Variation in Electronic Health Record Documentation of Social Determinants of Health Across a National Network of Community Health Centers

Abstract

Introduction This paper describes the adoption of an electronic health record-based social determinants of health screening tool in a national network of more than 100 community health centers. Methods In 2016, a screening tool with questions on 7 social determinants of health domains was developed and deployed in the electronic health record, with technical instructions on how to use the tool and suggested clinical workflows. To understand adoption patterns, the study team extracted electronic health record data for any patient with a community health center visit between June 2016 and May 2018. Patients were considered "screened" if a response to at least 1 social determinants of health domain was documented in the electronic health record tool. Results A total of 31,549 patients (2% of those with a visit in the study period) had a documented social determinants of health screening. The number of screenings increased over time, time; 71 community health centers (67%) conducted at least one screening, but almost 50% took place in only 4 community health centers. Over half (55%) of screenings only included responses for only 1 domain. Screening was most likely to occur during an office visit with an established patient and documented in the electronic health record by a medical assistant. Conclusions Screening documentation patterns varied widely across the network of community health centers. Despite the growing national emphasis on the importance of screening for social det…