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EHR documentation of SDOH rising among family physicians
While structured EHR documentation of SDOH is on the rise, future efforts are needed to understand how often structured data elements are mapped to consensus-based standards.
The use of structured EHR documentation methods for social determinants of health is on the rise among family physicians, according to a data brief from the Assistant Secretary for Technology Policy .
Nearly three-quarters of family physicians (73%) reported EHR documentation of social determinants of health (SDOH), according to 2022 to 2024 data from the American Board of Family Medicine Continuous Certification Questionnaire.
From 2022 to 2024, more than half of family physicians (61%) used free-text notes to document SDOH. However, only 16% used this method exclusively. Over the two years, 44% of clinicians used free-text notes along with at least one of two structured methods: checkboxes/buttons or diagnosis codes.
However, standardized SDOH documentation is on the rise, with 58% of family physicians using at least one structured documentation method in 2024. Still, it is unclear how often clinicians use these methods or which data elements clinicians capture more commonly using structured electronic screening tools.
Documentation practices vary by practice characteristics
From 2022 to 2024, family physicians in small, independently owned practices had lower rates of SDOH documentation compared to physicians in large practices, academic health centers or hospitals.
Notably, rates of SDOH documentation were higher among physicians at organizations that participate in at least one value-based care initiative, which often includes financial incentives for providers to address social needs.
SDOH documentation rates were also higher across physicians serving vulnerable populations, who might have a greater awareness of the social risk factors and their impact on patient health in their community. Structured SDOH documentation was also more common among family physicians who reported that their clinic has resources available to address social needs.
"The use of structured methods can enable providers to more easily coordinate with and share data with other providers or community-based organizations to connect patients to social services and address immediate unmet social needs," the brief authors noted.
Assistant Secretary for Technology Policy (ASTP) also found that family physicians who used one of the top three EHR vendors by market share had higher rates of SDOH documentation compared to clinicians using smaller vendors. This might be due to the greater availability of standardized SDOH screening tools integrated into systems of larger EHR vendors.
Nearly all family physicians reported that it was very or somewhat important to have access to external SDOH data. However, physicians serving vulnerable populations and those who reported their organization had resources to address SDOH rated the importance of SDOH data access from outside organizations higher.
This finding suggests that without resources to address patients' social needs effectively, physicians might place lower priority on having access to SDOH data.
Ongoing efforts for standardized SDOH documentation
There are several federal and federally supported efforts to drive interoperability of structured SDOH data. For instance, the United States Core Data for Interoperability standard includes structured SDOH data elements and standards for capturing screening or assessment, problems or concerns and goals.
Additionally, ASTP released an SDOH Information Exchange Toolkit in 2023 to provide resources and other guidance for implementing IT infrastructure for SDOH data exchange.
However, the data brief underscored that future efforts are needed to understand how often structured data elements are mapped to consensus-based standards, as this facilitates interoperability with other providers and community partners.
"Further, more work is needed to identify factors that influence the value of having access to external SDOH data which, combined with social needs data collected and documented internally, can help inform an individual's care plan and facilitate the delivery of person-centered care," ASTP noted.
Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.
