In the US, 26 million people, approximately 8.5% of the population, have type 2 diabetes. Type 2 diabetes is a major cause of morbidity and mortality in the US, especially among at-risk populations. One area in which HIT would provide new opportunities to improve the health of individuals and communities is in the identification and management of type 2 diabetes. We must also consider place-based SDOH and characteristics of the environment where patients live and assess how such factors affect one’s ability to stay healthy and receive care when needed. Moreover, to truly have an impact, assessment of individual social needs is not enough.
Although health systems are encouraging the uptake of HIT among their practitioners and patients, to advance population health, the application of HIT solutions needs to include the capture, analysis, and dissemination of information on social needs within electronic health records (EHRs).
Health information technology (HIT) offers considerable opportunities to advance the health system’s role in positively affecting the health of high-risk populations and achieving good population health. Thus, advancing population health goes beyond merely documenting clinical diseases and medical interventions. Challenges associated with social needs and SDOH disproportionately affect racial and ethnic minority populations, such as Black individuals, and are critical factors in explaining many health-related disparities, ultimately leading to higher mortality rates among racial and ethnic minority populations and those with low income and poor overall population health. Social needs and place-based social determinants of health (SDOH) greatly outrank medical care in terms of impact on a person’s length and quality of life.
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