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. 2018 Sep;16(5):399-407.
doi: 10.1370/afm.2275.

Adoption of Social Determinants of Health EHR Tools by Community Health Centers

Rachel Gold  1   2 , Arwen Bunce  3 , Stuart Cowburn  2 , Katie Dambrun  2 , Marla Dearing  2 , Mary Middendorf  2 , Ned Mossman  2 , Celine Hollombe  3 , Peter Mahr  4 , Gerardo Melgar  5 , James Davis  3 , Laura Gottlieb  6 , Erika Cottrell  2
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Adoption of Social Determinants of Health EHR Tools by Community Health Centers

Rachel Gold et al. Ann Fam Med. 2018 Sep.

Abstract

Purpose: This pilot study assessed the feasibility of implementing electronic health record (EHR) tools for collecting, reviewing, and acting on patient-reported social determinants of health (SDH) data in community health centers (CHCs). We believe it is the first such US study.

Methods: We implemented a suite of SDH data tools in 3 Pacific Northwest CHCs in June 2016, and used mixed methods to assess their adoption through July 2017. We modified the tools at clinic request; for example, we added questions that ask if the patient wanted assistance with SDH needs.

Results: Social determinants of health data were collected on 1,130 patients during the study period; 97% to 99% of screened patients (n = 1,098) had ≥1 SDH need documented in the EHR, of whom 211 (19%) had an EHR-documented SDH referral. Only 15% to 21% of patients with a documented SDH need indicated wanting help. Examples of lessons learned on adoption of EHR SDH tools indicate that clinics should: consider how to best integrate tools into existing workflow processes; ensure that staff tasked with SDH efforts receive adequate tool training and access; and consider that timing of data entry impacts how and when SDH data can be used.

Conclusions: Our results indicate that adoption of systematic EHR-based SDH documentation may be feasible, but substantial barriers to adoption exist. Lessons from this study may inform primary care providers seeking to implement SDH-related efforts, and related health policies. Far more research is needed to address implementation barriers related to SDH documentation in EHRs.

Keywords: community health centers; electronic health records; implementation; social determinants of health.

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References

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