Incorporating Social Determinants of Health in Electronic Health Records: Qualitative Study of Current Practices Among Top Vendors
Incorporating Social Determinants of Health in Electronic Health Records: Qualitative Study of Current Practices Among Top Vendors
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DOI：
10.2196/13849
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发表时间：
2019-04-01
影响因子：
3.2
通讯作者：
Dhopeshwarkar, Rina
中科院分区：
文献类型：
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作者：
Freij, Maysoun;Dullabh, Prashila;Dhopeshwarkar, Rina
背景：健康的社会决定因素（SDH）越来越被视为了解患者健康和确定适当干预措施以改善健康结果的重要因素，这是卫生系统、社区和个人层面因素之间复杂的相互作用。目的：本文的目的是调查电子健康记录（EHR）软件产品的发展，使卫生保健提供者能够识别和解决卫生保健环境中患者的SDH问题。方法对6家在门诊和住院均占有较大市场份额的电子病历供应商进行访谈。我们对访谈进行了专题分析，以(1)确定他们开发此类软件产品的动机，(2)描述他们的产品和用途，以及(3)确定通过他们的产品或其他方式收集和使用SDH数据的促进因素和挑战-无论是在护理点还是在人口健康干预中。结果：我们的研究结果表明，供应商系统及其功能受到客户需求和主动性、联邦主动性和供应商对医疗保健系统机会的战略愿景的影响。在拥有大市场份额的小样本供应商中，SDH是一个新的增长领域，供应商的SDH相关产品的数量和成熟度各不相同。为了实现更好的数据分析、人口健康管理和SDH数据的互操作性，供应商认识到需要在各种联邦和州计划中对SDH绩效指标进行更多标准化，更好地将SDH指标映射到多种类型的代码，并为所有感兴趣的SDH指标开发更多代码。结论：供应商表示，他们正在积极开发产品，以促进SDH数据的收集和使用，并通过内部产品决策和与政策制定者的合作，寻求数据标准化和互操作性挑战的解决方案。由于缺乏围绕SDH数据的政策标准，特定于产品的决策可能最终成为考虑到特定供应商市场份额的事实上的政策。然而，商业供应商似乎准备与彼此、卫生保健系统和政府机构合作讨论政策解决方案，如标准或指南，以进一步促进SDH数据整合到所有卫生系统的护理标准中。
Background: Social determinants of health (SDH) are increasingly seen as important to understanding patient health and identifying appropriate interventions to improve health outcomes in what is a complex interplay between health system-, community-, and individual-level factors.Objective: The objective of the paper was to investigate the development of electronic health record (EHR) software products that allow health care providers to identify and address patients' SDH in health care settings. Methods We conducted interviews with six EHR vendors with large market shares in both ambulatory and inpatient settings. We conducted thematic analysis of the interviews to (1) identify their motivations to develop such software products, (2) describe their products and uses, and (3) identify facilitators and challenges to collection and use of SDH data-through their products or otherwise-either at the point of care or in population health interventions.Results: Our findings indicate that vendor systems and their functionalities are influenced by client demand and initiative, federal initiatives, and the vendors' strategic vision about opportunities in the health care system. Among the small sample of vendors with large market shares, SDH is a new area for growth, and the vendors range in the number and sophistication of their SDH-related products. To enable better data analytics, population health management, and interoperability of SDH data, vendors recognized the need for more standardization of SDH performance measures across various federal and state programs, better mapping of SDH measures to multiple types of codes, and development of more codes for all SDH measures of interest.Conclusions: Vendors indicate they are actively developing products to facilitate the collection and use of SDH data for their clients and are seeking solutions to data standardization and interoperability challenges through internal product decisions and collaboration with policymakers. Due to a lack of policy standards around SDH data, product-specific decisions may end up being de facto policies given the market shares of particular vendors. However, commercial vendors appear ready to collaboratively discuss policy solutions such as standards or guidelines with each other, health care systems, and government agencies in order to further promote integration of SDH data into the standard of care for all health systems.