By OPEN MINDS Circle

Researchers have proposed a framework and a roadmap for learning health systems (LHS) to advance equity in digital health care delivery by integrating data for social determinants of health (SDOH) into electronic health records (EHRs) and value-based models. The framework calls for enabling services, community partnerships, policy advocacy, and direct investments in social infrastructure while aligning health care providers, policymakers, researchers, and technology developers. LHS were defined as engaged in continuous improvement using data and evidence to drive care delivery changes. The framework addresses the individual level, the organizational level, and policy and system levels.

The framework is intended to provide tools to health care systems to address immediate barriers and to drive structural change for achieving digital health equity within LHS to enable access to and benefits from digital health innovations. Recommended solutions integrate individual and structural changes, including digital literacy training, broadband infrastructure investment, and equitable policy reform.

Recommendations also include offering financial incentives tied to equity outcomes, supported by standardized SDOH data collection in EHRs, and tied to community resource referral platforms that provide real-time tracking and links to resources while generating data that can guide health care policies.

The paper cited the lack of systematic integration of SDOH data with EHRs as a barrier to equity, describing SDOH initiatives and interventions that are unsustainable, non-replicable, and unable to scale effectively across populations. Without consistent SDOH-EHR integration, health systems are limited in their ability to identify at-risk populations or design appropriately targeted interventions, the researchers stated.

Strategic, long-term recommendations to align SDOH with EHRs and value-based care to support digital health equity include:

• Investments in broadband infrastructure, universal digital access policies, and community-level digital literacy programs.
• Health care organizations must prioritize equity-centered practices, cultivate partnerships, and employ iterative learning to scale and sustain effective interventions.
• Policymakers must foster enabling environments through incentives, infrastructure investments, and equity-focused accountability mechanisms.
• Researchers can refine evidence-based strategies to ensure interventions are effective and adaptable across populations.
• Technology developers must address barriers such as digital literacy, language accessibility, and connectivity to support equity.

To achieve the goals of the quintuple aim—optimizing consumer experience, improving population health, supporting provider well-being, lowering costs, and advancing health equity—short-term interventions were judged insufficient. Food assistance or temporary housing referrals are not a permanent remedy for housing affordability or employment instability, the researchers stated. Similarly, distributing smartphones or promoting telehealth, while useful, do not address low digital literacy rates or limited broadband connectivity.

The framework’s four key strategy levers (services, partnerships, policy advocacy, and direct investments) can create lasting impact, according to the researchers. Health systems should embed equity into the design and operation of care processes rather than treating equity as a downstream byproduct, researchers recommended. A more intentional approach to equity can address individual barriers and upstream structural drivers, such as digital infrastructure, policy constraints, and resource allocation.

These findings were reported in A Multi-Level Framework For Advancing Digital Health Equity In Learning Health Systems: Aligning Practice And Theory With The Quintuple Aim by Pavani Rangachari, Khadija Al Arkoubi, and Rajaa Shindi. The researchers presented a path for health systems to achieve digital health equity, which they defined as ensuring health care consumers can fully access and benefit from digital health innovations.

The full text of A Multi-Level Framework For Advancing Digital Health Equity In Learning Health Systems: Aligning Practice And Theory With The Quintuple Aim was published on October 7, 2025, by International Journal for Equity and Health (accessed November 24, 2025).

OPEN MINDS last reported on this topic in Just 34% Of All Hospital/Health System Initiatives Used An EHR To Collect SDOH Data on May 12, 2025.

For more information, contact: Pavani Rangachari, Ph.D., CPH, Professor of Healthcare Administration & Public Health, Department of Population Health and Leadership, University of New Haven, 300 Boston Post Road, West Haven, Connecticut 06516; 203-479-4274; Email: PRangachari@newhaven.edu.