Ethically Managing Social Needs Data in an Era of Enhanced Electronic Health Information Sharing

Bouchelle, Zoe; Bowers, Megan; Vasan, Aditi

doi:10.1542/peds.2022-059046

Cited by 4 publications

(5 citation statements)

References 4 publications

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“… 13 Providing additional clinician training on the potential for bias when assessing and addressing social risk may also help to raise clinician awareness and attenuate harm done to patients. 14 Lastly, concerns around patient confidentiality were brought up in the qualitative data, which is a legitimate consideration given the potential risks associated with storing and sharing social needs data through EHR. Health systems should follow best practices to develop responsible social needs data management strategies that minimize potential harm.…”

Section: Discussionmentioning

confidence: 99%

“…Health systems should follow best practices to develop responsible social needs data management strategies that minimize potential harm. 14 While administering a short FI screener appeared very feasible for our study, FI screening protocols in similar clinical settings may benefit from developing standards of screening for social risk which account for the potential for stigma to negatively influence patient care and limitations of EHR in handling patient confidentiality.…”

Section: Discussionmentioning

confidence: 99%

“…This supports the ongoing call in the broader literature to set up documentation procedures which ethically manage patient social needs data. 14 Clinics and organizations should consider creating documentation and data use policies that securely store sensitive data, respect a patient’s right to withhold such data, and educate clinicians about how viewing such data may exacerbate their biases. 11 …”

Section: Discussionmentioning

confidence: 99%

“…Pursuing strategies that streamline EMR workflow and incorporate input and buy-in from clinical practice leaders may make FI screen and intervene protocols less burdensome. 14 Furthermore, we found that clinicians desired and used extra assistance to do the protocol, such as having additional staff. This finding is common among existing literature reviewing the impact of social needs protocols.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network

Kim,

Fischer,

Gross

et al. 2024

J Prim Care Community Health

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Introduction/Objectives: In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC. Methods: In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer’s V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results. Results and Conclusions: Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families’ needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as “Food as Medicine” offerings in partnership with community organizations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network

Kim,

Fischer,

Gross

et al. 2024

J Prim Care Community Health

View full text Add to dashboard Cite

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“…Pediatric EHR design features also make pediatric social risk data storage and access issues more complex. For example, EHR systems that allow all individuals with patient portal access to view completed questionnaires can compromise adolescent privacy and raise safety concerns [23]. In light of these added complexities related to pediatric clinical practice, more research is needed to identify tailored strategies for designing and implementing EHR-based social needs interventions in these settings.…”

Section: Introductionmentioning

confidence: 99%

Pediatric primary care provider and staff perspectives on the implementation of electronic health record-based social needs interventions: A mixed-methods study

LeLaurin¹,

Cruz²,

Theis³

et al. 2023

J. Clin. Trans. Sci.

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Introduction: Interventions to address social needs in clinical settings can improve child and family health outcomes. Electronic health record (EHR) tools are available to support these interventions but are infrequently used. This mixed-methods study sought to identify approaches for implementing social needs interventions using an existing EHR module in pediatric primary care. Methods: We conducted focus groups and interviews with providers and staff (n = 30) and workflow assessments (n = 48) at four pediatric clinics. Providers and staff completed measures assessing the acceptability, appropriateness, and feasibility of social needs interventions. The Consolidated Framework for Implementation Research guided the study. A hybrid deductive-inductive approach was used to analyze qualitative data. Results: Median scores (range 1–5) for acceptability (4.9) and appropriateness (5.0) were higher than feasibility (3.9). Perceived barriers to implementation related to duplicative processes, parent disclosure, and staffing limitations. Facilitators included the relative advantage of the EHR module compared to existing documentation practices, importance of addressing social needs, and compatibility with clinic culture and workflow. Self-administered screening was seen as inappropriate for sensitive topics. Strategies identified included providing resource lists, integrating social needs assessments with existing screening questionnaires, and reducing duplicative documentation. Conclusions: This study offers insight into the implementation of EHR-based social needs interventions and identifies strategies to promote intervention uptake. Findings highlight the need to design interventions that are feasible to implement in real-world settings. Future work should focus on integrating multiple stakeholder perspectives to inform the development of EHR tools and clinical workflows to support social needs interventions.

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Parent Perspectives on Electronic Health Record-Based Social Needs Screening and Documentation: A Qualitative Study

LeLaurin

Cruz

Theis

et al. 2023

Academic Pediatrics

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Ethically Managing Social Needs Data in an Era of Enhanced Electronic Health Information Sharing

Cited by 4 publications

References 4 publications

Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network

Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network

Pediatric primary care provider and staff perspectives on the implementation of electronic health record-based social needs interventions: A mixed-methods study

Parent Perspectives on Electronic Health Record-Based Social Needs Screening and Documentation: A Qualitative Study

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