Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health

Rachel Gold, PhD, MPH; Erika Cottrell, PhD, MPP; Arwen Bunce, MA; Mary Middendorf, BS; Celine Hollombe, MPH; Stuart Cowburn, MPH; Peter Mahr, MD; Gerardo Melgar, MD


J Am Board Fam Med. 2017;30(4):428-447. 

In This Article


Standardized SDH data collection and presentation using EHR tools could facilitate diverse pathways to improved patient and population health outcomes in CHCs and other care settings. It could provide important contextual information to care teams, facilitate referrals to local resources, inform clinical decision making,[69] enable targeted outreach efforts, and support care coordination with community resources.[22,69,70] (We focused on how SDH data could be used to facilitate referring patients to local resources; research is needed on how else SDH data could inform clinical decisions). Such standardization will also provide data needed to document the SDH needs of CHC communities, inform policy and public health initiatives to improve health, and evaluate how addressing SDH risks affects health.

To attain these potential benefits, health care organizations need guidance on how to facilitate systematic SDH screening in primary care settings using EHR-based tools.[43,71,72] Little such guidance currently exists; we know of no previously published reports on processes used to develop EHR-based SDH data collection, summary, and referral tools. This article presents an example of a process through which stakeholder input informed the development of a preliminary set of SDH-focused EHR tools. While the results and lessons learned from our process may be useful to other organizations undertaking such efforts, they are preliminary and based on opinions from a relatively small group of stakeholders, health informaticists, and health services researchers. Extensive research is needed to empirically test the generalizability of these lessons.