Table 2.
Maturity level descriptions for the five domains of the social and environmental determinants of health informatics maturity model (SIMM)
| Level | Description |
|---|---|
| Domain 1: Data collection policies | |
| Level 1: Absent | Institutions are not collecting SEDoH data (collecting demographics, such as race and ethnicity, does not qualify as SEDoH data collection). No well-defined, operational data collection policies in the organization. |
| Level 2: Ad Hoc | Ad hoc. No policies exist yet but various groups in the organization are collecting SEDoH data inconsistently. |
| Level 3: Emerging | Individuals with consistent SEDoH data collection practices. |
| Level 4: Coordinated | Certain groups, like clinics within a division (e.g., labor and delivery clinic), have standardized policy for SEDoH data collection. |
| Level 5: Supported | Standard policy for SEDoH data collection exists at the division level of an organization (e.g., Division of Obstetrics and Gynecology). |
| Level 6: Integrated | Few departments/ sections within a division of the organization (e.g., Department of Medicine) have a standard policy for SEDoH data collection. |
| Level 7: Transformative | Standardized data collection policy for SEDoH exists at an organizational or institutional level. |
| Domain 2: Data collection methods and technologies | |
| Level 1: Absent | Paper-based SEDoH data collection. |
| Level 2: Ad Hoc | Electronic data collection that is not part of the EHR or it is being done for research only. |
| Level 3: Emerging | SEDoH data are unstructured and free-texted within the EHR. |
| Level 4: Coordinated | Electronic, structured SEDoH data collection using a third-party platform such as Purple Binder or native solutions such as Qualtrics. Data collection is not integrated into clinical workflow. |
| Level 5: Supported | EHR-linked, structured data collection. For example, using the SDOH Wheel in Epic or Cerner Determinants of Health to intervene at the point of care using evidence-based screening tools and gain a better understanding of the social risk factors impacting your patient population. |
| Level 6: Integrated | Integrating historical data from external sources (e.g., USDA, EPA, ACS)** |
| Level 7: Transformative | Dynamic query of external sources** to bring in real-time or near-real-time actionable information. |
| Domain 3: Technology platforms for analysis and visualization | |
| Level 1: Absent | No specific technology platforms are used for SEDoH data analysis and visualization. |
| Level 2: Ad Hoc | Non-EHR, basic software is used for data visualization and performing analysis (e.g., Excel) |
| Level 3: Emerging | Non-EHR, interactive visual analytics platform in use(e.g., Power BI or Tableau) |
| Level 4: Coordinated | Analytics and visualizations are embedded in the EHR, that is, EHR-linked (HL7 or FHIR integration) analytics platform. This is non-actionable, read-only information, like a PDF where you are presenting the information to the user but there is no specific pathway that is triggered by that information. |
| Level 5: Supported | EHR-linked integrated and interactive analytics capability. This means that the information is actionable (e.g., it can trigger a CDS pathway or an order for a social work consult) or it creates a structured data field, such as a risk profile, that can be used to identify risk and group patients. |
| Level 6: Integrated | EHR-based integrated analytics and population health platform in use to support specific care management goals. |
| Level 7: Transformative | EHR-based integrated analytics and population health platform, enriched with external feed, such as ACS data or USDA data. |
| Domain 4: Analytics capacity | |
| Level 1: Absent | Data within the technology platforms is not being used for analysis. |
| Level 2: Ad Hoc | Standardized terminology is used to represent SEDoH concepts and data elements across the institution. |
| Level 3: Emerging | Internal reporting of SEDoH data, that is, reports and dashboards are created for internal consumption of the institution. |
| Level 4: Coordinated | Creating reports and dashboards for external agencies (for community benefits requirement, for federal agencies, etc.) |
| Level 5: Supported | SEDoH data are being used for waste and care variability reduction. |
| Level 6: Integrated | SEDoH data are being used for population health management, for example, identifying high-risk patients for targeted interventions. |
| Level 7: Transformative | SEDoH data inform precision medicine and prescriptive analytics initiatives resulting in a learning healthcare system. |
| Domain 5: Operational and strategic impact | |
| Level 1: Absent | Leadership is not committed to SEDoH data initiatives. |
| Level 2: Ad Hoc | SEDoH data are presented for research or projects only. |
| Level 3: Emerging | Presenting SEDoH data at point of care to help clinicians make clinical decisions. |
| Level 4: Coordinated | SEDoH data inform department or division or clinic decisions within an organization (e.g., use of heat maps to assess high-prevalence asthma areas for establishing outpatient clinics). |
| Level 5: Supported | SEDoH services center (infrastructure and operational unit) that operates to support patient-specific SEDoH needs and delivery of services to address SEDoH. |
| Level 6: Integrated | SEDoH data guide programmatic implementation, that is, all organizational decisions (not just specific SEDoH initiatives) take into consideration the SEDoH data about the target population. For example, hiring Spanish staff for a population with 30% Spanish patients. |
| Level 7: Transformative | SEDoH data influence strategic and financial decisions at the highest organizational level. Organizational leadership is committed and makes decisions based on SEDoH data, including allocation of significant financial resources. |
ACS = American community survey; = clinical decision support; CDS PDF = portable document format; EPA = Environmental Protection Agency; FHIR = fast healthcare interoperability resources; HER = electronic health record; HL7 = health level 7; SEDoH = social and environmental determinants of health; USDA = United States department of agriculture.
Data sources for social and environmental determinants of health (SEDoH) informatics maturity model include Person-level data (SEDoH data about an individual, ideally self-reported, and often collected using standardized and validated instruments) and Contextual data (Data about the environments in which a patient lives). All of the levels and descriptions outlined below apply to both personal and contextual data, except where noted.
**Primarily for contextual data, but also personal data where relevant;, patients are providing personal-level SDoH data to some other entity, and the health system in question is integrating it into their data.