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Should We Include Social Determinants in Electronic Health Records?

Social factors account for a significant percent of deaths in the United States; however, research and the inclusion of standard ways to define and capture these determinants into patient health records are arguably in their nascent stage. As talk of social determinants of health permeate the halls of academic medical centers and schools of public health, it has become increasingly important for providers to embrace the incorporation of data beyond clinical findings in their medical decision making and counseling. In the April 2018 issue of Health Affairs, an article entitled "Integrating Data On Social Determinants of Health Into Electronic Health Records" delves into the current state of and challenges associated with integrating the social determinants of health (SDOH) in electronic health records. The authors provide a brief overview of efforts underway in health systems and marketed by electronic health record (EHR) vendors. They highlight the technical issues and challenges associated with differing terminology and existing health record interoperability limitations. Despite this, they point to the recent progress seen in efforts by the Office of the National Coordinator for Heath Information Technology and the Social Interventions Research and Evaluation Network at the University of California San Francisco.

The authors describe how efforts are underway to capture community-level determinants via census bureau or other governmental agency data and incorporate this geocoded data in to EHRs to prompt risk-directed screenings of certain groups. However, the authors admit that collecting individual level determinants are subject to potentially already-strained workflows in clinical settings. One area that was alluded to but not explicitly expounded upon is how patient trust might be a significant barrier in patients sharing potentially intimate details about their life. Lastly, the article briefly broaches the potentially difficult question of what to do with SDOH data once it is obtained amidst limited evidence to support best practices or evidence-based interventions. This article provides an important opportunity for us to reflect on how social determinants impact the health of our patients and what structures exist to understand and capture this information during our clinical encounters.

-Thomas K.M. Cudjoe, fellow in Geriatrics


Kelsey Bennett