Community services can now replace medical prescriptions — but this will require organizations to share data.

This independent journalism on data, digital transformation and technology for social impact is made possible by the Future of Good editorial fellowship on digital transformation, supported by Mastercard Changeworks™. Read our editorial ethics and standards here. 

At the Askennonia Senior Centre in Midland, Ontario – the traditional land and treaty territory of the Anishinabek people, now known as the Chippewa Tri-Council, comprised of the Beausoleil First Nation, Rama First Nation, and the Georgina Island First Nation – one volunteer, Mary Moreau, runs Reach Out and Touch Someone. It’s a program supporting older adults with complex health, social and financial needs. 

Moreau has a background in social work, and develops individual, tailored care plans with program participants. She prescribes a range of non-medical interventions to help older adults to manage their health and wellbeing, recognizing that a person’s health is often affected by external circumstances that are outside of their control. In one instance, she “prescribed” a small amount of funding to help repair a participant’s broken refrigerator.

What if, in a similar vein, people could be prescribed a gym membership, a food box from a community kitchen, or a music therapy session, in order to better handle their physical health and wellbeing? This approach, called social prescribing, recognizes that health problems are often linked to social and environmental stressors. 
 

What is social prescribing?

For social prescribing to work, a link worker – a liaison between healthcare providers and social or community organizations – should be able to access data about a person’s health status, as well as social and economic factors that might be impacting their health. The link worker can then make an assessment on how community services – including food banks, youth groups or housing providers – could positively impact that person’s health outcomes. 

Social prescribing requires health providers and community organizations to share data with link workers, and on occasion, between each other as well. However, for many community organizations, data gathering and sharing is still not enough of a priority. 

The practice of social prescribing is starting to become formalized within Canada, with the launch of the Canadian Institute for Social Prescribing (CISP) earlier this year. With funding from the Public Health Agency of Canada, CISP is anchored by the Canadian Red Cross. The Institute acts as a national hub for advancing social prescribing and non-medical interventions to healthcare, as well as educating healthcare providers, community organizations and link workers on how to get involved in the practice. 

People going to a primary care doctor to deal with loneliness, isolation and the associated health and wellbeing impacts, can be diverted to services and social groups within their community, says Dr Kate Mulligan, senior director at CISP. That can reduce the pressure on – and ultimately the cost of – health services as well. 
 

Why is good data critical for social prescribing to work? 

The definition of a ‘community organization’ in the context of social prescribing can be quite wide ranging, Dr Mulligan adds. “These are organizations that can impact the social determinants of health, but aren’t funded by the health systems,” she says. 

“They’re neighbourhood-level organizations that support social services, such as childcare centres, building associations, immigrant service centres and even services like parks.” 

The data accessed from a community organization will depend on the work that it does, and how regularly the organization interacts with the person who needs a social prescription. For example, a social or community housing provider might be able to provide a link worker with data on a person’s living circumstances, which might be contributing to both wellbeing and financial challenges. A youth group, on the other hand, might be able to offer insight into a young person’s family situation and educational attainment, which could both be impacting their health and stress levels. 

Armed with this data about a person’s circumstances, healthcare providers and link workers are then able to refer clients to social and community services that can help them manage the stresses on their physical and mental wellbeing. That could include referring people to the necessary housing or unemployment services, or encouraging them to join an activity group on a regular basis to tackle isolation. 

However, according to research by the UK-based consultancy Frontier Economics, “there are a number of barriers to social prescribing reaching its full potential, amongst them the lack of available data, and solid data infrastructure; information such as statistics, maps and real-time service-use data that could help link workers and providers of services to make decisions, build services and gain insight.”

Local authorities, health and nonprofit organizations operate completely separate directories of local services that could be used by link workers in their social prescribing practice, the research adds. That information also isn’t frequently updated to reflect which services are still running and what their capacity is to take on new clients. Frontier Economics adds that this undermines trust for everybody in the system, including healthcare providers, community organizations, link workers, and crucially, clients. 

The healthcare sector is fairly sophisticated when it comes to tracking patient data, Dr Mulligan says. Community organizations, on the other hand, are often lagging behind when it comes to building this data-gathering process, which makes social interventions hard to track, she adds. The two sectors need to be able to build up internal data gathering capacity and data sharing policies in order for social prescribing to work. 

For the handful of community organizations that are collecting data actively, they are still relying on paper-based systems, the CISP team says. “Many people working in health and community organizations aren’t used to having to collect data – it’s not a part of their usual practice,” Dr Mulligan adds. “It’s about education, training, practice and understanding the benefits of doing it.”

Sonia Hsiung, director at CISP, warns against gathering data for data’s sake as well: “People are tired of giving input and not seeing it go anywhere. The data needs to be fed back and meaningfully evaluated for community organizations.” 

Katie Gibson, co-founder of the Canadian Centre for Nonprofit Digital Resilience echoes this: “It’s important for organizations to ask themselves the question of if the person whose data is being collected is benefiting from it, and if not, why not?”
 

Why is data sharing still a hurdle for community organizations? 

Community Connectors, who work with older adults at Fraser Health Authority in British Columbia, found that there was an opportunity to “share information between organizations to create proactive care plans for vulnerable individuals ahead of climate emergencies (e.g. heat domes.)” However, for many community organizations, even those that gather client data, sharing that information in a timely manner – with client privacy and sensitivity in mind – is another hurdle to overcome.

One of the first logistical challenges in sharing data between healthcare providers and community organizations is standardization. In other words, are both organizations using the same indicators or definitions for certain data points? “One organization may have already defined who a ‘youth’ is, while the other organization might be using a completely different age range,” says Gibson.

Then there is the need for more awareness among community organizations about data privacy issues, particularly when it comes to sharing an individual’s personal data or health data. Hsuing suggests investing in low-tech methods for community organizations with low resource capacity or data skills: among them, she suggests ‘coding’ client data to preserve anonymity, storing the codes in a separate Excel database. 
 

Where back-end technology can support community organizations and link workers

Like Hsiung, Dr Mulligan suggests that community organizations keep things extremely simple to start with when embarking on a data gathering and sharing journey. “We need technology to support social prescribing and keep databases up to date. Technology is a tool for enabling good relationships between sectors, as well as learning from frontline services, feeding back, and improving and pivoting services.”

“e-Health services and technology can be complex, but it’s more important to keep the technology simple, well-governed and safe. We can build sophistication as we go. Otherwise, we’ll just have to keep starting from scratch,” she adds.

The more complicated the technology, the more it costs a community organization to implement. More time is also required to train staff up in using and managing complex data capture systems. “There is a huge role for technology companies to provide some of that training,” Dr Mulligan adds.

Even though the technology may be in place, there’s often a cultural lag within community organizations, Gibson points out. “We need to see non-profit executive directors, boards and CEOs prioritizing data gathering. We need to ensure that all staff have the tech and data literacy to carry out the various functions they are responsible for.” 

Data sharing is also vital to improve the quality of care given to a person. Service users – particularly those affected by ongoing difficult, traumatic circumstances that are outside of their control – shouldn’t need to keep repeating their health stories, says the Professional Records Standards Body in the UK. If a healthcare professional, a community volunteer, and a link worker can all access the same, up-to-date information, a service user is more likely to feel cared for and respected.

Tell us this made you smarter | Contact us | Report error