Using the cloud to better understand and address social determinants of health

Telehealth solutions have exploded in popularity over the last year due to COVID-19. According to FAIR Health and the American Medical Association, telehealth use saw a nearly 3000% growth from pre-pandemic to during the pandemic. These services make virtual, real-time interactions between patient and provider possible. However, the great promise of telehealth has highlighted existing roadblocks that some face when trying to access healthcare in this country. Federal Communications Commission (FCC) data shows nearly 30 million Americans cannot reap the benefits of telehealth due to lack of broadband access.

The National Health IT Collaborative for the Underserved (NHIT) is a 501(c)3 non-profit organization on a mission to provide equitable access to health technologies and to make sure that these technologies address the needs of underserved communities and communities of color. Since its founding in 2008, NHIT has worked to advance health equity and economic viability on issues such as broadband access, electronic health records, precision medicine, consumer health applications and disaster resiliency.

In support of this mission, NHIT recently launched the Data Fusion Center, built on the Tyler Technologies Socrata platform that runs exclusively on Amazon Web Services (AWS), to help tackle intergovernmental data challenges and to translate social determinants of health (SDoH) data into actionable insights. The Center pulls together de-identified, aggregated, and publicly available data and tools that allow for a granular understanding of SDoH—conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes. Examples of SDoH include safe housing, transportation, education, access to nutritious foods, polluted air and water, and more. Through the Center, industry, academia, and communities can discover, explore, and visualize SDoH and health equity-related factors and their impact. For example, a user could pull a report looking at broadband access, transportation and food insecurity, and layer those data sets on top of one another to get a more nuanced understanding of how these different SDoH data points (or sets) interact.

The Center includes validated SDoH data and other correlated data sets at the US national, state, and county levels from all of the major federal agencies including Health and Human Services (HHS), Department of Agriculture (USDA), Federal Communications Commission (FCC), Bureau of Economic Analysis (BEA), Centers for Medicare and Medicaid Services (CMS), the Department of Homeland Security (DHS), and more. Data from these and all federal and state agencies are further enriched with additional meta-data from private industry partners.

The platform also includes capabilities to make the contextualization of information user-friendly, updates data frequently, and allows for users to search by zip code or census tract level where possible. Users can create their own visualizations that range from simple (histograms and tables) to complex (geospatial data) data types and styles, and data stories that can be shared and open-sourced to the larger community. Since its launch in January 2021, the Center has ingested, cleaned, and published approximately 100 million rows and 3,500 features (and counting) of traditional and non-traditional information.

This kind of sophisticated, large-scale data storage and analysis requires massive computing power, and AWS helps make that possible. To meet these needs, NHIT utilizes AWS technologies such as Amazon Simple Storage Service (Amazon S3), AWS Glue, and Amazon Athena to help manage the consumption and processing of an ever-growing set of data assets at a predictable, low cost.

“With support from AWS, NHIT for the first time is able to bring together many disparate public and private data sources and make that data available to a wide array of stakeholders in a way that allows them to take action. If it weren’t for the power of the cloud, policymakers, innovators, data scientists, and academic institutions would have to go through the work of consolidating and cleaning this data on their own, which could take hundreds of hours,” said Luis Belen, chief executive officer (CEO) of NHIT.

Users are already leveraging this data to conduct critical research and make an impact in their communities. Recently, NHIT partnered with the American Telemedicine Association, telehealth platform Hims & Hers, Howard University, National Digital Inclusion Alliance and almost 100 other organizations to launch the Telehealth Equity Coalition, a data-driven project to review public data on telehealth adoption in communities across the country. The Coalition is leveraging the Data Fusion Center to empower their members with actionable insight and stories that resonate with their communities and their local governmental, civic, and educational leaders.

“We launched the Telehealth Equity Coalition to improve access to quality, affordable healthcare by increasing adoption of telehealth, especially among those who have been left out or left behind. Together with nearly 100 nonprofit, academic, and industry partners, we are leveraging unique data insights from the NHIT Data Fusion Center to guide our agenda and drive for equitable telehealth delivery and utilization,” said April Mims, vice president of public policy at Hims & Hers (Telehealth Equity Coalition founding member).

In addition, graduate student fellows from the Applied Health Informatics program at Stony Brook University used the Data Fusion Center to conduct an analysis titled “COVID-19 Deaths in Relation to Social Determinants of Health Factors.” Among other findings, their analysis showed that internet access may also have a positive correlation with COVID-19 deaths: as the number of households without internet access increases in Georgia, Florida, and Louisiana, so does the COVID-19 death count. Tulane University School of Public Health and Tropical Medicine and Howard University’s Department of Community and Family Medicine are two additional academic institutions using the Data Fusion Center with their faculty and students.

“Being able to harness the power of cloud computing from AWS with extensive data about social determinants of health has the potential to be a game-changer in public health,” said Thomas LaVeist, PhD, dean of the Tulane School of Public Health and Tropical Medicine and Weatherhead Presidential Chair in Health Equity. “We are excited to be able to make this data accessible to our faculty and students who are working to improve health outcomes and eliminate barriers to health equity.”

“The Department of Community and Family Medicine has been working with NHIT for several years, in part, because our missions mesh well. We look forward to continuing our collaboration by using the Data Fusion Center to explore patterns related to health disparities that can lead to improved health outcomes and expanding educational opportunities for our trainees,” said Mark S. Johnson, MD, MPH, Professor and Chair, Dept. Community and Family Medicine, Howard University.

Students at Stony Brook University used the Data Fusion Center to analyze the correlation between the number of individuals aged 25+ with a high school education with COVID-19 deaths in Georgia, Florida, and Louisiana. As the number of people without a high-school diploma increases, so does the COVID-19 death count.

In the coming months, NHIT plans to continue building out capabilities of the Fusion Center to solve other issues of transportation, food security, and broadband access that contribute to social determinants of health. If you are interested in learning more about the NHIT Data Fusion Center and its potential applications for your organization, please contact data@nhitc.org.

Tyler Technologies is a member of the AWS Partner Network. Tyler’s Socrata data platform runs exclusively on AWS and is used across federal, state, and local governments to improve the discovery, access, and collaboration of data. The Socrata data platform enables government leaders to rapidly modernize their organization’s data infrastructure in a FedRAMP secure environment.

To learn more about AWS’s support of the Data Fusion Center and/or our work supporting global public health initiatives, please contact us at aws-global-social-impact@amazon.com.