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

https://doi.org/10.1016/j.amepre.2014.07.009Get 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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