In a brief titled The Feasibility of Social Determinants of Health Clinical Decision Support, ONC explores how clinical practice guidelines that include social determinants of health (SDOH) factors present an opportunity to advance health equity and improve health outcomes. A standardized approach to clinical decision support (CDS) using SDOH factors can enable clinical practice guidelines to become part of routine care delivery. Such an approach has the potential for broad implementation in a variety of settings and with various systems.

ONC prioritizes standardized SDOH data as evidenced by the inclusion of SDOH data elements in the U.S. Core Data for Interoperability (USCDI) version 2 and in subsequent versions of USCDI. The inclusion of these data elements in USCDI can support a standardized SDOH CDS approach.

Exploring the Feasibility of Clinical Practice Guidelines for SDOH

CDS uses computable logic to evaluate patient data and apply recommendations derived from clinical guidelines within an electronic health record (EHR) system workflow. When built using health IT standards, CDS can potentially interact with all health IT systems that support those standards. Over 50% of health IT modules are certified to the CDS criteria as of the end of 2022 (to see the most current list, visit the CHPL and filter for the CDS criteria and those currently certified).

Understanding how standardized CDS interacts with EHR systems, the status of standards that support CDS, and the process for translating written guidelines into CDS all provide useful context for an investigation of CDS feasibility for specialty clinical practice guidelines with SDOH factors. Today, there are more than 2,600 guidelines that include evidence-based recommendations for a wide variety of specialty fields. Many of the clinical guidelines for clinical specialties focused on pediatrics, cardiovascular health, and substance use disorders incorporate SDOH information within their recommendations.

Getting to Clinical Decision Support for SDOH

The brief examines the readiness and feasibility for engaging a cross-functional team of providers, researchers, and health IT developers to evaluate guideline recommendations that reference SDOH for standardized CDS implementation. It also includes an example of how technology specifications such as a patient-view CDS Hooks service could suggest the need to conduct a SDOH assessment using clinical guidelines.

Additional resources to explore include

• The ONC 2022 Annual Meeting exhibit presentation, Social Determinants of Health Clinical Decision Support, which illustrates how the HL7 FHIR Clinical Guidelines Implementation Guide (IG) selection process may be applied to evaluate the CDS feasibility of candidate recommendations that are inclusive of SDOH factors.

The 2022 ONC Tech Forum presentation, Developing Clinical Decision Support with SDOH Data for Improved Patient Outcomes, which offers examples and discussion about the different stages of guideline development to determine an outcome of successful CDS that incorporates SDOH.