Identification of Social Risk-Related Referrals in Discrete Primary Care Electronic Health Record Data: Lessons Learned From a Novel Methodology

Top Things to Know

Implementing standardized coding practices for social risk referrals can enhance the accuracy of documenting and reporting interventions, ensuring patients receive necessary resources.

Identifying and addressing food insecurity through structured EHR data can improve patient health outcomes by ensuring access to nutritious food.

Direct provision of resources, such as food assistance, can be effectively documented and tracked using structured data fields, supporting the food is medicine approach to healthcare.

Summary of Conclusion/Findings

This study assessed the utility of using discrete primary care electronic health record (EHR) data to identify social risk referrals in community-based clinics. It found that structured data fields, such as smartphrases and procedure codes, can indicate social risk referrals but are often inconsistent with chart note documentation. The primary social risks addressed were food insecurity, financial stress, and housing needs. Common referral activities included providing contact information, assistance with applications, and direct provision of resources. Documentation showed that patients received resources in 29% of cases. The study highlights the need for standardized coding practices to improve the accuracy and feasibility of reporting social risk referrals.