Oracle Health’s Nasim Afsar discusses tech and equity in healthcare

Nasim Afsar, chief health officer of Oracle Health

Hospitals and health systems are paying more attention to health equity, including the factors that affect the health of patients in their own neighborhoods.

Oracle Health is working with hospitals to reduce disparities in outcomes. Since completing the $28 billion acquisition of Cerner in June, Oracle has said healthcare is now the company’s primary focus.

In an interview with Chief Healthcare Executive, Nasim Afsar, chief health officer of Oracle Health, discussed the organization’s work to identify the health needs in different neighborhoods. She also outlined how hospitals and health systems can improve health equity.

Why do zip codes play such an outsized role in a person’s health?

We all know that clinical factors aren’t the only influence on a person’s health and wellness. Where you live by country, by state, and even by neighborhood makes a profound difference. That’s why it’s important to bring social determinants of health into the EHR (electronic health records). Zip codes can tell us a lot about a person and are often indicative of the available resources in a community as well as people’s access to health clinics or to grocery stores with fresh, healthy fruits and vegetables. They also reflect income levels, with housing security and access to public transportation. These are all factors that play a critical role in an individual and community’s health and care.

How are we only recently seeing the role of one’s neighborhood as a key factor affecting health?

This is definitely not a new or recent phenomenon. For decades, public health experts, researchers and clinicians have seen the impact of zip codes on the health of individuals in communities across the globe.

However, over the past decade, as more medical records have been digitized and we are asking for and capturing more of these elements, we are able to have a better data-driven understanding and approach to the true impact of these indicators on health. Proactive relationships between health systems and communities help broaden healthcare and can be a game-changer. Data-driven insights should be integrated into the EHR to help providers identify those who might be at a health risk, food and housing insecurities and other factors.

How does Oracle Cerner’s Determinants of Health solutions help providers improve their health care and move closer to health equity?

Our job at Oracle Cerner is to create tools that enable clinicians to get back to what matters most – caring for patients. We have a real opportunity to not only raise awareness of but to also examine and identify how we can eliminate inequities today and into the future.

Rich data sets, dashboards and technologies such as Oracle Cerner’s data and insights platform can help providers access clinical, behavioral and social data about patients in one place, identify existing disparities and suggest community resources as part of a patient’s care plan.

Oracle Cerner’s Determinants of Health can help providers conduct community needs assessments to proactively address social risk factors. At the population level, you can see social risk factors like transportation barriers, food insecurity or housing instability all broken down by demographics. In June 2022, we added a new feature - the ability to zoom in to neighborhood groupings of 600 to 3,000 people to better understand and target social risk.

Why is this new capability so important? Consider Wyandotte County in Kansas – in the tool, you can see the entire county is coded red for being at high risk due to social factors such as lack of health insurance and a high prevalence of gaming and alcohol establishments. But that’s not the full story. The tool also shows that the eastern part of the county makes up most of this at-risk population. With this enhanced data, healthcare organizations can more accurately tailor and target their outreach and intervention programs.

What should hospitals and health systems be thinking about when it comes to “techquity”? Technology shouldn’t be something we think about – yet it should seamlessly connect to the most relevant data at the right time so clinicians can focus on the purpose of healing through compassionate connections with their patients. Technology and data insights are being used today to address health disparities, to prevent bias in care delivery and ultimately help improve overall outcomes in communities. Clinicians can look to understand how they can leverage a person’s social risk factors to provide proactive interventions that improve health and care. Many current systems are focused too much on reactive responses. Leveraging data enables us to be more proactive and prevent or minimize illnesses and diseases.

The Oracle Cerner Determinants of Health solution helps organizations advance whole person care by identifying and intervening on social risk factors through action-oriented community analytics and social determinants of health capabilities embedded within care management workflows.

Can you offer a little more insight on how geospatial modeling identified patients at risk for diabetes and hypertension at an African American church in South Carolina?

Roper St. Francis Healthcare, using geospatial mapping within Oracle Cerner technology, analyzed publicly available information and identified other institutions that patients frequent, such as churches. In collaboration with the Roper St. Francis Healthcare chief diversity and inclusion officer, the analytics team cross-referenced African American patients that had a high prevalence of diabetes and hypertension with the location of churches they attended. Working with the church, the chief diversity and inclusion officer provided literature, engaged church leaders and identified nurses who were members of the congregation to conduct screenings and outreach. This helped the system to step outside of the four walls and help ensure that community members received care in environments they trusted, ultimately impacting their health for the better.

Can you share more about the screening tool used to help the University of New Mexico Health Sciences Center spot the tie between social determinants and poor health outcomes in the diabetes population?

Within its Oracle Cerner platform, the University of New Mexico Health Sciences Center uses a screening tool to determine the correlation between adverse social determinants and poor health outcomes in populations with diabetes and other chronic conditions. The results led the organization to hire community health workers for its primary care clinics and its emergency room, to help make a more positive impact in vulnerable patient populations. Their Office of Community Health plays a vital role in advancing health and health equity, recognizing social determinants, such as housing, education, food, transportation, utilities, income and social inclusion, play a far greater role in health.

Where should hospitals or health systems start on health equity efforts?

Improving the health of populations without understanding the conditions in which they live is a difficult undertaking. Having accurate, localized community data within the EHR is crucial to addressing social risk factors and improving community health. This same data can also be used to advance health equity – a specific focus of many of our health systems here in the U.S.

What can smaller hospitals or health systems with more modest resources do to use data to address disparities?

Addressing inequities in healthcare is not easy, whether you’re a critical care hospital or a large integrated delivery system. And we have developed the Learning Health Network. Today a group of more than 100 health systems from 43 states, including small community hospitals and academic medical centers, share de-identified EHR data for the purpose of advancing clinical research. More than half of the health network members are small critical access hospitals who now have the chance to bring clinical studies to their rural communities. Healthcare is about people helping people – and the Learning Health Network is a very definition of that.

By design, diversity has become the Learning Health Network’s superpower. Clinical trials that run through the health network have three times the national average of Black and Hispanic participants. Take for example, Osmond General Hospital - a 20-bed critical access hospital in rural Nebraska. For the first time ever, they enrolled in their first clinical trial earlier this year for early detection of colorectal cancer. One of their patients who qualified for the study tested positive on her at home screening test. This prompted her to go in for a colonoscopy which confirmed a diagnosis of cancer. She is now undergoing treatment potentially years earlier into the disease.

This example brings to life the major benefit of the Learning Health Network – and how caregivers and patients are able to access leading therapeutics, diagnostics and medication sooner.

How do you ensure technology solutions to improve health equity don’t actually exacerbate disparities?

This is an area of increasing assessment and work for all of us in the healthcare industry. Data that’s entered into electronic health systems can reflect societal bias. Therefore, machine-learning algorithms that build off of data, can reflect and exacerbate disparities. To eliminate this, we have to take a proactive approach on multiple levels, including education at the delivery side to ensure we are bias-free in our documentation and data collection, and active monitoring and surveillance to ensure we are looking for and eliminating bias when identified in systems. This requires broad conversation and commitment from all of us.

How should hospitals and health systems work with the community in addressing health disparities?

Despite commitment across healthcare organizations to address health disparities, some have found it hard to detect and address inequities. An important step is to build relationships and infrastructure to support community engagement - something that historically hasn’t been considered. We haven’t always looked to what happens in clinics and hospitals without considering the full picture. However, what happens outside the doctor’s office and in daily life can influence decisions we make and opportunities we have. Robust, thriving relationships can help communities together understand how to identify gaps and address them to ensure better health and care for individuals, communities, and neighborhoods.