The Expanding Role of HIM in SDOH Data

Great patient health goes beyond the care they get from healthcare organizations, according to the American Health Information Management Association (AHIMA). These factors include food insecurity, housing status, and transportation needs and are referred to as social determinants of health(SDOH), which significantly affect quality of life, health, and healthcare outcomes.

“When SDOH data is appropriately collected, used, and securely shared, the entire healthcare team can gain insight into various elements that make up a person’s medical and nonmedical story, allowing them to collaborate on improving an individual’s overall health and well-being,” according to AHIMA.

“HIM professionals sit at the pivotal intersection between clinical documentation and revenue cycle management,” says NyEela Harney, RN, BSN, CLNC, product owner at TruBridge. “This unique position makes them ideal champions for SDOH initiatives that can simultaneously improve patient care and organization-wide financial health. By expanding beyond traditional coding functions, HIM departments can leverage SDOH data to drive multiple revenue streams.”

HIM professionals must lead education efforts with clinical teams to ensure consistent documentation of SDOH factors in a manner that supports accurate Z-code assignment.

Frequent mistakes concerning Z-codes include defaulting to general codes instead of specific options, inconsistently applying codes across similar scenarios, and failing to update codes when circumstances change, according to Harney.

“HIM teams can prevent these errors through regular coding education, targeted audits, and condition-specific templates with embedded guidance,” she says. “Reducing assignment errors through bidirectional mapping between screening results and appropriate codes (following Gravity Project terminology standards)streamlines documentation while improving accuracy. When standardized SDOH screening tools automatically suggest specific Z-codes based on positive responses and simultaneously generate clinically relevant health concerns, the connection between coding and clinical care becomes clear. Collaboration with social workers and case managers further ensures documentation accurately reflects the patient’s current social circumstances and connects to relevant clinical conditions.”

According to Harney, beyond fee-for-service billing, SDOH data captured through HIM processes can significantly impact the following:

To maximize SDOH’s contribution to both patient care and revenue optimization, Harney encourages HIM departments to consider implementing a structured approach, including the following:
Standardize collection methodologies:

• Implement validated screening tools integrated directly into electronic health record (EHR) workflows with structured data fields mapped to appropriate Z-codes
• Develop comprehensive coding guidelines: Create facility-specific guidance for consistent SDOH documentation and code assignment
• Establish data governance: Form interdisciplinary committees with HIM leadership to establish standards for SDOH data capture, use, and protection
• Design revenue cycle integration points: Map SDOH data flows to specific revenue cycle touchpoints, including charity care screening, grant application, and payer reporting Create accountability metrics: Develop dashboards tracking SDOH documentation completeness, Z-code utilization rates, and financial impact

HIM professionals should align SDOH data collection with direct patient care applications rather than just compliance goals. This means developing clinical decision support tools suggesting interventions based on SDOH factors, incorporating findings into care huddles, and creating point-of-care reference dashboards, says Harney.

“By implementing integrated solutions where Z-codes trigger specific health concerns and suggested interventions, organizations create a tangible link between documentation and clinical action,” she says. “This integrated approach eliminates duplicate documentation while ensuring proper code assignment, particularly when codes are mapped to specific interventions and follow-up workflows. Soliciting regular clinician feedback ensures focus remains on actionable elements that genuinely impact treatment decisions and community resource connections.”

The biggest barriers to standardized SDOH data collection include inconsistent screening tools, regulatory compliance pressures, lack of interoperability across systems, and missing or inconsistent staff training, according to Harney.

“Without clear, standardized workflows, different departments collect data in silos, creating documentation gaps and reporting inconsistencies,” she says.

HIM leaders should assist and advocate for integrating SDOH documentation into existing workflows rather than adding extra steps. This means implementing” collect once, use many times” approaches, leveraging support staff for initial screening, and creating direct connections between documentation and order sets, according to Harney.

“A powerful approach for gaining clinician buy-in is implementing systems that automatically generate clinical decision support alerts and suggested health concerns when patients screen positive for specific SDOH domains,” she says. “By mapping Z-codes to evidence-based health risks (e.g., food insecurity, Z59.4,triggering nutrition-related concerns or medication adherence warnings), EHR scan provide immediate clinical context that demonstrates the relevance of SDOH documentation to patient care. This automation helps clinicians see SDOH screening not as administrative burden but as a clinical tool that informs their decision-making.”

“Embedding HIM staff within clinical care teams provides real-time documentation support, while interdisciplinary documentation improvement teams with rotating leadership from different departments ensure all perspectives are represented in workflow design and implementation,” she adds.

The most successful collaboration models establish clear role definitions across the care continuum, with HIM focusing on structure and standardization while case management and social work provide content expertise, according to Harney.

“Creating joint documentation templates where SDOH information captured during social work assessments automatically generates appropriate coding opportunities and eliminates duplicate work,” she says. “Regular cross-department documentation quality audits identify opportunities for workflow refinement, particularly around ensuring continuity of SDOH information from identification through intervention and follow-up.”

Critical workflow gaps include disconnects between screening processes and intervention documentation, inconsistent capture of SDOH resolution over time, and limited feedback loops when referrals are made to external organizations.

“Developing standard protocols for SDOH reassessment at key care transition points maintains data currency, while automated tracking systems for community referrals ensure comprehensive documentation of intervention outcomes,” says Harney. “Standardizing discrete SDOH data fields across all care settings facilitates consistent reporting regardless of where information is initially captured.”

Committees should focus on maintaining a clear separation between clinical SDOH documentation and financial screening processes to avoid compliance issues, according to Harney.

Other critical areas include preventing inappropriate use of SDOH data for patient discrimination, establishing protocols for information exchange with community partners that align with information blocking regulations, and developing policies addressing when SDOH information can be used in coverage determinations.

“As value-based care expands, ensuring Z-code documentation supports medicalnecessity without triggering audit flags becomes increasingly important,” saysHarney.

A critical emerging challenge is navigating the increasingly politicized environment surrounding health equity initiatives. As federal policies and priorities shift, HIM professionals must develop frameworks for sustaining SDOH programs amid changing regulatory requirements while preparing for potential reimbursement model adjustments, according to Harney.

As stewards of patient information, HIM professionals must also lead inestablishing appropriate safeguards for SDOH data

Harney recommends the following:

• Implementing enhanced consent processes for sensitive social information
• Creating tiered access controls based on data sensitivity
• Ensuring compliance with evolving regulations around social risk data

“HIM leaders must develop appropriate consent models for sharing sensitiveSDOH information with community-based organizations, many of which aren’tcovered entities under HIPAA,” she says. “Implementing role-based accesscontrols that limit SDOH data visibility based on clinical relevance is essential, asis establishing special protections for highly sensitive factors like domesticviolence or legal problems. Creating transparent patient notification processesabout how SDOH information will be used builds trust while maintainingcompliance with evolving state privacy laws that may impose additionalrestrictions beyond federal requirements.”

HIM leaders should monitor the rapidly evolving regulatory landscape around SDOH initiatives. As of March 4, 2025, CMS announced it will only consider state Medicaid and CHIP waiver applications related to health-related social needs on a rolling basis, pulling back previous guidance from 2023–2024 that outlined opportunities for addressing health equity through these programs.

“This policy shift signals a changing federal approach to health equity initiatives that may impact future reimbursement models,” Harney says. “Despite this uncertainty, commercial payers continue developing enhanced care management payments for providers demonstrating systematic SDOH screening and intervention. Medicare Advantage plans are still incorporating Z-codes in risk adjustment calculations beyond traditional HCCs, while value-based contracts increasingly include SDOH adjustment factors for quality metrics. HIM leaders should prepare for a potentially fragmented landscape where state-by-state variations and commercial payer policies may diverge from federal approaches to SDOH reimbursement.”

Harney says tomorrow’s HIM leaders will need to develop expertise beyond traditional coding and documentation to embrace the following:

• Community partnership data exchange frameworks
• Predictive analytics using SDOH data
• Integration of nontraditional data sources

“As healthcare organizations increasingly recognize SDOH’s impact on both outcomes and financial performance, HIM departments that proactively develop these capabilities will position themselves as essential strategic partners in organizational success,” she says. “By expanding their focus from documentation integrity to revenue optimization through SDOH data, HIM professionals can drive significant value while supporting their organizations’ missions to provide more holistic, person-centered care.”

The ability to map community resources, thereby connecting clinical documentation with available interventions, will be essential, as will political advocacy skills to navigate shifting regulatory landscapes, says Harney.

“Advanced capabilities in natural language processing to extract SDOH insightsfrom narrative documentation will become increasingly valuable as organizationsseek to maximize capture rates,” she adds.

As SDOH becomes central to value-based care, HIM professionals will evolve from documentation specialists to strategic data integrators connecting clinical, financial, and community information systems. This elevation in organizational influence will create new leadership roles in social risk data management and analysis.

“HIM departments will assume greater responsibility for community data partnerships and exchange frameworks, while coding professionals develop specialized expertise in social risk stratification methodologies crucial for performance in alternative payment models,” says Harney.