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How can SDOH screening, data collection improve?

Better EHR workflows and overtures to support patient trust will be key to improving SDOH screening.

Sara Heath
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Published: 04 Feb 2025

Patients and providers agree that social determinants of health, or SDOH, screening and data collection are important, but both groups experience key barriers to that work, according to a new report from OpenNotes, the Assistant Secretary for Technology Policy and the Office of the National Coordinator for Health IT.

The information, published as a JAMA Network Open study and a report from ASTP, was gleaned from focus groups with 235 patients, clinicians or care partners. Overall, stakeholders were on the same page about SDOH data collection, stating that it's important for promoting the overall health and well-being of patients.

But a streamlined approach to SDOH data collection is lacking, the report added. Providers reported a fragmented approach to data capture, while patients noted some concerns about divulging sensitive and personal information.

The good news is that most providers are currently collecting SDOH data. However, not every provider is collecting that information consistently, with primary care providers, pediatricians, mental health providers and case managers being the most likely to document SDOH.

Furthermore, providers don't all screen for the same SDOH. The most common SDOH for which providers documented information included housing, food security and access to transportation, although some also reported screening for employment, home environment and intimate partner violence, as well.

These trends were echoed by patients, who said their primary care providers and other usual sources of care typically screen for SDOH using paper questionnaires. Patients agreed that SDOH screening is integral to supporting wraparound care.

SDOH screening has complications

Still, SDOH screening is not without its difficulties, the report furthered.

For example, providers said they don't always have enough time to screen for SDOH or discuss them in the clinical setting.

Relatedly, many said they don't have the "right" staff to help screen for, understand and refer for SDOH. These issues highlight potential lapses in provider training as well as limited resources. Organizations with staff case managers or social workers were better equipped to document and address SDOH than those without.

Both patients and providers also noted concerns that SDOH screening might affect the patient-provider relationship.

Providers said they feared SDOH screening could trigger implicit biases. Patients echoed that sentiment, saying they did not want the information they shared to be used against them or change how they are treated. In particular, patients were worried about discussing their financial situation, where they live and their educational attainment.

Patients from traditionally marginalized groups, like Black patients, patients with disabilities, members of the LGBTQ+ community and those with limited English proficiency, were more likely to express those fears than others.

Clinicians can sense patient apprehension, which can often deter them from beginning SDOH screening conversations.

Improving SDOH data collection

ASTP, Office of the National Coordinator for Health IT and OpenNotes said providers have several ideas for improving SDOH data collection, from leveraging payer information to supporting better workflows.

Standardized workflows and templates for the EHRs, offering reimbursement for the time taken to document SDOH and providing clinician and staff education could make SDOH data collection commonplace.

But improving SDOH data capture will also require comfort for patients.

Patients said they mostly trust their primary care providers to gather information about their SDOH. Creating a standardized workflow prompting PCPs to ask permission before sharing SDOH data with other relevant providers will be helpful, the data indicated. Providers might also consider outlining how they will use SDOH data to engender patient trust.

Sara Heath has covered news related to patient engagement and health equity since 2015.

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