ONC tests the link between low interoperability and social deprivation

Small and rural hospitals that treat economically and socially disadvantaged populations are less likely to exchange health data, a recent study from the Office of the National Coordinator for Health IT shows — a wider digital divide for marginalized zip codes than previously thought.


While economically and socially disadvantaged groups are at greater risk of fragmented, poorly coordinated care, ONC officials saidResearch published earlier this year shows that socio-economic factors are directly linked to low investment in interoperability.

ONC sought to find out whether differences in hospital interoperability are related to the extent to which hospitals treat marginalized groups. It turned out that 20% of hospital zip codes were the highest Social deprivation index (SDI) were 21 percentage points less likely to participate in interoperable exchange than the remaining 80% of hospitals.

Previous data on smaller, rural, and independent hospitals with lower data sharing relied on Medicaid caseload, Medicare Disproportionate Share Hospital Index, uncompensated care burden, and Critical Access Hospital designations to identify designations achieved by the Centers for Medicare & Medicaid Services State Innovation Models and ONC’s Regional Extension Center Program.

For the new study, the agency’s researchers also used the SDI, which is based on seven demographic characteristics collected in the American Community Survey to quantify socioeconomic variation in health outcomes, to better capture a geographic area’s relative disadvantage. area and its inhabitants. .

“We found that these five measures identified overlapping but clearly distinct groups of hospitals. Of the five measures, only the SDI consistently identified a difference in interoperability,” the ONC researchers said.

The SDI applies statistical methods that produce a strong correlation between the variables that make up the factor and the factor itself. The higher the factor loading score, the greater the variation explained by that variable.

ONC analysts Jordan Everson, Vaishali Patel and Bob Phillips say policies aimed at improving interoperability and addressing health disparities can be more effective if guided by an empirical understanding of which hospitals need additional support.


Achieving interoperability can also be a means to promote equity in healthcaresaid a HIMSS23 expert panel last spring, noting that the exchange of key health information between health care entities is an important first step in closing the health equity gap.

“We have such limited data in an interoperability environment that we tend to look for clusters and focus on them,” explains Ammon Fillmore, associate chief legal officer, information and technology at AdventHealth.

Rethinking what data can and should be interoperable is part of tackling health inequities, he said: “Interoperability exposes data silos and data deserts, where no data can be found.”

A lack of interoperability has also hindered patient care, said Dr. Ben Zaniello, Chief Medical Officer at PointClickCare.

In October he discussed three processes to improve care coordination and visibility Healthcare IT news and shared his personal experiences involving social determinants of health in the coordination of post-acute care.


“These findings indicate that relying on a single proxy (such as the Medicaid caseload) could lead policymakers to focus on only a subset of hospitals that serve populations that have been marginalized, and perhaps inadvertently exclude hospitals that also need them ONC officials said of their investigation. recent research.

“Further evaluation of these and other proxy measures will be important to help policymakers at the federal, state, and local levels effectively reduce disparities in who benefits from the appropriate flow of health information.”

Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org

Healthcare IT News is a HIMSS Media publication.