Social determinants of health in electronic health records and their impact on analysis and risk prediction: A systematic review
Open accessAbstract
Objective: This integrative review identifies and analyzes the extant literature to examine the integration of social determinants of health (SDoH) domains into electronic health records (EHRs), their impact on risk prediction, and the specific outcomes and SDoH domains that have been tracked. Materials and Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a literature search in the PubMed, CINAHL, Cochrane, EMBASE, and PsycINFO databases for English language studies published until March 2020 that examined SDoH domains in the context of EHRs. Results: Our search strategy identified 71 unique studies that are directly related to the research questions. 75% of the included studies were published since 2017, and 68% were U.S.-based. 79% of the reviewed articles integrated SDoH information from external data sources into EHRs, and the rest of them extracted SDoH information from unstructured clinical notes in the EHRs. We found that all but 1 study using external area-level SDoH data reported minimum contribution to performance improvement in the predictive models. In contrast, studies that incorporated individual-level SDoH data reported improved predictive performance of various outcomes such as service referrals, medication adherence, and risk of 30-day readmission. We also found little consensus on the SDoH measures used in the literature and current screening tools. Conclusions: The literature provides early and rapidly growing evidence that integrating individual-level SDoH into EHRs can assist in risk assessment and predicting healthcare utilization and health outcomes, which further motivates efforts to collect and standardize patient-level SDoH information.
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Health and healthcare utilization are shaped by social determinants of health (SDOH) such as food security, housing stability, and transportation access.
“A compelling body of evidence demonstrates that health and healthcare utilization are shaped by social determinants of health (SDOH), such as food security, housing stability, and transportation access.1–3”
From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [3]
Variability in screening and documentation practices currently limits the ability to mobilize SEDH data for secondary uses.
“the variability in screening and documentation practices currently limits the ability to mobilize SEDH data for secondary uses”
Mobilizing SEDH data from the EHR is hindered by heterogeneous provider documentation practices and interoperability issues.
“Mobilizing this data from the electronic health record (EHR) is hindered by heterogeneous provider documentation practices and interoperability issues [1,2,9–22].”
Systematic screening and documentation of health determinants can directly impact patient care and research efforts.
“Systematic screening and documentation of health determinants can directly impact patient care [1–8] and research efforts [1,5].”
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“The digitization of clinical records presents a new opportunity to integrate SDoH into electronic health records (EHRs) to enhance care delivery and population health.(12,13) The 2009 U.”
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- Authors
- Chen, M., Tan, X., & Padman, R.
- Affiliations
- Florida International University (US)
- Carnegie Mellon University (US)
- Corresponding author
- Chen, Min
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-11-01
- Volume
- 27
- Issue
- 11
- Pages
- 1764-1773
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC7671639
- OpenAlex
- W3104193169
- Cited by
- 287
- References
- 8
- Citations by year
- 2026: 37 · 2025: 76 · 2024: 71 · 2023: 38 · 2022: 43 · 2021: 21 · 2020: 1
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- College of Business at Florida International University
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- social determinants of health, electronic health records, risk prediction, health care utilization, 30-day readmission, medication adherence, referral services, clinical note extraction, prediction model performance
- MeSH terms
- Humans, Patient Acceptance of Health Care, Risk Assessment, Electronic Health Records, Social Determinants of Health
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