Towards A Model Representation Of Residence, Living Conditions, And Living Situation: An Evaluation Of Clinical Practice In Documentation, And Associated Standards And Informational Models

Abstract

Social determinants of health (SDOH) play an important role in diagnosis, prevention, health outcomes, and quality of life and have long been a consideration in the provision of care. SDOH can cause illness, exacerbate chronic illness, but can also improve health. The SDOH target domains of interest for this proposal are Residence, Living Situation, and Living Conditions. Historically, these three topic areas are either not well documented in the EHR or, if they are documented, they are in unstructured or semi-structured text making the information inaccessible to clinical decision support tools or secondary use in research. Building upon previous work, the overall goal of this three-part study is to enhance current information models of these three domains through the evaluation of content and completeness of existing standards and terminologies and examine how coherent our documentation is of these target domains is in the electronic health record through analysis of specific ancillary notes as well as other structured and unstructured sections of the EHR. Examination of 27 standards and terminology sources contributed to an enhanced model representation for Residence, Living Situation, and Living Conditions. However, our findings show there are no fully comprehensive standards for EHR documentation of these topic areas. An analysis of unstructured text from the EHR demonstrated that SDOH are being documented in notes and these data contributed to further enhanced model. Lastly, an examination of flowsheet data showed many inconsistencies in flowsheet build and documentation, many of which could be solved if we have a comprehensive standard for documentation of SDOH.