Cerner integrates social determinants of health into EHR to advance health equity
In a laudable initiative to advance health equity, Cerner Corporation, working at the intersection of healthcare and information technology, has recently launched a new solution called Cerner Determinants of Health.
The solution, which is designed to help healthcare providers address inequities in healthcare, is a dashboard and supporting set of tools, integrated into the Cerner electronic health record, to help clinicians determine social risk factors for patients and provide a more holistic patient care plan that can help identify potential targets for social intervention opportunities.
A key aspect of Cerner Determinants of Health is its ability to identify community-level vulnerabilities and a patient’s social needs. The dashboard within the technology uses combined geospatial, public data and patient-clinician insights to provide a view of the conditions in which people live.
Social risk factors for health include non-clinical influences such as housing instability, transportation barriers and employment which have a profound bearing on a person’s overall health. There are several studies that highlight this. The American Action Forum (AAF) notes [1] that while 95 percent of U.S. health expenditures go toward medical care, most experts have long-agreed that medical services have a limited impact on health and well-being. What determines someone’s health is a combination of genetic predisposition, behaviours, the medical services received, and the social and physical environment. The AAF points out that recent estimates attribute 10 to 20 percent of health outcomes to medical care, 30 percent to genetics, 40 to 50 percent to behaviour, and 20 percent to the social and physical environment. Individual behaviour and the environment are often studied together as the non-medical determinants of health. In studies that only consider modifiable determinants and ignore genetics, the non-medical factors account for 80 to 90 percent of a person’s health, and the contribution of medical care remains 10 to 20 percent.
Dr. April Giard, Vice President and Chief Information Officer, Northern Light Health in Brewer, Maine, which has recently implemented the solution, said: “Addressing health equity and access to care issues is a critical need for us. We can’t truly provide patient-centred, comprehensive care without understanding social risk factors our patients are experiencing. Through use of screening tools and the determinants of health dashboard, care managers are able to engage and build a trusting relationship with patients to identify and intervene on their social needs. Furthermore, we plan on leveraging the dashboard to pinpoint and prioritize areas of vulnerability and create plans to address social barriers for better health across our service lines.”
Jvion’s AI solution
Cerner Determinants of Health was developed with the integration of a solution developed by Jvion, a Suwanee, Georgia, U.S.-based company with a focus on providing prescriptive intelligence using clinical artificial intelligence. As the company puts it, they aim to “address whole patient health by surfacing the clinical and social determinants of health barriers influencing poor clinical outcomes and patient engagement. These modifiable risk factors are then mapped to evidence-based clinical guidance to enable decisionmaking within clinical and operational workflows”.
Lizzy Feliciano, Jvion’s Chief Marketing Officer, noted that they are “seeing incredible momentum in terms of both need and adoption of our prescriptive intelligence. These partnerships represent a vote of confidence from some of the biggest names in healthcare that our use of clinical AI to understand the modifiable aspects of a person’s healthcare journey can enable better care delivery and outcomes.”
Feliciano added: “Clinicians and case management teams are overwhelmed and overburdened by the sheer volume of data they are expected to sift through to inform care decisions. We solve that by connecting risk to action via evidence-based guidance and helping our customer operationalize those insights across their enterprise. We’ve had a number of studies published this year highlighting the accuracy of our models and their ability to drive down the cost of care in areas like oncology.”
Spotlight on health inequity
The Covid-19 pandemic has cast a spotlight on the devasting impact of health inequity across the U.S. As Rebecca Winokur, MD, MPH, pointed out in a recent perspective article for Cerner [2]: “ We’re not only seeing stark differences in health outcomes during the Covid-19 pandemic, but we continue to see the devastating effects of historic and ongoing disparities in health outcomes across all specialties and venues of care.”
She noted the following examples in the U.S.:
- Black and Indigenous women are two to three times more likely to die [3] from pregnancy-related causes than white women – and this disparit increases with age.
- In 2018, black patients were 30% more likely than white patients to die prematurely from heart disease. [4]
- LGBTQ+ patients face health disparities linked to societal stigma, discrimination and denial of their civil and human rights resulting in “high rates of psychiatric disorders, substance abuse and suicide”. Elderly LGBTQ+ individuals face additional barriers to health because of isolation and a lack of social services an culturally competent providers.
- Over the last year, Latino food and agriculture workers experienced a nearly 60% increase in deaths [5] compared with previous years; the increase for white workers was just 16%. Winokur noted that while these disparities are costing many their health, or even their lives, there’s also a broader economic cost.
- A 2011 study [6] estimated that eliminating health disparities for marginalized people would have reduced direct medical care expenditures in the U.S. by roughly $230 billion and indirect costs associated with illness and premature death by more than $1 trillion between 2003-2006.
Opportunity for change
Winokur added that while the Covid-19 pandemic has exacerbated long-standing health disparities, it has also highlighted significant opportunities for the healthcare industry to drive change around eliminating health inequities and improving outcomes for all.
“ Equity recognizes that each person has a fair and just opportunity unique to their individual circumstances. Whereas equality means that everyone is given the same resources despite consideration for their individual circumstances. Health inequity therefore speaks to all individuals not being given fair and just opportunities to access high quality care. The outcomes of health inequities are the health disparities we see across communities and groups of people.”
Dr. Andrea Hendricks, Senior Director, Cerner Chief Diversity, Equity & Inclusion Officer
Reaffirming this, Dick Flanigan, Senior Vice President & Brand Ambassador, Cerner, said: “This is an opportunity to raise awareness about racial and ethnic disparities, examine health IT’s role as an unintentional contributor and create resources to eliminate inequities now and in the future.”
Speaking on the benefits of Cerner Determinants of Health, Kevin Seabaugh, Vice President & Health Network General Manager, Cerner, said: “We are energized to hear from clients who are embracing our innovative solutions to help remediate this 80/20 imbalance and further advance health equity efforts.”
Jvoin pointed out that a steady stream of results over the past year have convinced more than a few healthcare organizations to enter new partnerships with them. The company referred to recent peer-reviewed studies that demonstrate Jvion’s impact. including:
- A study published last year in Applied Clinical Informatics [7] which summarises Jvion’s role in helping a Wisconsin hospital reduce readmissions by 25% within 6 months of implementation.
- More recently, a study published together with Cardinal Health in Future Oncology [8] shows that Jvion’s insights could accurately predict patient risk for short-term mortality. A complementary study, due to be published in JCO Oncology Practice, demonstrates how these improved mortality predictions helped oncologists at Northwest Medical Specialties increase utilization of palliative care services by over 80%.
There is now immense opportunity to support healthcare organizations with data and technology that can enhance understanding of the causes and impacts of health disparities and help providers deliver effective approaches to tackle inequities, Winokur pointed out. She provided the following examples of organizations that are using data to tackle inequities in their communities with the help of Cerner.
- Roper St. Francis Healthcare in Charleston, South Carolina uses geospatial mapping capabilities [9] within Cerner to analyse publicly available social determinants data in the communities they serve and implement appropriate strategies.
- The University of New Mexico Health Sciences Center uses the WellRx screening tool within their Cerner platform to determine the correlation between adverse social determinants and poor health outcomes in populations with diabetes and other chronic conditions. The results led the organization to hire community health workers for all of its primary care clinics and its emergency room.
- North Central London ICS in the United Kingdom created a Covid-19 vaccination analytics dashboard [10] focused on health equity. For the population served by the ICS “targeted public communication and engagement interventions to increase uptake have been guided in part through vaccination analytics identifying population needs by ethnicity, deprivation, religion and first language spoken”.
Conclusion
Addressing social needs among vulnerable populations – in terms of improved health outcomes as well as reduced costs – has become a driving force of healthcare investment. Studies show that non-clinical, modifiable risk factors can impact as much as 80 percent of a person’s overall health.
While the concept of addressing social determinants of health is not new, organizations are increasingly seeking guidance and technology capabilities to address the non-medical needs of their at-risk patients and communities by screening patients for unmet social needs, connecting people to resources and measuring the impact of interventions.
Cerner Determinants of Health offers a standardized, integrated solution that helps bridge the fragmented gaps between health and social care across consumers, providers, payers and community organizations. It helps providers identify patients with social risk factors, suggests goals and activities, supports communitybased referrals and provides geospatial analytics that identify community-level vulnerabilities and patient-level social risks.
References
1. www.americanactionforum.org/research/understanding-thesocial-determinants-of-health/
2. www.cerner.com/perspectives/advancing-health-equity
3. www.cdc.gov/media/releases/2019/p0905-racial-ethnicdisparities-pregnancy-deaths.html
4. minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=19
5. www.nature.com/immersive/d41586-021-00943-x/index.html
6. pubmed.ncbi.nlm.nih.gov/21563622/
8. www.futuremedicine.com/doi/10.2217/fon-2021-0302
