In the Journals

How to incorporate social determinants of health data into EHRs

Potential ways to include social determinant of health data, such as inadequate physical activity or food insecurity, were recently published in Annals of Family Medicine.

“Numerous health care systems are exploring how to incorporate social needs documentation and intervention into routine care,” Rachel Gold, PhD, MPH, of the Kaiser Permanente Center for Health Research in Oregon, and colleagues wrote.

“These efforts are based on strong evidence that patients’ social and economic contexts (their social determinants of health) shape health, and on nascent evidence that clinic-based [social determinants of health] screening and intervention can improve health,” they wrote.

Gold and colleagues added that standardized social determinants of health screening documentation in EHRs is endorsed by professional organizations as well as the Medicare Access and Children’s Health Information Program Reauthorization Act of 2015 (MACRA), the 2016 Centers for Medicare and Medicaid Services’ Quality Strategy, but not much is known on “how to capture and present social determinants of health screening documentation in EHRs at community health centers or how to integrate EHR-based [social determinants of health] documentation into [community health centers].”

Researchers created a tool that would record and summarize social determinants of health screening results, make related referrals, and then evaluate how well the community health centers embraced the tools.

Gold and colleagues gathered data related to the social determinants of health for 1,130 patients and reported that 1,098 had one or more needs based on social determinants of health that were documented in the EHR. Of the patients with a documented need, 211 had a related referral in their EHR, and only 15% to 21% of the patients with a documented need said they wanted help to address that need.

Researchers also noted that although there were a high number of needs related to social determinants of health reported, critical barriers to document those needs exist, including the mindsets that the EHR tool “created a fragmented view of the patient ... [and] could add a layer of difficulty to collecting and acting on [social determinants of health] data ... and necessitated a data entry step if [social determinants of health] information were collected on paper.”

Gold and colleagues provided the following suggestions to clinicians to address these and other challenges related to documenting social determinants of health in an EHR:

  • Ensure that new and appropriate staff are trained on workflows.
  • Determine if upgrades or other EHR changes somehow change tool use and/or require more training.
  • Ensure that the correct staff have security access to the tool.
  • Contemplate conducting a staged rollout of the documentation to help ascertain needed changes in planned workflows.
  • Attempt to create workflows where data are entered directly in the computer until the data are in the EHR.
  • Make the review of individual patients’ data clear in workflows and stress how to find the summary tools in trainings.
  • Give thought to using roster tools to repeatedly review and adjust workflows as necessary.

They acknowledged their findings suggest the barriers are significant and solutions may not be easy, but said the end goal is important.

“The argument for such documentation is compelling: [Social determinants of health] profoundly impact health, so providers should know about social factors that might increase their patients’ health risks, or hinder their ability to follow care recommendations,” Gold and colleagues wrote. – by Janel Miller

 

Disclosures: The authors report no relevant financial disclosures.

Potential ways to include social determinant of health data, such as inadequate physical activity or food insecurity, were recently published in Annals of Family Medicine.

“Numerous health care systems are exploring how to incorporate social needs documentation and intervention into routine care,” Rachel Gold, PhD, MPH, of the Kaiser Permanente Center for Health Research in Oregon, and colleagues wrote.

“These efforts are based on strong evidence that patients’ social and economic contexts (their social determinants of health) shape health, and on nascent evidence that clinic-based [social determinants of health] screening and intervention can improve health,” they wrote.

Gold and colleagues added that standardized social determinants of health screening documentation in EHRs is endorsed by professional organizations as well as the Medicare Access and Children’s Health Information Program Reauthorization Act of 2015 (MACRA), the 2016 Centers for Medicare and Medicaid Services’ Quality Strategy, but not much is known on “how to capture and present social determinants of health screening documentation in EHRs at community health centers or how to integrate EHR-based [social determinants of health] documentation into [community health centers].”

Researchers created a tool that would record and summarize social determinants of health screening results, make related referrals, and then evaluate how well the community health centers embraced the tools.

Gold and colleagues gathered data related to the social determinants of health for 1,130 patients and reported that 1,098 had one or more needs based on social determinants of health that were documented in the EHR. Of the patients with a documented need, 211 had a related referral in their EHR, and only 15% to 21% of the patients with a documented need said they wanted help to address that need.

Researchers also noted that although there were a high number of needs related to social determinants of health reported, critical barriers to document those needs exist, including the mindsets that the EHR tool “created a fragmented view of the patient ... [and] could add a layer of difficulty to collecting and acting on [social determinants of health] data ... and necessitated a data entry step if [social determinants of health] information were collected on paper.”

Gold and colleagues provided the following suggestions to clinicians to address these and other challenges related to documenting social determinants of health in an EHR:

  • Ensure that new and appropriate staff are trained on workflows.
  • Determine if upgrades or other EHR changes somehow change tool use and/or require more training.
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  • Ensure that the correct staff have security access to the tool.
  • Contemplate conducting a staged rollout of the documentation to help ascertain needed changes in planned workflows.
  • Attempt to create workflows where data are entered directly in the computer until the data are in the EHR.
  • Make the review of individual patients’ data clear in workflows and stress how to find the summary tools in trainings.
  • Give thought to using roster tools to repeatedly review and adjust workflows as necessary.

They acknowledged their findings suggest the barriers are significant and solutions may not be easy, but said the end goal is important.

“The argument for such documentation is compelling: [Social determinants of health] profoundly impact health, so providers should know about social factors that might increase their patients’ health risks, or hinder their ability to follow care recommendations,” Gold and colleagues wrote. – by Janel Miller

 

Disclosures: The authors report no relevant financial disclosures.