Adoption of social determinants of health ehr tools by community health centers

Rachel Gold, Arwen Bunce, Stuart Cowburn, Katie Dambrun, Marla Dearing, Mary Middendorf, Ned Mossman, Celine Hollombe, Peter Mahr, Gerardo Melgar, James Davis, Laura Gottlieb, Erika Cottrell

Research output: Contribution to journalArticle

19 Scopus citations


PURPOSE This pilot study assessed the feasibility of implementing electronic health record (EHR) tools for collecting, reviewing, and acting on patient-reported social determinants of health (SDH) data in community health centers (CHCs). We believe it is the first such US study. METHODS We implemented a suite of SDH data tools in 3 Pacific Northwest CHCs in June 2016, and used mixed methods to assess their adoption through July 2017. We modified the tools at clinic request; for example, we added questions that ask if the patient wanted assistance with SDH needs. RESULTS Social determinants of health data were collected on 1,130 patients during the study period; 97% to 99% of screened patients (n = 1,098) had ≥1 SDH need documented in the EHR, of whom 211 (19%) had an EHR-documented SDH referral. Only 15% to 21% of patients with a documented SDH need indicated wanting help. Examples of lessons learned on adoption of EHR SDH tools indicate that clinics should: consider how to best integrate tools into existing workflow processes; ensure that staff tasked with SDH efforts receive adequate tool training and access; and consider that timing of data entry impacts how and when SDH data can be used. CONCLUSIONS Our results indicate that adoption of systematic EHR-based SDH documentation may be feasible, but substantial barriers to adoption exist. Lessons from this study may inform primary care providers seeking to implement SDH-related efforts, and related health policies. Far more research is needed to address implementation barriers related to SDH documentation in EHRs.

Original languageEnglish (US)
Pages (from-to)399-407
Number of pages9
JournalAnnals of family medicine
Issue number5
StatePublished - Sep 1 2018


  • Community health centers
  • Electronic health records
  • Implementation
  • Social determinants of health

ASJC Scopus subject areas

  • Family Practice

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    Gold, R., Bunce, A., Cowburn, S., Dambrun, K., Dearing, M., Middendorf, M., Mossman, N., Hollombe, C., Mahr, P., Melgar, G., Davis, J., Gottlieb, L., & Cottrell, E. (2018). Adoption of social determinants of health ehr tools by community health centers. Annals of family medicine, 16(5), 399-407.