Population and Public Health

Social Determinants of Health Obstacles in 280 Characters or Less

Social Determinants of Health Obstacles in 280 Characters or Less

We asked members from around the globe to share the single most pressing obstacle to getting social determinants of health (SDOH) fully integrated into healthcare. Here’s what they had to say—in 280 characters or less.

Providers learning how to collaborate w/ organizations and institutions who are fundamental to sustainable change, yet w/ whom they’re not accustomed to engaging. Engagement must be long-term, even lifelong, requiring staff w/a unique skill set for its creation and sustainment.

– Fran Ayalasomayajula, Head of Population Health, HP Inc.; Personal Connected Health Alliance’s Aging and Technology Task Force Co-Chair

CULTURE. The culture of providers is based upon episodic care and the lifetime care represented by SDOH may seem irrelevant. The systems supporting providers support episodic culture. The culture of those coordinating care and the patients themselves place high value in SDOH. .

– Leslie Kelly Hall, Founder, Engaging Patient Strategies; a HIMSS Interoperability & HIE Community Chair

The lack of real information about individuals-patients. To make SDOH go live in clinicians' practice means to know every patient's background, based not on a subjective opinion.

– Marianna Imenokhoeva, MSc, Founder, Linktomedicine; a HIMSS Innovation Committee Member & HIMSS EurAsia Ambassador

As a primary care provider, the biggest obstacle I see is having established workflows to sensitively and accurately collect and update SDOH information from individuals and integrate it into the care process, while maintaining appropriate privacy and security for the data.

– Steven Lane, MD, MPH, FAAFP, Family Medicine, Palo Alto Medical Foundation, Clinical Informatics Director, Privacy, Information Security & Interoperability, Sutter Health; a HIMSS Interoperability & HIE Committee Member

The single most pressing obstacle is disincentives in the healthcare system. All stakeholders are pursuing their own agenda but the interests of patients with social and personal issues are not really defended on a political level.

– Sunjoy Mathieu, Founder and Co-Lead, Women in Digital Health; a HIMSS International Member

Patients are people first; treating them holistically requires the use of insights from clinical and non-clinical data. To achieve full integration of SDOH into healthcare, collaboration among clinical and social entities is necessary to redefine how healthcare serves people.

– Chrissa McFarlane, Chief Executive Officer, Patientory, Inc.; a HIMSS Interoperability & HIE Committee and Blockchain in Healthcare Task Force Member

Specialization leads to breakthroughs, along with responsibilities confined to these specialties: a blind spot. Technology and information, healthcare providers’ no. 1 instrument, must be guided from the heart of care to create insight into the patient as an entity.

– Gabrielle Speijer, MD, Radiation-Oncologist; a HIMSS International Member

Integration of SDOH to improve healthcare needs digital workforce extenders to facilitate the day-to-day interactions and interventions required to optimize care and outcomes for patients who are at higher risk of not achieving treatment plan milestones.

– Alan S. Young, MD, MBA, PMP, Chief Medical Officer, GYANT; a HIMSS Physician Committee Member

Inconsistent Data and Measurement

It is imperative to focus on standards-based approaches to collect and share SDOH data. This foundation will become increasingly vital as SDOH initiatives scale and expand to truly embody the full healthcare continuum and target care where people live, eat, work and play..

– Christina Caraballo, Director, Audacious Inquiry; HIMSS Technical Guidance for Interoperability Work Group Chair

The most pressing obstacle to getting social determinants of health fully integrated into healthcare today is the lack of a national standard for both what data and what data format should be used by everyone in healthcare.

– Bart Carlson, Chief Executive Officer and Chief Patient Advocate, Azuba Corporation; a HIMSS Interoperability & HIE Committee Member

The biggest obstacle is the lack of a harmonized set of common data elements that support collection of SDOH and result in interoperable data suitable for multiple reuse scenarios.

– Davera Gabriel, RN, Research Informaticist, Clinical Research Informatics, Duke Clinical Research Institute; a HIMSS Interoperability & HIE Committee Member

Having a common person identifier, unique service provider ID and common nomenclature for services and categories is critical for us to be able to collect and share data, and to coordinate care across the broad spectrum of providers and services..

– Anna Pannier, MBA, FACHE, CHCIO, Senior Director, Technologies, Ascension Technologies; a HIMSS Innovation Committee Member

SDOH data collected on discharge, not passed electronically to community providers. SDOH data types not standardized so most information is embedded in text blobs. Community care coordinators track the information but no standards to transmit, track or measure consistently.

– Jeanette Polaschek, CPHIMS, RN, SHIMSS, Senior Consultant, HealthTech Solutions; a HIMSS Innovation Committee Member

Data, data, everywhere … nor any drop to analyze.

– Joel J. Reich, MD, FACEP, CPE, SHIMSS, Adjunct Faculty, Consultant/Advisor; a HIMSS Innovation Committee Member

It’s hard to measure or quantify social determinants of health. When healthcare professionals investigate the impact of social factors, how to prioritize and assess them via a systematic approach would be an obstacle for shareholders with various backgrounds.

– Lingyi Tang, MS, OMOP Consultant, IQVIA; a HIMSS Innovation Committee Member

Lack of Standardization

The single most pressing obstacle to integrating social determinants in healthcare is standardization. Both standardization in definition and in usage of specific SDOH data points in programs.

– Mishka Glaser, Senior Manager, Deloitte; HIMSS Interoperability & HIE Community Roundtable Co-Chair

The significant variation within the dozens of SDOH assessment tools being used today plus the lack of national standards regarding exchange format and content for the exchange of SDOH significantly restricts the ability to exchange meaningful and actionable information.

– Melissa Kotrys, Chief Executive Officer, Health Current; a HIMSS North America Board Member


A major obstacle to integrating social determinants of health data is the lack of standardization. These data are often only loosely documented and if so, usually in free text. The use of standard terminologies for this data will greatly improve integration.

– Brian Levy, MD, President, Peak Informatics; a HIMSS Physician Committee Member

The most pressing obstacle to integrating SDOH is the lack of standardization—of screening questions, tools and even what factors count as SDOH. Before we change workflows, culture, or technology, we must agree on what we’re trying to accomplish and move forward collaboratively.

– Paul Matthews, Chief Technology Officer, OCHIN Inc.; a HIMSS Interoperability & HIE Committee Member

The lack of a clear definition of SDOH with a consistent set of sub-domains disrupts collaboration and slows progress. We need consensus on a single model to categorize the different areas of SDOH to orchestrate efforts in this broad area.

– Lisa Nelson, MS, MBA, Principal Informaticist, MaxMD; HIMSS Health Story Project Co-Chair

The lack of well-funded, ongoing, globally coordinated dialogue leading to annual, universal, standardized measurements against goals with ongoing outcomes communicated to all nations.

– Gregory Walton, LFHIMSS, CHCIO; a HIMSS Innovation Committee Member

Solutions for Core Problems

Rural communities lacking transportation, closing the gaps in the community from local, religious, clinics and shelters, and access to ERs, FQHCs, and public health clinics. Evolution must happen in all these areas to provide a successful ecosystem of population health.

– Bonne Farberow, MSN, RN-BC, CCRP, Population Health Strategic Executive, Cerner Corporation; a HIMSS Innovation Committee Member

To be viable in a value-based environment, healthcare organizations must influence consumers’ social, environmental and behavioral determinants of health. Per 2018 Gallup poll, 55% of Americans “worry a great deal about the availability and affordability of healthcare

– Joan Imrich, MSc, PMP, Director, Advanced Analytics, Johnson & Johnson Healthcare; a HIMSS Innovation Committee Member

The single most pressing obstacle to getting social determinants of health fully integrated into healthcare is insufficient access: of people to healthcare systems and of their data to interoperable sharing among system components.

– Michael Miller, MD, Director, Clinical Research Informatics, Ann and Robert H. Lurie Children’s Hospital of Chicago; a HIMSS Physician Committee Member

Administrative and governance silos prevent a holistic approach to managing healthcare, and similarly digital health. We cannot continue to address symptoms without attacking the root causes … and social determinants are most often at the root.

– Michael Nusbaum, BASc, MHSA, FHIMSS, President, MH Nusbaum & Associates Ltd., Victoria BC.; a HIMSS Interoperability & HIE Committee Member

Single most pressing obstacle is that we have insufficient knowledge about the real needs and problems of patients and how to asses them in a healthcare context. For example: making debts can be a major issue in adherence to medication or adopting a healthy lifestyle.

– Anja Van der Heide, Project Manager, The University Medical Center Groningen; a HIMSS Innovation Committee Member

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

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