Hurricanes Harvey and Irma provide good illustrations of how important it is to document and code the social determinants of health (SDoH). There are multiple predictive models using demographic (U.S. Census), social, and economic data. In healthcare, data is collected either from the financial databases (for which ICD-10 data is key) or from more labor-intensive methods such as chart review and other studies.
There is unrealized potential for real-time data collection within the clinical documentation integrity (CDI) and medical coding communities. In these days and weeks ahead, coinciding with the post-disaster recovery efforts in both Texas and Florida, it is very important that healthcare professionals capture this information for several reasons. These include the following:
Problems related to other psychosocial circumstances: Z65.5, Exposure to disaster, war and other hostilities; Z64.4, Victim of crime and terrorism (if the patient is a victim of looting;
Occupation: They may be exposed to toxic agents, as in the case of the area where explosions shook a flooded chemical plant near Houston last week (Z57.5);
Problems related to housing and economic circumstances: Lack of adequate food and safe drinking water (Z59.4); insufficient social insurance and welfare support (Z59.7);
- This data is reflective of an untapped real-time ability to connect actual health issues with SDoH so that healthcare systems can prepare more for future disasters going forward.
- Traditionally, only physical manifestations of disaster have been acknowledged. But there currently exists the opportunity to link the additional layers of SDoH. If the patient’s psychological effects are also identified in the chart, it can be of great use as well. For example, in the past if patient presented to the ER after sustaining a laceration as a result disaster, the link would be made; however, the link to the SDoH is less clear when patients present to the ER for non-cardiac chest pain or shortness of breath, which may be a result of anxiety. Statisticians may find meaningful inference from the SDoH.