Methods for development and application of data standards in an ontology-driven information model for measuring, managing, and computing social determinants of health for individuals, households, and communities evaluated through an example of asthma

J Biomed Inform. 2022 Dec:136:104241. doi: 10.1016/j.jbi.2022.104241. Epub 2022 Nov 11.


Objective: To describe methods to approach application of data standards to integrate social determinants of health (SDoH) into EHRs through evaluation of a case of clinical decision support for pediatric asthma.

Materials and methods: We identified a list of environmental factors important for managing pediatric asthma. We identified and integrated data from local outdoor air quality monitors with elements available from the clinic's EHR and self-reported indoor air quality questionnaire data. We assessed existing SDoH frameworks, assessment tools, and terminologies to identify representative data standards for these environmental SDoH measures.

Results: We found many-to-many relationships between the multiple framework domains, the environmental exposure measures collected, and existing standards. The majority of concepts did not accurately align with environmental exposure measurements. We propose an ontology-driven information framework methodology to apply standards for SDoH measurements to support measuring, managing, and computing SDoH data.

Discussion: To support methods of integrating SDoH data in the EHR via an ontology-driven information framework, a common SDoH ecosystem should be developed descriptively and prescriptively integrating framework domains, assessment tools, and standard ontologies to support future data sharing, aggregation, and interoperability. A hierarchical object-oriented information model should be adopted to manage SDoH to extend beyond patient-centered orientation of EHRs to orient to households and communities.

Conclusion: SDoH data pose unique challenges and opportunities in collecting, measuring, and managing health information. Future work is needed to define data standards for implementing SDoH in a hierarchical, object-oriented information model representing multiple units of orientation including individuals, households, and communities.

Keywords: “Asthma; “Electronic Health Records; “Information Model; “Ontologies; “Social Determinants of Health; “Terminologies.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma* / diagnosis
  • Asthma* / therapy
  • Child
  • Decision Support Systems, Clinical*
  • Ecosystem
  • Humans
  • Social Determinants of Health
  • Surveys and Questionnaires