I am sharing this to keep my promise to develop a health equity analytic architecture that promotes health equity and related decision-making. It took time and effort to frame this, and I’m finally sharing it with everyone.
I am proposing a health equity analysis architecture based on the loopholes in the HL7 FHIR SDOH Clinical Care Implementation Guide developed by the Gravity Project, since the UK, Canada, Australia, New Zealand, and European nations have adapted their own version based on it. The HL7 FHIR SDOH Clinical Care Implementation Guide is the de facto USA standard for capturing and exchanging social determinants of health (SDOH) data at the point of care. It defines how screening responses, social risk diagnoses, goals, referrals, and interventions move between electronic health records [EHR] and community-based organizations using Fast Healthcare Interoperability Resources [FHIR], such as Observation, Condition, Goal, ServiceRequest, Task, Consent, and Healthcare Service.
However, this guide was built to standardize clinical workflow and data at the point of care by defining a transaction contract for one patient, one encounter, and one referral at a time. It offers no opinion on aspects of what an ideal health equity analytics platform requires. For instance: Longitudinal storage, community-level data enrichment, disparity measurement, bias-aware modeling, or formal governance guardrails. So, this proposal provides a new target architecture that keeps the IG as the ingestion standard while adding the layers needed to turn point-of-care SDOH data into reliable, fair, and actionable equity insight.
I applied this proposal to Sweden’s Universal, high-quality, and publicly funded health care system. I noticed that, unlike the hardest problem in health equity analytic platform architecture in the USA, Sweden has its own set of national registers and reporting tools, not a single health equity analytic platform. The Personnummer identity system, nearly 100 National Quality Registries, the National Patient Register, Statistics Sweden’s socioeconomic registers, and the Öppna Jämförelser [Open Comparisons] reporting tool, jointly run by Socialstyrelsen and SKR. These data sets resolve the primary issue of data linkage to a unique identity, providing precise data for analytical capture, and enrich these data with community context, as Sweden’s health equity focus moved to a different set of harder problems of digital literacy, health access among immigrant populations, and north –south regional disparities.
I observed that Sweden’s reputed, robust universal health system needs to address gaps in explicit fairness monitoring, bias-aware missingness handling, and formal governance guardrails to achieve health equity, as this proposed architecture comparison shows.
What do you say about this architecture? This is a brief overview of the architecture; I will share details in the following blog posts. Until then, take care and be optimistic, because change is happening for everyone’s good health, wealth, and success.
Leave a Reply