TEN TRANSFORMATIVE TRENDS 2021
For SDOH Standardization, Gravity Project’s Pull Creates Hope
There is industry optimism that the work currently being done by the Gravity Project will be a critical step in achieving standardization around social determinants of health data By Rajiv Leventhal
S
ocial determinants of health (SDOH) has become one of the most buzz- worthy phrases in healthcare these
days, and for good reason: research- ers believe that around 80 percent of a person’s health outcomes is driven by SDOH factors such as food insecurity, housing instability, and transportation. As such, it’s now become common to see collaborations between traditional healthcare players and community-based organizations, with the goal being to piece together patients’ daily experiences with their healthcare system interactions. At the same time, there are still a slew
of challenges that remain around integrat- ing SDOH data into care delivery, and successfully merging that information with other important data points for population health success. One of the biggest barriers in this area is the lack of standardization in what variables defi ne the social determinants of health. From the 40,000-foot view, the issue
is this: before healthcare providers’ workfl ows can be changed, there must be agreed-upon methods for screening questions, tools used, and identifying the elements that are included in SDOH. From the 1,000-foot view, meanwhile, documenting the effect that social deter- minants of health have on an individual can be quite diffi cult to quantify since traditionally, healthcare organizations have not focused on collecting struc- tured, standardized data about socio- economic factors. Without this level of standardization, providers’ ability to truly identify and assess SDOH needs, share information with other stakeholders, and connect patients with community-based resources, is greatly hampered. The Centers for Medicare and Medicaid
Services (CMS) did create “Z codes”—a subset of ICD-10-CM codes to capture social determinants—in 2016, but in the fi rst two years that diagnostic codes specifi c to social determinants of health were available in Medicare fee-for-service claims, they were used for only 1.4 percent of the total benefi ciary population, accord- ing to a January 2020 report released by
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the federal agency. The most frequently used codes were related to homelessness, social isolation, and troubled domestic relationships, the data showed. In the private sector, organizations
have taken a stab, too. In 2019, a major collaboration was announced between UnitedHealthcare, the nation’s largest private payer, and the American Medical Association (AMA) that would support the creation of nearly two dozen new ICD- 10 codes related to SDOH. On the clinical side, of course, physicians use a system of ICD-10 codes to classify and record all diagnoses, symptoms, and medical treatments and procedures. The data model developed by UnitedHealthcare focused on standardizing the capture and processing of SDOH-related information, and offi cials said the codes will combine clinical data and self-reported SDOH data, which will then trigger referrals to social and government services to address social needs. Then there’s the work being done by the Gravity Project, a community-led
2018, Gravity Project consists of over 1,000 healthcare stakeholder participants. In December, the coalition published an implementation and recommendation guide for SDOH data and terminology, with a focus on food insecurity, hous- ing instability and homelessness, and transportation access. As a collective, the Gravity Project created recommendations for the necessary context, and for each domain, some are already existing in the U.S. terminology and some are not, explains Sarah DeSilvey, SDOH clinical informatics director at the Gravity Project. She notes that while food insecurity, hous- ing instability and transportation access were the original focus areas, the next domains to tackle will be fi nancial strain, education, unemployment and Veteran status. Once those domains and recom- mendations are complete, the next phase is working with terminology standards organizations to build them into code, and that process can take six months up to a year or more, says DeSilvey. She goes on to explain that the Gravity
Sarah DeSilvey
HL7 Fast Healthcare Interoperability Resources (FHIR) Accelerator that grew out of efforts to identify data elements for sharing information about social determinants of health. Founded by the University of California San Francisco (UCSF) Social Interventions Research and Evaluation Network (SIREN) in
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hcinnovationgroup.com | MARCH/APRIL 2021
Project also has small terminology devel- opment teams that have subject matter expertise for each domain. “Part of the reason why we’re trusted is we ground everything that we’re doing regarding that domain in peer-reviewed literature. We employ subject matter expertise, and terminology and clinician experts; I am a clinical informaticist myself and I’m a family nurse practitioner. We also use the community to cross-check. So through peer literature review, through analysis of white papers, and through community
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