Social and Health Information Platform: Piloting a Standards-Based, Digital Platform Linking Social Determinants of Health Data into Clinical Workflows for Community-Wide Use.

BACKGROUND: Social determinants of health (SDoH)a are increasingly recognized as a main contributor to clinical health outcomes, but the technologies and workflows within clinics make it difficult for health care providers to address SDoH needs during routine clinical visits. OBJECTIVES: Our objectives were to pilot a digital platform that matches, links, and visualizes patient-level information and community-level deidentified data from across sectors; establish a technical infrastructure that is scalable, generalizable, and interoperable with new datasets or technologies; employ user-centered codesign principles to refine the platform's visualizations, dashboards, and alerts with community health workers, clinicians, and clinic administrators. METHODS: We used privacy-preserving record linkage (PPRL) tools to ensure that all identifiable patient data were encrypted, only matched and displayed with consent, and never accessed or stored by the data intermediary. We used limited data sets (LDS) to share nonidentifiable patient data with the data intermediary through a health information exchange (HIE) to take advantage of existing partner agreements, technical infrastructure, and community clinical data. RESULTS: The platform was successfully piloted in two Federally Qualified Health Clinics by 26 clinic staff. SDoH and demographic data from findhelp were successfully linked, matched, and displayed with clinical and demographic data from the HIE, Connxus. Pilot users tested the platform using real-patient data, guiding the refinement of the social and health information platform's visualizations and alerts. Users emphasized the importance of visuals and alerts that gave quick insights into individual patient SDoH needs, survey responses, and clinic-level trends in SDoH service referrals. CONCLUSION: This pilot shows the importance of PPRL, LDS, and HIE-based data intermediaries in sharing data across sectors and service providers for scalable patient-level care coordination and community-level insights. Clinic staff are integral in designing, developing, and adopting health technologies that will enhance their ability to address SDoH needs within existing workflows without adding undue burdens or additional stress.

FHIRedApp: a LEAP in health information technology for promoting patient access to their medical information.

OBJECTIVE: Our aim is to develop a patient engagement technology that makes it easy for patients to access their own medical information and share it with others. MATERIALS AND METHODS: This paper describes our design through an adapted Community Engagement Studio methodology to identify the needs and preferences of a diverse group of Latinx, African-American, and Asian-American individuals in the community. We use Human-Centered Design to interpret these needs and preferences to build a digital app platform, using national data standards, clinical data aggregators, and privacy-preserving solutions while maintaining the security and confidentiality of patients. RESULTS: We designed and developed FHIRedApp, an app platform, that allows patients to access their data and to share that access as HL7® FHIR® application programming interfaces with third-party app developers. We accomplished 2 major tasks: first, to demonstrate the use of interoperability and authentication standards, such as HL7® FHIR and OAuth2, to help develop patient engagement technologies, and second, to co-develop and co-design FHIRedApp with active involvement of African-American, Latinx, and Asian-American community members. Usability results show high satisfaction rates for FHIRedApp. CONCLUSION: The development of FHIRedApp demonstrates how technology innovations using national interoperability standards can be informed through a methodology of community engagement and human-centered design that involves local racial and ethnic groups.