Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health

Abstract

Background These ‘Social determinants of heath’ (SDH) are non-clinical factors that profoundly impact health. Helping community health centers (CHCs) document patients’ SDH data in electronic health records (EHRs) could yield substantial health benefits, but little has been reported about CHCs’ development of EHR-based tools for SDH data collection and presentation. Methods We worked with 27 diverse CHC stakeholders to develop strategies for optimizing SDH data collection and presentation in their EHR, and approaches to integrating SDH data collection and use (e.g., through referrals to community resources) into CHC workflows. Results We iteratively developed a set of EHR-based SDH data collection, summary, and referral tools for CHCs. We describe considerations that arose during the tool development process, and present a number of preliminary lessons learned. Discussion Standardizing SDH data collection and presentation in EHRs could lead to improved patient and population health outcomes in CHCs and other care settings. We know of no previous reports on processes used to develop EHR-based SDH data tools. This paper provides an example of one such process. Conclusion Lessons from our process may be useful to healthcare organizations interested in using EHRs to collect and act on SDH data. Research is needed to empirically test the generalizability of these lessons.

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

“…Recent research has suggested that exactly this approach—limiting screening to only a subset of patients and using information in electronic medical records to target this subset—should be given consideration as a potential strategy for minimizing the workload burden placed on health care teams when administering screenings for social determinants of health . In the aggregate, this approach would greatly reduce the amount of clinician time dedicated to the HSCR given the size of the VHA patient population.…”

“…Prior studies have documented the challenges of effectively using information from self-reported screening instruments on social determinants of health such as housing instability. [20][21][22][23][24] These challenges fall into two broad categories: (a) determining how to resolve the logistical, resource, and workload issues associated with the collection of information about housing instability and other social factors from patients; and (b) optimizing procedures for taking action on such information. With respect to the first set of challenges, evidence suggests that workload concerns are barriers to the effective implementation of screening tools.…”

“…The HSCR is part of an ambitious primary prevention approach to address housing instability; however, the existence of the HSCR alone is insufficient to improve housing stability. Prior studies have documented the challenges of effectively using information from self‐reported screening instruments on social determinants of health such as housing instability . These challenges fall into two broad categories: (a) determining how to resolve the logistical, resource, and workload issues associated with the collection of information about housing instability and other social factors from patients; and (b) optimizing procedures for taking action on such information.…”

“…With respect to the second set of challenges, taking action on information about housing instability and other social factors requires that this information is readily available to health care team members when they are making decisions about how to tailor care, referrals, and follow‐up to patient needs . Acting on information about housing instability also requires knowledge about what resources are available to address needs and how to connect people with those resources …”

Living in “Cold Spot” Communities Is Associated with Poor Health and Health Quality

“…42 Others have outlined the specific questions and processes that should be used to standardize collection of individual social needs in primary care settings. 43 At a system level, organizations are experimenting with novel methods for addressing social needs. CommunityRx combines e-prescribing and community engagement to connect patients with community resources, via the diagnoses generated in EHRs.…”