Incorporating health-related social needs data into electronic health records is an increasingly integral part of accountable care performance in healthcare, but there's no real consensus on how to best capture and manage this data.
With a lack of any kind of standardized approach, Sparta Community Hospital in Illinois devised its own framework for the capture of social needs data, working with nursing, case management and IT teams to implement better social determinants of health (SDOH) patient screening technology, procedures and workflows.
Susan Gutjhar, the hospital's HIT director and compliance officer, said that inpatients at Sparta Community represent a very small percentage of total patients, with the insurance market driving most patients toward observation – often a clinically appropriate move, as inpatients tend not to stay at the hospital very long.
That makes it difficult to screen them or capture their data – and before the promoting interoperability rules, the hospital wasn't required to get the information.
"So for us, that did not give us very much information, and it didn't lead to us to truly providing assistance to those patients," said Gutjhar. "Because a lot of our patients come from the local nursing homes, so their needs are being met already."
Even before Medicare started promoting interoperability, the hospital knew it wanted to make inroads on improving its data capture. It invited Blue Cross to partner with its ACO organization to provide some incentive dollars for quality data capture, and this required Sparta to conduct SDOH assessments on clinic patients.
"That's where you can really help the patient," said Gutjhar.
Because of the timeframe, Gutjhar and her crew began on paper – a screening form that could be physically handed to the patient. That then made its way to someone within the organization who entered the information into an Excel spreadsheet to capture the data.
The hospital now has the capability in its EHR to create an electronic form, and team members can code the fields of this form to automatically capture data off of it and run reports. The electronic form makes it easier to review the interventions that were taken to assist the patient.
"We're fortunate in our county that we had a county resource guide, and it lists everything from churches you'd want to go to, to food pantries, transportation – everything," said Gutjhar. "We were able to take that guide as we started screening patients who would tell us they were having food insecurities. We were able to then embed those resources into documents into our EHR, and we could produce a guide, the necessary pages to give to the patient to begin making some phone calls."
By the time Medicare's Promoting Interoperability Program was released, Sparta Community's vendor had a tool and dashboard already in place to capture data and report it to Medicare. SDOH information on inpatients is encouraged under the Promoting Interoperability Program.
"Blue Cross has since abandoned that requirement," she said, "but we continue to screen our patients annually in our clinic, because we found it was beneficial to know why the provider's plan of care was failing, only to find out they never bought their medicine, or they bought it but they only took it every other day."
The hospital has continued this program in the clinical setting. It recently started being implemented in pathology.
The biggest challenge in setting this up, said Gutjhar, was making sure staff members knew why it was so important to capture this data. They had to know that it wasn't just a task, and had to be trained to ask questions in a manner that would elicit an honest response from the patient, and to truly understand what the patient's needs were.
"They're treating their neighbors, families and friends," said Gutjhar. "And we're now asking very sensitive questions, and that was awkward to them. It's one thing to talk medically, because that's how they were all trained. They didn't necessarily expect to be asked if they could afford their food, or if they had utility problems, or they were homeless. Those were real embarrassing to the patients, and we had to be very tactful in how we asked."
Mental health is a big need in the area, said Gutjhar, so the hospital recently added a mental health component to the questionnaire to better stratify patients and more quickly get them to the right resources.
It's all about helping patients, she said.
"How are we going to help the patient?" said Gutjhar. "Talk to your referral sources, and make sure that when you start asking these questions, that you understand how you can truly help the patient."
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.