Our results indicate that adoption of systematic EHR-based SDH documentation may be feasible, but substantial barriers to adoption exist. Lessons from this study may inform primary care providers seeking to implement SDH-related efforts, and related health policies. Far more research is needed to address implementation barriers related to SDH documentation in EHRs.

Little is known about how healthcare organizations are developing tools for identifying/addressing patients’ social determinants of health (SDH). We describe the processes recently used by six organizations to develop SDH screening tools for ambulatory care, and the barriers they faced during those efforts. Common processes included reviewing literature and consulting primary care staff. The organizations prioritized avoiding redundant data collection, integrating SDH screening into existing workflows, and addressing diverse clinic needs. This paper provides suggestions for others hoping to develop similar tools/strategies for identifying patients’ SDH needs in ambulatory care settings, with recommendations for further research.