Cross-Sector Integration of Clinical and Social Service Data During COVID-19: Implementation of a Regional Integrated Data System Partnership.

CONTEXT: The COVID-19 pandemic exacerbated long-standing health inequities, especially among racial and ethnic minority populations and individuals with chronic conditions. Efforts to mitigate these disparities are often hindered by fragmented data systems that separate health care and social service data. Integrated Data Systems (IDS) offer a promising cross-sector solution to link patient-level data for more targeted interventions. PROGRAM: We established a partnership between a nonprofit health system and a university-based IDS, the Charlotte Regional Data Trust, to link electronic health records with social service data on food, housing, and employment for a cohort of underserved patients in Mecklenburg County, North Carolina. This case report describes the governance framework and technical infrastructure used to develop a replicable data-sharing model. IMPLEMENTATION: Over 24 months, we executed key agreements including an Enterprise Memorandum of Understanding (EMOU), Business Associate Agreement (BAA), and Data Sharing Agreement (DSA) and secured institutional approvals. A probabilistic matching algorithm linked clinical and social service data, and the final dataset was deidentified before analysis. EVALUATION: The integrated dataset includes 28 258 patients with 36 months of clinical and social service data, including 12 months prepandemic and 24 months during the pandemic. Linkage was successful for 41% of patients with at least 1 social service record. Social service engagement, particularly food assistance, increased over time, whereas health care utilization patterns fluctuated. These linked data provide critical insights into how social needs and clinical outcomes intersect across crisis and recovery phases. DISCUSSION: This project demonstrates the feasibility of IDS-based cross-sector integration in a real-world setting. Key lessons include the value of legal infrastructure, institutional trust, and governance structures. Findings support the use of IDS to guide care coordination, advance health access, and build preparedness for future public health and disaster recovery challenges.