Electronic Health Reporter

By Baraka Floyd, MD, pediatrics physician at Stanford Medicine Children’s Health and Clinical Assistant Professor at Stanford School of Medicine and Lindsay Stevens, MD, pediatrics physician at Stanford Medicine Children’s Health and Clinical Professor at Stanford School of Medicine

The emerging focus on social factors that influence health outcomes has necessarily transformed the approach clinicians take in patient care. These factors, otherwise known as “social determinants of health (SDOH),” include food insecurity, housing and utility instability, transportation access, and personal safety, among others. These have a tremendous impact on long-term health outcomes and quality of life.

When problems arise in these areas, patients and families struggle to focus on medical needs. As a clinician, identifying and keeping track of these social determinants of health help create the opportunity for patient-focused solutions. This could be the difference between a food insecure family gaining access to resources and that same family not being aided appropriately.

Food insecurity as an example of a social determinant of health

More common among families with children, food insecurity impacts more than 34 million people, including nine million children in the United States. It is a lack of consistent access to food for every person in a household to live a healthy life. Influenced by several factors that includes income, employment, race, ethnicity, and disability status, food insecurity has been exacerbated by the COVID-19 pandemic.

As the pandemic left many households with limited food access and financial opportunities, numerous families were forced to rely on food assistance programs for the first time. As even more families faced a lack of access to sufficient food and nutrition, health care providers had to ensure that they addressed food insecurity as a key determinant that impacts their patients’ long-term health.

Data is the answer to better understanding the situation

It is understandable that patients are reticent to provide this sensitive information unsolicited. Because of this, clinicians must take a more proactive approach to ask these questions. But they face problems tracking issues like food insecurity without a tool. The acceleration of digital transformation in health care has allowed us to use data to understand and improve care delivery, igniting unique opportunities to innovate processes and redesign workflows across the industry.

It is important for the nation’s health care systems to adopt an accurate, simple, and consistent approach to recording those responses. Consistent screening and documentation tools can empower care providers to successfully support and holistically address patients’ medical needs.

Turning screening data into action

At Stanford Medicine Children’s Health, the electronic health-record (EHR)-enabled documentation of social determinants of health has provided an opportunity to better address the impact these issues have on patients and their families. Incorporating screening into routine visit workflows and leveraging the power of analytics tools allow clinicians to understand the scope of need and direct resources accordingly.

Patients are now screened for social determinants of health with a set of validated questions recorded in the EHR. As part of this screening, patients’ families are asked whether, in the previous 12 months, they worried about their family’s food source and ability to purchase sufficient food. This digitized tool allows care teams to make sure the questions reach every patient, regardless of social and economic standing, and clinicians to find responses easily via their EHR. In doing so, care teams can connect families with helpful resources and referrals to food banks, programs, organizations, and more. Understanding the patient population and their needs can help support longer-term solutions for alleviating these challenges within the community, which is the ultimate goal.

The bigger picture

EHRs play a critical role in addressing social determinants of health – if we document, analyze, and act on the information provided. The primary aim is to make health care more responsive to social factors that influence patients’ health, and help their families gain reliable access to nutritious and healthy food, stable housing, and mitigate other challenges that are barriers to optimal health.