In an interview with Chief Healthcare Executive, Oracle Health’s chief healthcare officer talks about the role of data in closing disparities. She also provides guidance to hospitals aiming to improve equity in care.
Hospitals and health systems are paying more attention to health equity, including the factors that affect the health of patients in their own neighborhoods.
Oracle Health works with hospitals to reduce disparities in outcomes. Since completing the $28 billion acquisition of Cerner in June, Oracle has said healthcare is now the company’s primary focus.
In an interview with Healthcare Executive, Nasim Afsar, chief health officer of Oracle Health, discussed the organization’s work to identify the health needs in different neighborhoods. She also outlined how hospitals and health systems can improve health equity.
Why do zip codes play such a big role in a person’s health?
We all know that clinical factors are not the only influence on a person’s health and well-being. Where you live by country, state and even neighborhood makes a big difference. This is why it is important to bring social determinants of health into the EHR (electronic health records). Zip codes can tell us a lot about a person and are often an indicator of the resources available in a community as well as people’s access to health clinics or to grocery stores with fresh, healthy fruits and vegetables. They also reflect income levels, with housing security and access to public transport. These are all factors that play a critical role in an individual’s and community’s health and care.
How do we only recently see the role of one’s neighborhood as a key factor influencing health?
This is certainly not a new or recent phenomenon. For decades, public health experts, researchers, and clinicians have seen the impact of zip codes on the health of individuals in communities around the world.
However, over the past decade, as more medical records have been digitized and we ask and capture more of these elements, we are able to have a better data-driven understanding and approach to the true impact of these indicators on health. Proactive relationships between health systems and communities help broaden health care and can be a game-changer. Data-driven insights should be integrated into the EHR to help providers identify those who may be at health risk, food and housing insecurity, and other factors.
How do Oracle Cerner’s Determinants of Health solutions help providers improve their healthcare and move closer to health equity?
Our work at Oracle Cerner is to create tools that enable clinicians to get back to what matters most – caring for patients. We have a real opportunity to not only raise awareness of, but also investigate and identify how we can eliminate inequalities today and in the future.
Rich datasets, dashboards and technologies such as Oracle Cerner’s Data and Insights Platform can help providers access clinical, behavioral and social data about patients in one place, identify existing disparities and represent community resources as part of a patient s care plan.
Oracle Cerner’s Determinants of Health can help providers conduct community needs assessments to proactively address social risk factors. At the population level, you can see social risk factors such as transport barriers, food insecurity or housing instability, all broken down by demographics. In June 2022, we added a new feature – the ability to zoom in on neighborhood groups of 600 to 3,000 people to better understand and target social risk.
Why is this new capability so important? Consider Wyandotte County in Kansas – in the tool you can see that the entire county is coded red because it is at high risk due to social factors such as a lack of health insurance and a high prevalence of gambling and alcohol establishments. But that is not the full story. The tool also shows that the eastern part of the country makes up the largest part of this risk population. With this improved data, healthcare organizations can more accurately tailor and target their outreach and intervention programs.
What should hospitals and health systems think about when it comes to “technology”? Technology should not be something we think about – yet it must connect seamlessly with the most relevant data at the right time so clinicians can focus on the goal of healing through compassionate connections with their patients. Technology and data insights are being used today to address health disparities, prevent bias in care delivery and ultimately help improve overall outcomes in communities. Clinicians can look to understand how they can leverage a person’s social risk factors to provide proactive interventions that improve health and care. Many current systems are too focused on reactive responses. Using data allows us to be more proactive and prevent or reduce disease and illness.
The Oracle Cerner Determinants of Health solution helps organizations advance whole-person care by identifying and intervening on social risk factors through action-oriented community analytics and social determinants of health capabilities embedded in care management workflows.
Can you provide a little more insight into how geospatial modeling identified patients at risk for diabetes and hypertension at an African American church in South Carolina?
Roper St. Francis Healthcare, using geospatial mapping within Oracle Cerner technology, analyzed publicly available information and identified other institutions that patients frequently visit, such as churches. In collaboration with the Roper St. Francis Healthcare chief diversity and inclusion officer, the analysis team cross-referenced African-American patients who had a high prevalence of diabetes and hypertension to the location of churches they attended. In collaboration with the church, the chief diversity and inclusion officer provided literature, engaged church leaders and identified nurses who were members of the congregation to do screenings and outreach. This helped the system to step outside the four walls and help ensure that community members received care in environments they trusted, which ultimately impacted their health for the better.
Can you share more about the screening tool used to help the University of New Mexico Health Sciences Center see the link between social determinants and poor health outcomes in the diabetes population?
Within its Oracle Cerner platform, the University of New Mexico Health Sciences Center uses a screening tool 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 its primary care clinics and its emergency room to make a more positive impact on vulnerable patient populations. Their Office of Community Health plays an important role in promoting health and health equity, and recognizes that social determinants, such as housing, education, food, transportation, utilities, income and social inclusion, play a much larger role in health.
Where should hospitals or health systems begin with health equity efforts?
Improving the health of populations without understanding the conditions in which they live is a difficult undertaking. Having accurate, localized community data within the EHR is essential to addressing social risk factors and improving community health. This same data can also be used to advance health equity—a particular focus of many of our health systems here in the US
What can smaller hospitals or health systems with more modest resources do to use data to address disparities?
Addressing health care disparities is not easy, whether you are a critical care hospital or a large integrated delivery system. And we developed the Learning Health Network. Today, a group of more than 100 health systems from 43 states, including small community hospitals and academic medical centers, share de-identified EHR data with the goal of advancing clinical research. More than half of the health network members are small critical access hospitals that now have the chance to bring clinical studies to their rural communities. Healthcare is about people helping people – and the Learning Health Network is a very definition of that.
By design, diversity has become the Learning Health Network’s superpower. Clinical trials run by the health network have three times the national average of black and Hispanic participants. Take, for example, Osmond General Hospital – a 20-bed critical access hospital in rural Nebraska. For the first time ever, earlier this year they enrolled in their first clinical trial for early detection of colorectal cancer. One of their patients who qualified for the study tested positive on her home screening test. This prompted her to go in for a colonoscopy which confirmed a diagnosis of cancer. She is now undergoing treatment possibly years earlier for the disease.
This example brings to life the great benefit of the Learning Health Network – and how caregivers and patients can gain faster access to leading therapeutics, diagnostics and medications.
How do you ensure that technology solutions to improve health equity do not actually exacerbate inequities?
This is an area of increasing assessment and work for all of us in the healthcare industry. Data entered into electronic health systems may reflect societal bias. Machine learning algorithms that build on data can therefore reflect and exacerbate inequalities. To eliminate this, we need to take a proactive approach at multiple levels, including delivery-side education to ensure we are bias-free in our documentation and data collection, and active monitoring and surveillance to ensure we look for bias and eliminate when identified in systems. This requires broad discussion and commitment from all of us.
How should hospitals and health systems work with the community to address health disparities?
Despite commitment across health care organizations to address health disparities, some have found it difficult to detect and address disparities. An important step is to build relationships and infrastructure to support community engagement – something that has historically not been considered. We have not always looked at what is happening in clinics and hospitals without considering the full picture. However, what happens outside the doctor’s office and in daily life can affect decisions we make and opportunities we have. Robust, thriving relationships can help communities understand together how to identify and address gaps to ensure better health and care for individuals, communities and neighborhoods.