Brief ReportMoving Electronic Medical Records Upstream: Incorporating Social Determinants of Health
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
References (26)
- et al.
Food insecurity affects school children’s academic performance, weight gain, and social skills
J Nutr
(2005) - et al.
Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women
J Nutr
(2006) - et al.
Food security and metabolic syndrome in U.S. adults and adolescents: findings from the National Health and Nutrition Examination Survey
Ann Epidemiol
(2010) - et al.
Household food insecurity is associated with adult health status
J Nutr
(2004) - et al.
A brief indicator of household energy security: associations with food security, child health, and child development in U.S. infants and toddlers
Pediatrics
(2008) - et al.
Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002
J Gen Intern Med
(2007) - et al.
Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their pre-school-aged children
Pediatrics
(2006) - et al.
Food insecurity and hunger in the kindergarten classroom: its effect on learning and growth
Contemp Econ Policy
(2003) - et al.
Determinants of behavior in homeless and low-income housed preschool children
Pediatrics
(1997) - et al.
Relations between housing characteristics and the well-being of low-income children and adolescents
Dev Psychol
(2013)
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
Cited by (137)
Social determinants of health and obstetric outcomes: A report and recommendations of the workshop of the Society for Maternal-Fetal Medicine
2024, American Journal of Obstetrics and GynecologyA Systematic Review of Electronic Community Resource Referral Systems
2023, American Journal of Preventive MedicineRacial Disparity and Percutaneous Coronary Intervention Outcomes
2023, American Journal of CardiologyAddressing Social Determinants of Health in Practice
2023, Pediatric Clinics of North AmericaArea deprivation index and segregation on the risk of HIV: a U.S. Veteran case–control study
2023, Lancet Regional Health - AmericasHealth care utilization among women of reproductive age living in public husing: Associations across six public housing sites in San Francisco
2022, Preventive Medicine ReportsCitation Excerpt :In particular, while our findings suggest that public housing is consistently associated with health care utilization for women in the AANHPI/Other group, comprehensive consideration of variation across sites and by racial/ethnic group is needed to better identify mechanisms driving heterogeneity in associations. This is important as health care systems increasingly find ways to incorporate the social and structural determinants of health in their provision of care (Gottlieb et al., 2015; Sandel and Desmond, 2017) in order to ensure that effective approaches to action can be developed to positively impact women’s reproductive health care utilization and long-term health trajectories. Irene E. Headen: Conceptualization, Methodology, Formal analysis, Writing – original draft, Writing – review & editing.