Boston Medical Center implements SDOH screening tool in EHR

Boston Medical Center is able to gather social determinants of health information with an electronic health record-based model that screens primary care patients for unmet needs.

The THRIVE model, developed by researchers at Boston Medical Center, leverages a one-page screener that patients fill out in the waiting room prior to their appointment. Then, a medical assistant enters those responses into the EHR.

Based on that input information, the EHR prompts the provider to address any SDOH concerns raised by the patient in the screener during the appointment and adds these needs to the patient’s chart through auto-generated ICD-10 codes.

The system also prints out information on referral resources available at BMC and in the community, where a patient—upon request—can get help for an SDOH need that has been identified in the screening tool.

An observational study, published in the journal Medical Care, concludes that “implementing a systematic clinical strategy in primary care using EHR workflows was successful in identifying and providing resource information to patients with SDOH needs.”

In the study, 26 percent of patients responded positively to one or more social needs, with employment (12 percent), food insecurity (11 percent) and problems affording medications (11 percent) cited as the most prevalent needs based on the screening tool.

“The screening and referral workflow in the EHR facilitated documentation of ICD-10 codes and streamlined the provision of resources to patients requesting additional information,” according to the study’s authors.

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“The ability to successfully incorporate this critical information into the electronic medical record is a true game changer when it comes to addressing the whole patient,” says lead author Pablo Buitron de la Vega, MD, a physician in general internal medicine. “As a physician, this information is vital to the health and well being of my patients and their families. Now that I am aware of these issues, I can better treat them by connecting them with resources that will help them thrive.”

As a result of the successful study, all patients in BMC ambulatory primary care clinics—including family medicine, pediatrics, obstetrics and gynecology, and general internal medicine—are being screened using THRIVE. So far, the medical center has screened more than 57,000 patients, with housing, food and education emerging as the most common SDOH needs among patients.

In addition, the THRIVE model—including the screening tool—has been shared with BMC’s accountable care organization partners as well as other healthcare providers nationwide that have successfully implemented the solution into their systems.

“This data-driven approach is a novel way to address healthcare inequity while also addressing the rising costs of healthcare, including Medicaid,” says senior author Nancy Kressin, a professor of medicine at Boston University School of Medicine. “We believe that THRIVE can help change the delivery of care at BMC, within our ACO, and that its scalability can have positive impacts on healthcare delivery at the national level.”

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