Nursing Classification EHR Integration Could Boost SDOH Management

EHR integration of nursing classifications could help drive health equity through enhanced social determinants of health (SDOH) documentation, according to an article published in JAMIA.

Researchers mapped three standardized nursing classifications (SNCs) to five Healthy People 2030 SDOH domains/objectives to reveal the comprehensiveness and value of these classifications.

The SNCs included: NANDA International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). In the article, the authors refer to the group of three SNCs as “NNN.”

The researchers found that the nursing classifications addressed all SDOH domains/objectives. Additionally, the SNC terms often mapped to multiple domains/objectives.

Other classifications include SDOH, such as the Omaha System. When EHR systems leverage these classifications, the ability to track and address a person’s SDOH is simplified.

However, the authors emphasized that NNN goes beyond naming and tracking SDOH to intervening and monitoring progress toward goals over time.

“Once a problem or a need is identified (using NANDA-I) in a nursing or interdisciplinary care plan, it is incumbent upon the clinicians to provide a means of addressing the issue,” they wrote. “Multiple evidence-based interventions that can address the problem can be found in NIC with measurable outcomes in NOC.”

Using these unique NNN terms mapped to the SDOH in practice would indicate an SDOH need, and clinicians would be alerted to make appropriate interventions.

However, the authors noted that these classifications are not extensively used in the EHR due to a lack of nursing informaticist inclusion in health IT standards development.

“Unfortunately, with the movement toward computerized health care using EHRs in the US, the knowledge of nursing informaticists with expertise in standardized nursing classifications is not always pursued,” they wrote.

Additionally, unlike many European countries, the US has not created federal policies for the use of standardized nursing languages.

“This has resulted in nursing documentation in EHR systems that focuses on flowsheets with check-boxing tasks and assessments,” the authors explained.

Therefore, the work of nurses to identify patient problems, plan interventions, and measure outcomes is largely invisible in current EHR systems. 

“Many documentation systems currently implemented by EHR vendors do not contain SNCs, thus creating missed opportunities to use NNN to target and address SDOH needs such as those arising from the recent pandemic,” the authors wrote.

“If assessment and management of SDOHs are easily found in SNCs and these classifications are used regularly as part of the nursing process of care, more incorporation of SNCs into the EHRs should be occurring,” they argued.