Awareness of EHR SDOH Documentation Capabilities Varies by Practice Type

While almost 9 in 10 physicians are aware of EHR social determinants of health (SDOH) documentation capabilities, levels of awareness vary significantly by practice characteristics, according to a study published in JAMIA.

Researchers analyzed data from the National Electronic Health Records Survey (NEHRS), an annual nationally representative cross-sectional survey of non-federally employed, office-based physicians on EHR use.

Prior work has used NEHRS data to explore the proportion of physicians using EHRs with SDOH documentation capabilities. However, this work excluded respondents that were not aware of these functionalities.

In the current study, researchers intentionally included these respondents to measure the share of providers who were aware their EHR could document SDOH.

“Our approach examines a distinct concept (awareness) and simultaneously strengthens the earlier work, which overestimated capability prevalence by excluding respondents that were not aware of these functionalities,” the researchers explained.

The authors said that EHR training initiatives targeting providers less likely to be aware of SDOH capabilities could help increase SDOH documentation.

“Despite the increasing focus on SDH screening and social care in the US healthcare settings, physicians’ awareness of EHR-based SDH documentation capability varies,” they wrote. “Awareness of these capabilities is relevant to direct clinical care.”

High-quality EHR training may facilitate using advanced EHR capabilities, like SDOH documentation.

“Associations between SDH awareness and awareness of other advanced EHR capabilities reveal that lack of awareness is not unique to SDH functions and training to increase awareness could therefore target a broad set of these high-value functions,” the authors said.

“Against this backdrop, our finding that awareness differs based on practice and EHR characteristics suggests the need for different types of interventions to increase the utilization of documentation capabilities based on the extent of social care provided by healthcare organizations,” they added.

The authors suggested that some variation in SDOH EHR awareness by organizational characteristics likely stems from differences in practice motivation or the need to provide social care. Providers that frequently engage in screening and social care may be more likely to be aware of SDOH documentation capabilities.

For instance, physicians in community health centers (CHCs) were more likely to be aware of these capabilities because they likely have more expertise in addressing social needs than physicians working in other settings.

Conversely, other practice characteristics, such as payer-owned clinics and medical centers, were associated with lower awareness of SDOH documentation capabilities.

“Physicians in these organizations with historically less engagement in screening and social care may benefit from targeted educational interventions to increase awareness of SDH capabilities,” the researchers explained.

“Although awareness is a prerequisite to use, it is not the sole or best indicator of use,” they continued. “Moving forward, it will be critical to study the systematic uptake of SDH documentation capabilities and associated barriers and facilitators.”

The study authors suggested that NEHRS add questions to capture documentation and data review rates, including workflows for SDOH screening and navigation and information about the workforce involved in SDOH screening, documentation, and referral functions.

“Together, these data would enable us to identify those characteristics associated with promoting higher levels of use of SDH documentation capabilities,” they wrote.