Study finds challenges in using EHR tools for collecting social determinants of health data

November 6, 2018
Medicare Web

A study recently published in the Annals of Family Medicine examined the challenges of implementing electronic health (EHR) tools for collecting, reviewing, and acting on social determinants of health (SDH) data in community health centers. The study by Rachel Gold et al. is the first of its kind in the United States to formally test the feasibility of collecting and using EHR-based SDH data documentation in community health centers.

The study found that though it is feasible to adopt an EHR-based SDH documentation system, implementation barriers exist, and more research needs to be done to determine the best means of implementation.

Researchers collected data for the study between June 2016 and July 2017 at three community health centers in the Pacific Northwest that adopted a suite of EHR-based SDH data tools that were customized at the clinics’ requests.

The results of the study found challenges to EHR-based SDH documentation that parallel other studies examining other types of patient-reported data using EHRs. These challenges included difficulties with staff training and workflow optimization. Referral workflows specifically were seen as too time-consuming, especially if no follow-up to the referral was planned. In addition, the study found three perceptions of the EHR-based tool:

  1. It created a fragmented view of the patient with relevant data in multiple places instead of documenting the patient’s narrative.
  2. It could add a layer of difficulty to collecting and acting on the data due to lack of EHR expertise among the staff, the tools’ customization, and differences in EHR security access by staff role.
  3. It necessitated a data entry step if the SDH information was first collected on paper.

The study also notes that some barriers to SDH screening occur regardless of the technology used, including screening for SDH when little intervention is possible.

The study notes that standardized SDH screening documentation in EHRs is endorsed by the National Academy of Medicine and encouraged by the Medicare Access and Children’s Health Information Program Reauthorization Act of 2015 (MACRA), as well as the 2016 CMS Quality Strategy. Because the SDH are known to affect health and screening and referrals have been shown to improve health outcomes, the study notes numerous benefits to including the SDH in EHRs, including enabling care plan adjustments or referrals to social services, tracking referrals, identifying resource gaps in community programs, and enabling advocacy.

Ultimately, the study concluded that more research is needed in the area. And though EHR documentation and management of SDH could positively impact patient health, optimizing the EHR-based tool and integrating it into workflows will require addressing knowledge gaps and having clear strategies for implementation.

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