Moving Electronic Medical Records Upstream: Incorporating Social Determinants of Health

doi:10.1016/j.amepre.2014.07.009

American Journal of Preventive Medicine

Volume 48, Issue 2, February 2015, Pages 215-218

https://doi.org/10.1016/j.amepre.2014.07.009 Get rights and content

Background

Knowledge of the biological pathways and mechanisms connecting social factors with health has increased exponentially over the past 25 years, yet in most clinical settings, screening and intervention around social determinants of health are not part of standard clinical care. Electronic medical records provide new opportunities for assessing and managing social needs in clinical settings, particularly those serving vulnerable populations.

Purpose

To illustrate the feasibility of capturing information and promoting interventions related to social determinants of health in electronic medical records.

Methods

Three case studies were examined in which electronic medical records have been used to collect data and address social determinants of health in clinical settings.

Results

From these case studies, we identified multiple functions that electronic medical records can perform to facilitate the integration of social determinants of health into clinical systems, including screening, triaging, referring, tracking, and data sharing.

Conclusions

If barriers related to incentives, training, and privacy can be overcome, electronic medical record systems can improve the integration of social determinants of health into healthcare delivery systems. More evidence is needed to evaluate the impact of such integration on health care outcomes before widespread adoption can be recommended.

Introduction

Despite growing evidence demonstrating that behavioral and social factors impact short- and long-term health,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 electronic medical records (EMRs) generally do not capture data on social determinants of health (SDH). In 2013, the IOM convened an expert committee charged with articulating recommendations for SDH domains and measures to include in EMRs.¹⁶ Though there are limited data available evaluating the health impacts of this integration, prefacing the IOM Committee’s final report (due in late 2014), this paper highlights three case studies of EMR platforms that capture and address information on these fundamental mortality drivers.

Section snippets

Case Study 1: Tailoring Electronic Medical Record Social Screening and Referrals to Available Community-Based Agencies

Pediatricians from Johns Hopkins Children’s Center Harriet Lane Clinic (HLC) capture families’ basic resource needs in a social history section of the pediatrician’s note (Figure 1) in their EMR, Epic. Physicians refer families with identified needs to Health Leads, a non-profit organization contracted by the hospital¹⁷ that uses trained college student Advocates, whom the hospital has granted EMR access as cleared hospital volunteers under Health Leads’ Business Associates agreement, to link

Barriers and Opportunities

When adequately leveraged, electronic platforms improve integration between medical and social service delivery. These case studies highlight EMR features that facilitate this integration, including screening for social needs; triaging these needs and making referrals to internal, external, or automated resources; tracking both individual- and population-level data; and sharing tracked data with community partners (Figure 2).

Across healthcare systems, however, there are challenges to medical

Summary

New recommendations are likely to be available soon from the IOM regarding SDH domains to include in EMRs. Using these recommendations, healthcare settings may create opportunities to integrate evidence-based SDH metrics systematically into clinical care processes, including functions related to social screening; triaging social needs; making referrals; tracking individual- and population-level data; and sharing tracked data. These could enhance the integration of social services and medical

Acknowledgments

Laura Gottlieb’s work on this project was supported by the Lisa and John Pritzker Family Fund. The funding agency played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Gottlieb is employed by the University of California, San Francisco and is Co-Founder of HealthBegins.

Karen Tirozzi acknowledges the leadership of Dr. Barry Solomon and Dr. Tracy King in incorporating social

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This review includes 41 articles of the 2,473 initial search results. Included literature revealed that Community Resource Referral Systems functioned to address a variety of health-related social needs and were delivered in different ways. Integrating the Community Resource Referral Systems into clinic workflows, maintenance of community-based organization inventories, and strong partnerships between clinics and community-based organizations facilitated implementation. The sensitivity of health-related social needs, technical challenges, and associated costs presented as barriers. Overall, electronic medical records–integration and automation of the referral process was reported as advantageous for the stakeholders.
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Brief ReportMoving Electronic Medical Records Upstream: Incorporating Social Determinants of Health

Background

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Case Study 1: Tailoring Electronic Medical Record Social Screening and Referrals to Available Community-Based Agencies

Barriers and Opportunities

Summary

Acknowledgments

J Nutr

J Nutr

Ann Epidemiol

J Nutr

A brief indicator of household energy security: associations with food security, child health, and child development in U.S. infants and toddlers

Pediatrics

Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002

J Gen Intern Med

Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their pre-school-aged children

Pediatrics

Food insecurity and hunger in the kindergarten classroom: its effect on learning and growth

Contemp Econ Policy

Determinants of behavior in homeless and low-income housed preschool children

Pediatrics

Relations between housing characteristics and the well-being of low-income children and adolescents

Dev Psychol

Academic achievement trajectories of homeless and highly mobile students: resilience in the context of chronic and acute risk

Child Dev

Childhood residential mobility and multiple health risks during adolescence and adulthood: the hidden role of adverse childhood experiences

Arch Pediatr Adolesc Med

Subsidized housing and children’s nutritional status: data from a multisite surveillance study

Arch Pediatr Adolesc Med

Brief Report
Moving Electronic Medical Records Upstream: Incorporating Social Determinants of Health