A driving force for health equity

Collection and Utilization of Social Determinants of Health Through the EHR

In the first of its kind research, OCHIN, combined with its collaborative partners, have published a study which piloted the capture and integration of data on social determinants of health (SDH)— the conditions of an individual’s environment that impact their health and quality of life – into the electronic health record (EHR).

“Integrating social determinants data into patient care is critical in OCHIN’s mission and central to our efforts in improving health across the nearly 500 clinics we serve,” said Abby Sears, OCHIN CEO.   

OCHIN’s research team, together with Kaiser Permanente, Multnomah County Health Department, Cowlitz Family Health Center, La Clinica del Valle (Oregon) and the University of California – San Francisco, developed “SDH Data Tools” and worked closely with three pilot clinics to help them adopt tools in EHR-based documentation of patients’ SDH and actions taken by the clinics to address noted SDH needs.

The team developed “EHR SDH Tools” and worked closely with three pilot clinics to help them adopt EHR-based documentation of patients’ SDH and any actions taken by the clinics to address these patient needs. Their findings are presented in Gold et al’s “Adoption of Social Determinants of Health EHR Tools by Community Health Centers” in the September 2018 issue of the Annals of Family Medicine. 

“This study sheds light on some of the obstacles to SDH collection, and indicates steps needed to improve the outcomes of integrating SDH documentation into primary care,” said Lead Research Scientist Rachel Gold, PhD, MPH. “There is still plenty of work to be done in this area, but our research lays the foundation for successful SDH incorporation into the EHR with potential to improve health outcomes.”

Despite a rapidly increasing national emphasis on EHR-based SDH documentation, research on SDH screening optimization is still in its infancy. Lacking a standard way to apply SDH questions, clinical teams in this study faced challenges in the application of screening tools. The researchers were surprised to find that only 15 to 20% of screened patients with a documented SDH need—such as food, housing or other social insecurity—requested support from the clinic in addressing that need. The researchers concluded that it is important to determine if patients want such assistance in order to avoid undesired clinic interventions for a patient.

Individual patient level data collection in community health centers is a challenging task. Vulnerable, complex patients are hesitant to share their societal hardships. Extensive training is necessary to teach staff successful communication techniques to obtain accurate SDH information.

The research team also found that some clinics do not want to conduct SDH screening unless there are local resources to which they can refer patients to take steps towards addressing SDH needs. Gold et al see building and sustaining community connections as one of the hardest aspects of implementing ongoing SDH screening. There is a need for more research on how to best incorporate SDH and referrals into workflows for improved health outcomes.

Finally, the movement towards value-based payment models, which hinge on improved patient outcomes, heighten the need to capture patient social complexity in the EHR. Without such data, clinics treating the most complex patients and using resources to build community connections will lack appropriate risk adjustment.

Find the article, here.