The conversation around SDOH in healthcare used to live mostly in academic papers and policy briefs. That has changed. Inconsistencies in housing, lack of access to food, deficiencies in transportation and the Internet have all made their mark on clinical outcomes, and the health care industry is no longer ignoring these components as part of the background.
The change has not been in the importance of these SDOH in healthcare, but rather in the capability of the healthcare industry to actually observe, track, and respond to them through digital technologies integrated with clinical processes.
Screening Tools Are Finally Catching Up
For decades, social needs were flagged informally, if at all, through a nurse’s intuition or a passing comment during intake. Digital screening tools have replaced guesswork with structure. Tablet-based questionnaires integrated into electronic health records ask patients about food access, housing stability, and utility shutoffs during visits.
A recently published scoping review on digital technologies in healthcare shows that the use of such technologies in screening for social needs among vulnerable patient populations has become more systematic than ever before. The difference is very important since any unmet needs are going to stay unmet regardless of the quality of clinical care provided alongside.
Referral Platforms Close the Loop
Identifying a need is only half the job. Community resource platforms, sometimes called closed-loop referral systems, now connect clinics directly with food banks, housing agencies, and transportation services. In cases where the physician identifies the patient as having food insecurity, the referral process is automated and can be monitored and acted upon, as opposed to passing the referral through a piece of paper pamphlet that gets lost in the glove box.
Healthcare organizations such as Endeavor Health and Sentara Healthcare have adopted these platforms because they understand that addressing SDOH in healthcare involves handling social risk information as an infrastructure, and not as a sideline program for one tired social worker.
Access Itself Has Become a Determinant
There is a strange loop worth naming here. These very technologies that are used for decreasing the gap can increase the gap if patients do not have access to devices, broadband internet, or knowledge on how to use those technologies properly. Access to technology has now become known as a social determinant of health. This statement might sound circular, but it actually makes sense. When a patient is unable to fill out a form online or take part in telemedicine visits, he/she will be automatically screened out by this tool, which was initially supposed to help him/her.
Where Is This Heading?
The newest paradigm, often referred to as Health Elements, states that digital technologies and algorithms are no longer merely instrumental means to affect health, but rather become structural factors of health along with biology and environment. Regardless of the fate of the paradigm, there is no doubt that changes are already taking place in clinics – technology makes social determinants of health not an annotation in a patient’s record, but crucial for decisions on referrals and follow-ups.
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