- A new study in the Annals of Family Medicine analyzes a year-long pilot in which three clinics tested a suite of EHR-based tools used to screen for and document social determinants of health. Researchers found 97% to 99% of all patients had at least one SDOH need documented in the EHR, and 19% received a related EHR-documented referral.
- The majority of patients, however, were not interested in receiving clinical help to address their social determinant needs. To the researchers' surprise, only 15% to 21% patients with a documented need indicated wanting a physicians' help in addressing it.
- The study authors concluded that "far more research is needed to address implementation barriers related to [social determinant of health] documentation in EHRs."
Clinicians have been clamoring for ways to document and address social determinants of health in day-to-day practice, but there hasn't been much empirical evidence to prove there's a business case or market for such tools. As this study shows, there is a lot more work to be done before applications like EHR-based social determinants documentation become practical for clinicians.
Researchers noted several barriers that still exist for EHR-based SDOH tools, including perceptions that the tools instilled an extra layer of difficulty in collecting and acting on the data, created a "fragmented view of the patient, with relevant data in multiple places" and added to workload by necessitating an extra data entry step.
Additionally, researchers noted that referral workflows were perceived as being too time-consuming, and the high positive screening rate of 97% to 99% "yielded an unmanageable follow-up workload" until questions asking whether patients desired help with SDOH needs were added to the process.
Providers are acutely aware of the immediate and long-term impacts of social determinants, but to date there hasn't been ample evidence that workflow tools can help address those needs. A recent Patchwise Labs analysis found fewer than 4% of health systems and managed care organizations have invested in SDOH technology, putting the market somewhere between $88 million to $92 million.
Instead, providers are looking toward other tactical methods of addressing social factors. Last summer, for example, the American Hospital Association published a guide discussing the impact of housing on a community's health, including recommendations on how hospitals can assist. Recently, Intermountain Healthcare announced it is investing $12 million in an effort to tackle housing instability, utility needs, food insecurity, interpersonal violence and transportation alongside city, county and state government agencies and community-based organizations in Utah.
There's also evidence to counter the idea that social determinants should be clinical issues. According to a recent white paper from Leavitt Partners, most physicians agree that SDOH influence health but don't believe addressing those issues are their responsibility.
Meanwhile, there is interest in addressing SDOH from the side of payers as well. More than eight in 10 insurers are currently integrating those factors into their member programs, according to the 8th annual Industry Pulse survey.