find the resources, and hope, they’re in need of. 

When all else fails engage your populations via social media.  Channel at-risk patients from there to your care coordination arms. Engage, engage, engage.

Summary: 

Our world is more prepared now than ever for healthcare to step up and address SDOH with real solutions matching real risk. It doesn’t matter where you start or why, what matters is that as a healthcare leader, you do so, and that you do so in a way that makes the most efficient use of your valuable HIT and social services care team resources. The time is now, be the SDOH change.

Thank you for reading. If this content speaks to you, please follow CJ on Twitter or LinkedIn to be made aware of future blog content when it’s hot off the presses.