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Researchers Add Social Determinants of Health to Epic EHR

Researchers found standardizing the collection and presentation of data related to social determinants of health in Epic EHR systems could lead to improved patient health outcomes.

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Source: Thinkstock

By Kate Monica

- A recent study by Gold et al. found that standardizing social determinants of health (SDH) data collection and presentation in Epic EHR systems could improve patient and population health outcomes in community health centers.

Researchers worked with 27 different community health center stakeholders to develop ways to optimize SDH data collection, present this data in EHR systems, and integrate the information into physician workflows. 

The non-profit community-based organization Oregon Community Health Information Network (OCHIN) conducted the study. Researchers utilized OCHIN’s Epic EHR to observe the benefits of collecting and presenting SDH data in a way that is easily accessible for providers.

The Epic EHR serves more than 440 primary care community health centers in 19 states and is the largest community health center network on a single EHR system in the country.

Patients in OCHIN’s network in particular are subject to several socioeconomic risks.

According to existing SDH data already in the community health center network’s EHR, 23 percent of patients are uninsured, 91 percent are from households living well below the poverty line, and 28 percent are primarily non-English speakers.

Conducting the study at OCHIN allowed researchers to gain insight into how including additional data in physician workflows improves patient care at community health centers where social determinants of health play a significant role in a patient’s wellbeing.

 “Systematically documenting patients' SDH data in EHRs could help care teams incorporate this information into patient care, for example, by facilitating referrals to community resources to address identified needs,” wrote researchers in the report published by the Journal of the American Board of Family Medicine (JABFM). “This could be especially useful in “safety net” community health centers, whose patients have higher health risks than the general US population.”

Researchers developed EHR-based tools community health centers can use to identify and address SDH-related health concerns with the ultimate goal of creating SDH-related workflows aligned with clinical referral processes.

The Institute of Medicine (IOM) recommended that 10 patient-reported SDH domains be documented in the Epic EHR based on their health impact.

While some of the recommended domains are already regularly collected by federally-funded clinics, others were not.

Primary care providers, community health workers, behavioral health staff, EHR specialists, and other staff members participated in the study by further incorporating additional SDH data into their daily clinical processes.

Specifically, participants collected SDH data, reviewed patient’s SDH-related needs, identified referral options to address the specified needs, ordered referrals to appropriate services, and tracked the outcomes of past referrals.

As a result of the study, stakeholders requested that SDH tools include all patient-reported domains recommended by IOM beyond merely those already regularly collected by federally-funded clinics.

For example, stakeholders requested further information regarding patient financial strain.

“The hope was that this granularity would identify the specific areas in which assistance was needed,” stated researchers in the report.

In terms of strategies for collecting SDH data, stakeholders emphasized a need to enable SDH data collection by various members of a community health center’s care team.

Stakeholders also devised strategies allowing individuals with limited EHR access to enter SDH data into the system, including through SDH documentation flowsheets, electronic tablets in clinic waiting rooms, and other methods of patient-reported data entry.

Participants in the study also successfully created EHR tools for reviewing SDH needs, identifying referral options, ordering referrals, and tracking past referrals.

Ultimately, researchers determined that standardized SDH data collection and presentation could improve several aspects of clinical care.

“Standardized SDH data collection and presentation using EHR tools could facilitate diverse pathways to improved patient and population health outcomes in CHCs and other care settings,” wrote researchers. “It could provide important contextual information to care teams, facilitate referrals to local resources, inform clinical decision making, enable targeted outreach efforts, and support care coordination with community resources.”

However, researchers noted that primary care clinics will need a significant amount of assistance with implementing these strategies and EHR tools before the benefits of SDH data collection become evident.

“To attain these potential benefits, health care organizations need guidance on how to facilitate systematic SDH screening in primary care settings using EHR-based tools,” they wrote. “Little such guidance currently exists; we know of no previously published reports on processes used to develop EHR-based SDH data collection, summary, and referral tools.”

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