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Cited by 65Electronic Health Records SystemsMedical Coding and Health InformationNursing Diagnosis and Documentation

Incorporating Social Determinants of Health in Electronic Health Records: Qualitative Study of Current Practices Among Top Vendors

Open access
Freij, Maysoun, Dullabh, Prashila, Lewis, Sarah, Smith, Scott R, Hovey, Lauren, Dhopeshwarkar, Rina·2019·JMIR Medical Informatics
DOI 10.2196/13849PMC PMC6592390
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Abstract

BACKGROUND: Social determinants of health (SDH) are increasingly seen as important to understanding patient health and identifying appropriate interventions to improve health outcomes in what is a complex interplay between health system-, community-, and individual-level factors. OBJECTIVE: The objective of the paper was to investigate the development of electronic health record (EHR) software products that allow health care providers to identify and address patients' SDH in health care settings. METHODS: We conducted interviews with six EHR vendors with large market shares in both ambulatory and inpatient settings. We conducted thematic analysis of the interviews to (1) identify their motivations to develop such software products, (2) describe their products and uses, and (3) identify facilitators and challenges to collection and use of SDH data-through their products or otherwise-either at the point of care or in population health interventions. RESULTS: Our findings indicate that vendor systems and their functionalities are influenced by client demand and initiative, federal initiatives, and the vendors' strategic vision about opportunities in the health care system. Among the small sample of vendors with large market shares, SDH is a new area for growth, and the vendors range in the number and sophistication of their SDH-related products. To enable better data analytics, population health management, and interoperability of SDH data, vendors recognized the need for more standardization of SDH performance measures across various federal and state programs, better mapping of SDH measures to multiple types of codes, and development of more codes for all SDH measures of interest. CONCLUSIONS: Vendors indicate they are actively developing products to facilitate the collection and use of SDH data for their clients and are seeking solutions to data standardization and interoperability challenges through internal product decisions and collaboration with policymakers. Due to a lack of policy standards around SDH data, product-specific decisions may end up being de facto policies given the market shares of particular vendors. However, commercial vendors appear ready to collaboratively discuss policy solutions such as standards or guidelines with each other, health care systems, and government agencies in order to further promote integration of SDH data into the standard of care for all health systems.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study interviewed six large-market EHR vendors about developing products to capture and use social determinants of health (SDH) data. Vendors were motivated by client demand, federal initiatives, and strategic opportunity, but reported wide variation in SDH product maturity and major challenges with standardization, coding, and interoperability.

Key findings

  • All six vendors used or enabled SDH screening tools, most commonly configurations of PRAPARE; one vendor developed a fully integrated screening product with eight NAM-recommended measures and two from PRAPARE.
  • Product development varied: three vendors described proprietary population health management tools, five had referral products, and three reported using SDH data for risk stratification and outcome assessment.
  • One vendor’s proprietary value set found that 30% of clients had collected 90% of the SDH data, and 90% of what was collected covered only 13 SDH measures, such as separation/divorce, death in family, unemployment, problems living alone, family addiction, and caregiver roles.
  • Vendors reported coding ambiguity: one noted about 45 ICD-9 codes for SDH cross-walking to about 127 SNOMED codes, and some SDH information, such as transportation assistance, lacked standard LOINC/SNOMED codes and might be tracked with dummy CPT codes.

Methods

  • The authors scanned PubMed for English-language peer-reviewed and grey literature on EHRs, SDH, and/or health disparities published January 2012–June 2018; from over 250 articles, 52 underwent in-depth review and thematic analysis.
  • They conducted key informant interviews with six purposively sampled EHR vendors with large inpatient and ambulatory market shares; one to three representatives per vendor joined 60-minute phone interviews in March and April 2018, which were audio-recorded and transcribed.
  • Interview transcripts were thematically analyzed in NVivo using a codebook developed from interview topics and an emergent conceptual model, with intercoder reliability testing and senior review; the study was approved by the University of Chicago IRB.

Limitations

  • Stated: the findings come from a purposive qualitative sample of a small number of vendors and are not intended to represent the EHR field at large; the study was limited to vendors reachable during a limited study period, and with more time the authors would have sought more input from representatives in this increasingly commercialized area.
  • Evident from the text: only six of nine selected vendors participated, three could not be reached, and the findings rely on vendor self-report without independent validation from health systems, clinicians, or patients.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/13849

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 19 cited sources checked · 1 supported · 0 flagged

  • Premisecitation

    Lack of standardization for incorporating data from various screening tools and measures has limited the usefulness of the data within and across EHR systems.

    “Lack of standardization for incorporating data from various screening tools and measures has limited the usefulness of the data within and across EHR systems [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Findingown data

    All vendors recognized growing demand from clients to "move the needle in population health."

    “All vendors recognized growing demand from clients to, as one put it, “move the needle in population health.””
    Quote in the paperNot a substantial claim
  • Findingown data

    All vendors described offering clients multiple or customizable screening tools to focus on fewer or additional measures as needed.

    “All vendors described offering clients multiple or customizable screening tools to focus on fewer or additional measures as needed.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Vendors report that measuring both short-term outcomes (such as completion of the referral) and long-term outcomes (such as changes in costs, utilization, and health outcomes) is difficult both technically and due to challenges addressing SDHs.

    “In terms of assessing health outcomes, vendors report that measuring both short-term outcomes, such as the completion of the referral, and long-term outcomes, such as changes in costs, utilization, and health outcomes, are difficult both technically and due to challenges addressing SDHs.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    For the five vendors with products capable of making referrals for community services, the common methods are a third-party tool like Aunt Bertha, an EHR-integrated tool like order forms, or a proprietary tool that allows information exchange among health care systems and outside service providers.

    “For the five vendors with products capable of making referrals for community services, the common methods are (1) the use of a third-party tool like Aunt Bertha [28], (2) using an EHR-integrated tool like order forms, or (3) using a proprietary tool that allows information exchange among health care systems and outside service providers.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Aunt Bertha2018-11-10https://company.auntbertha.com/

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 23
  • Classified as probably not a substantial claim. 37

  • May combine two claims.

    Findingown data

    Vendors recognized the need for more standardization of SDH performance measures across various federal and state programs, better mapping of SDH measures to multiple types of codes, and development of more codes for all SDH measures of interest.

    “To enable better data analytics, population health management, and interoperability of SDH data, vendors recognized the need for more standardization of SDH performance measures across various federal and state programs, better mapping of SDH measures to multiple types of codes, and development of more codes for all SDH measures of interest.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among the small sample of vendors with large market shares, SDH is a new area for growth, and the vendors range in the number and sophistication of their SDH-related products.

    “Among the small sample of vendors with large market shares, SDH is a new area for growth, and the vendors range in the number and sophistication of their SDH-related products.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Although there is not widespread use of SDH data in population health initiatives, one vendor expected they could be used for diabetes management and food security or medication adherence and utilities.

    “Although there is not widespread use of SDH data in population health initiatives, one vendor expected that they could be used for diabetes management and food security or medication adherence and utilities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One vendor reports that 90% of what is being collected is only for 13 types of SDH measures, namely separation or divorce, death in the family, unemployment, problems living alone, addiction in family, and caregiver roles; less common are issues like homelessness or child abuse.

    “Further, it reports that 90% of what is being collected is only for 13 types of SDH measures, namely separation or divorce, death in the family, unemployment, problems living alone, addiction in family, and caregiver roles; less common are issues like homelessness or child abuse.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Variation in screening tools was attributed to the variable demands of particular patient populations (eg, pediatrics) and to the lack of common screening requirements across different federal or state programs.

    “Variation in screening tools was attributed to the variable demands of particular patient populations (ie, pediatrics) and to the lack of common screening requirements across different federal or state programs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    One vendor found that SDH indicators are highly concentrated among a third of the clients, or that 30% of clients have collected 90% of the SDH found in the data set.

    “It has found that SDH indicators are highly concentrated among a third of the clients or that 30% of clients have collected 90% of the SDH that have been found in the data set.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Several vendors emphasized that vendors must follow the recommendations that public agencies outline and sought direction on standardized tools to collect SDH data, standards for SDH data coding and interoperability, and incentives for SDH data collection and use.

    “Ultimately, several emphasized that vendors must follow the recommendations that public agencies outline and sought direction on standardized tools to collect SDH data, standards for SDH data coding and interoperability, and incentives for SDH data collection and use.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Findingown data

    One individual commented that the PRAPARE tool is not an exact match to some other national programs, creating a disconnect that leads to implementation of differing SDH tools across health systems.

    “one individual commented that, “The PRAPARE tool is great, but the private sector does not seem to be open to it, and it is not an exact match to some of the other national programs already, so there is some disconnect there” that leads to the implementation of differing SDH tools across health systems.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Findingnone given

    Vendors wonder whether the incentives will be fair and whether SDH collection is a fad versus a priority with longevity.

    “However, vendors wonder whether the incentives will be fair and whether SDH collection is a fad versus a priority with longevity.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One vendor reported participation in an industry-wide interoperability initiative called Carequality that grew out of the Sequoia Project.

    “One vendor reported participation in an industry-wide interoperability initiative called Carequality that grew out of the Sequoia Project [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] The Sequoia Project2018-11-10https://sequoiaproject.org/

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    One vendor stated it is hard for an IT company to push a standard because others may perceive it as bias, and that an open standard pushed from a national group is better and supported.

    “It’s hard as an [information technology] company to push a standard, because others may perceive it as bias. When an open standard for social determinants is pushed from a national group it is better and that’s something we support.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Vendors would appreciate guidance on the preferred standard to be used for a minimum set of data elements.

    “Vendors would appreciate guidance on the preferred standard to be used for a minimum set of data elements.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    The vendors have large market shares.

    “but the vendors have large market shares”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Vendors showed support for discussions among vendors, standards bodies, and government organizations to reduce ambiguity in code sets and ensure all voices are heard.

    “Vendors showed support for discussions among vendors, standards bodies, and government organizations to reduce ambiguity in the code sets, as well as to ensure all voices are heard.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Practices may use a dummy CPT code to track transportation assistance.

    “practices may use a dummy CPT code to track it.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Vendors generally agreed that having standardized definitions of SDH across all government programs would improve the field from a research and analytics perspective.

    “Vendors generally agreed that having standardized definitions of SDH across all government programs would improve the field from a research and analytics perspective.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Classified as probably not a substantial claim.

    Findingown data

    Vendors in this sample indicated that in the absence of national standards, clients are getting "pretty creative" in the collection and use of SDH data.

    “Vendors in this sample indicated that in the absence of national standards, clients are getting “pretty creative” in the collection and use of SDH data.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Classified as probably not a substantial claim.

    Findingown data

    One vendor explained that C-CDA does not codify specific SDH data elements.

    “one vendor explained that the C-CDA does not codify specific SDH data elements.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • May combine two claims.

    Findingown data

    Not all SDH information can be coded, and free-text fields are frequently used.

    “Further, not all SDH information can be coded, and free-text fields are frequently used.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Vendors appreciated the potential for standardized SDH data to identify patients with high social need, improve care coordination between health care providers and community service providers, and build further evidence on the connections between SDH and health outcomes through better data analytics and population health management.

    “They appreciated the potential for standardized SDH data to identify patients with high social need, improve care coordination between health care providers and community service providers, and build further evidence on the connections between SDH and health outcomes through better data analytics and population health management.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    One vendor reported that approximately 45 ICD-9 codes can be used for SDH and approximately 127 SNOMED codes link back to SDH.

    “When looking at the ICD-9 codes, there are about 45 codes that can be used for SDH and when you look at cross-walking those there are about 127 codes in SNOMED that link back to a SDH.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Vendors caution that not all elements can be codified.

    “they also caution that not all elements can be codified”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • May combine two claims.

    Findingown data

    Even among vendors with large market shares in both ambulatory and inpatient settings, SDH is a new area for investment, and there is room for growth in terms of product development and analytic capacity.

    “In this study, we found that even among vendors with large market shares in both ambulatory and inpatient settings, SDH is a new area for investment, and there is room for growth in terms of product development and analytic capacity.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Classified as probably not a substantial claim.

    Findingnone given

    LOINC and SNOMED do not provide codes for transportation assistance.

    “since LOINC and SNOMED do not provide codes for transportation assistance”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One vendor spoke of the need to standardize or structure SDH data while preserving client flexibility in its collection.

    “One vendor spoke of the need to standardize or structure SDH data while preserving client flexibility in its collection.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Findingreasoning

    How a specific tool is implemented in the EHR should be at the client's discretion.

    “how a specific tool is implemented in the EHR should be at the client’s discretion.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    One vendor stated they have a role to play in developing standards for coding SDH data but want other vendors to participate and do not want to be perceived as commandeering the narrative.

    “Yes, we have a role to play [in developing standards for coding social determinants of health data], but we also want to be cognizant of the optics and want other vendors to participate. We don’t want to be perceived as commandeering the narrative.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The vendors interviewed accurately reported their practices and their clients’ behavior.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Testing of intercoder reliability involved multiple staff coding samples of the same text using an initial codebook.

    “Testing of intercoder reliability involved multiple staff coding samples of the same text using an initial codebook.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was reviewed and approved by the University of Chicago's Institutional Review Board.

    “This study was reviewed and approved by the University of Chicago’s Institutional Review Board.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    PRAPARE EHR templates exist on most top vendor platforms, and the tool is free as part of a publicly available toolkit.

    “PRAPARE EHR templates exist on most top vendor platforms, and the tool is also free as part of a publicly available toolkit [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] The protocol for responding to and assessing patients' assets, risks, and experiences (PRAPARE)20172018-11-09National Association of Community Health Centers, Association of Asian Pacific Community Health Organizations, Oregon Primary Care Associationhttp://www.nachc.org/research-and-data/prapare/

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A 2014 NAM report argued that integrating SDH into EHRs would better enable health providers to address health inequities and support research into how social and environmental factors influence health.

    “A 2014 report by the National Academies of Medicine (NAM) argued that the integration of SDH into EHRs would better enable health providers to address health inequities and support research into how social and environmental factors influence health [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] 2014, Capturing Social And Behavioral Domains In Electronic Health Records: Phase 1

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Vendors indicate they are actively developing products to facilitate the collection and use of SDH data for their clients and are seeking solutions to data standardization and interoperability challenges through internal product decisions and collaboration with policymakers.

    “Vendors indicate they are actively developing products to facilitate the collection and use of SDH data for their clients and are seeking solutions to data standardization and interoperability challenges through internal product decisions and collaboration with policymakers.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Six vendors participated in the study, but the researchers were unable to reach appropriate staff for three vendors during the study period.

    “Through email solicitation, we gained participation from six vendors but were unable to reach appropriate staff for three vendors during the study period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There are concerns that the large market shares of relatively few EHR vendors may make vendors less responsive to designing EHRs to meet patients' and clinicians' needs, particularly while controlling costs and promoting interoperability.

    “While health care systems may influence the development of EHR features, there are concerns that the large market shares of relatively few EHR vendors may make vendors less responsive to designing EHRs to meet patients’ and clinicians’ needs, particularly while controlling costs and promoting interoperability [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The CMS 2016 Medicaid Managed Care rule has encouraged states to include more community-based, nonclinical services that may address SDH.

    “The Centers for Medicare & Medicaid Services (CMS) 2016 Medicaid Managed Care rule has encouraged states to include more community-based, nonclinical services that may address SDH [6,7].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] MachledtDAddressing the social determinants of health through Medicaid managed care2019-05-20Commonwealth Fundhttp://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/nov/machledt_social_determinants_medicaid_managed_care_ib_v2.pdf

      Not checked in the free run.

    • cites [7] SpencerAFredaBMcginnisTGottliebLMeasuring social determinants of health among Medicaid beneficiaries: early state lessons20162018-11-09http://www.chcs.org/media/CHCS-SDOH-Measures-Brief_120716_FINAL.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    A senior researcher developed the codebook and trained three research analysts to each code two to three interviews they had observed and transcribed.

    “A senior researcher developed the codebook and trained three research analysts to each code two to three interviews that they had observed and transcribed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    If different federal programs can agree on a set of measures, it would facilitate more standardization.

    “Specifically, if different federal programs can agree on a set of measures, it would facilitate more standardization.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Standardized definitions of SDH across government programs would help vendors build tools that are more interoperable.

    “It would also help vendors build tools that are more interoperable.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ICD-10/Z-codes, LOINC, SNOMED, and CPT codes are necessary for standardized coding of multiple aspects of the patient record.

    “which are necessary for the standardized coding of multiple aspects of the patient record [29-31].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [29] Factors influencing health status and contact with health services Z00-Z992018-11-10https://www.icd10data.com/ICD10CM/Codes/Z00-Z99

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [30] International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)20182018-11-10Centers for Disease Control and Preventionhttps://www.cdc.gov/nchs/icd/icd10cm.htm

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [31] Supporting interoperability: terminology, subsets, and other resources from NLM20182018-11-10US National Library of Medicinehttps://www.nlm.nih.gov/hit_interoperability.html

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Better standardization would allow health systems to better analyze and interpret SDH data in clinical decision-making.

    “it is understood that generally better standardization would allow health systems to better analyze and interpret SDH data in clinical decision-making.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Vendor systems and their functionalities are the result of the multiple, interrelated forces of federal policy and regulation, client demand, and the vendors' own strategic vision for opportunities in the health care system.

    “Vendor systems and their functionalities are the result of the multiple, interrelated forces of federal policy and regulation, client demand, and the vendors’ own strategic vision for opportunities in the health care system.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The findings are not intended to represent the state of the EHR field at large but rather to help identify trends in the development and use of SDH screening tools and data among vendors with considerable stake in this area given their market shares in inpatient and outpatient settings.

    “They are not intended to represent the state of the EHR field at large but rather to help identify trends in the development and use of SDH screening tools and data among vendors with considerable stake in this area given their market shares in inpatient and outpatient settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The findings from this study are based on a purposive, qualitative sample with a small number of vendors.

    “The findings from this study are based on a purposive, qualitative sample with a small number of vendors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Vendors and providers seek approaches that balance the use of existing data with the need to collect standardized new data in order to streamline the integration of SDH data in providers' workflow and create a holistic picture of patients that may ultimately reduce health disparities.

    “Vendors and providers seek approaches that balance the use of existing data with the need to collect standardized new data in order to streamline the integration of SDH data in providers’ workflow and create a holistic picture of patients that may ultimately reduce health disparities.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Senior staff reviewed coded transcripts to assure accuracy and consistency in coded material.

    “The senior staff also reviewed coded transcripts to assure accuracy and consistency in coded material.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The codebook was revised and code definitions were refined as needed to assure consistency across staff coding styles.

    “We revised the codebook and refined code definitions as needed to assure consistency across staff coding styles.”
    Quote in the paperNot a substantial claim
46 of 46

  • The paper relies on this without support.

    EHR vendors have a unique position at the nexus of health systems and health policies, and their organizational decisions significantly impact EHR-based data capture and clinical practice.

    “Because of their unique position at the nexus of health systems and health policies and the significant impact their organizational decisions have on EHR-based data capture and clinical practice, we conducted key informant interviews with top EHR vendors focused on SDH.”

  • The authors state this as an assumption.

    In the conceptual model, vendors’ clients have their own interests and preferences in relation to the policy environment, needs of their patients, resources in their community, and their own models of health care.

    “In the conceptual model, vendors’ clients (ie, health care systems or providers) have their own interests and preferences in relation to the policy environment, needs of their patients, resources in their community, and their own models of health care.”

  • The paper relies on this without support.

    The vendors interviewed accurately reported their practices and their clients’ behavior.

    “Through interviews with vendors, we explored the roles of client demand and federal policies related to SDH capture and use.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Large EHR vendors such as Epic and Cerner have recently added structured data fields to specifically capture SDOH data.

    “Large EHR vendors, such as Epic and Cerner, have gone further and recently added structured data fields to specifically capture SDOH data.15,17,18”

    From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [15]

    The Results section, “Screening Tools Are the Most Common Type of Social Determinants of Health Product” (page unavailable), says that most top-vendor platforms have PRAPARE templates that use structured data, and that one vendor developed an integrated SDH screening product. It does not identify Epic or Cerner as having recently added structured fields specifically for SDH. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • EHR vendors and health systems have increasingly added designated fields to promote the capture of SDOH data in structured formats.

    “As a result, EHR vendors and health systems have increasingly added designated fields to promote the capture of SDOH data in structured formats.”

    From Documentation and review of social determinants of health data in the EHR: measures and associated insights (2021) · cites this paper as [15]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Accountable Health Communities tool citation points to a CT article

    Minor

    The text cites reference 13 for the Accountable Health Communities screening tool, but reference 13 is titled "Is computed tomography safe?"

  • Thirteen SDH measure types are said to comprise a shorter list

    Minor

    The sentence says there are 13 types but introduces only six listed categories with "namely," which presents the list as complete.

  • Hospital and ambulatory reference links are reversed

    Minor

    Reference 23 describes hospitals but its URL names participating professionals; reference 24 describes ambulatory professionals but its URL names participating hospitals.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. 2014, Capturing Social And Behavioral Domains In Electronic Health Records: Phase 1
  2. 2015, Capturing Social And Behavioral Domains And Measures In Electronic Health Records: Phase 2
  3. Tripathi, M, 2012, J AHIMA, 83, 24
  4. Arons, A, 2017, Social Interventions Research & Evaluation Network Stakeholder Meeting, 1

Cited by

Sorted by citations

Related

Authors
Freij, M., Dullabh, P., Lewis, S., Smith, S. R., Hovey, L., & Dhopeshwarkar, R.
Affiliations
  • National Opinion Research Center (US)
  • Centers for Medicare and Medicaid Services (US)
  • Office of the Assistant Secretary for Planning and Evaluation (US)
Corresponding author
Freij, Maysoun
ORCID
Venue
JMIR Medical Informatics
Publisher
JMIR Publications Inc.
Published
2019-06-07
Volume
7
Issue
2
Pages
e13849
ISSN
2291-9694 (ISSN-L)
DOI
10.2196/13849
PMC
PMC6592390
OpenAlex
W2951195907
Semantic Scholar
18c6739b1a66484c95b0564f55447b2493e9878d
Cited by
65
References
10
Citations by year
2026: 3 · 2025: 7 · 2024: 12 · 2023: 14 · 2022: 8 · 2021: 12 · 2020: 8 · 2019: 1
FWCI
7.94
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Medical Informatics (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
  • Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
Keywords
social determinants of health, electronic health records, EHR vendors, data standardization, interoperability, population health management, health IT policy, federal health programs

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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