Department of Sociology, University of Michigan, 500 S. State St., Ann Arbor, MI, 48109, USA.
Department of Family Medicine, Henry Ford Health System, One Ford Place, 3E, Detroit, MI 48202, USA.
Soc Sci Med. 2022 Dec;315:115548. doi: 10.1016/j.socscimed.2022.115548. Epub 2022 Nov 15.
There is growing interest in standardizing data about social determinants of health (SDOH) in electronic health records (EHRs), yet little is known about how clinicians document SDOH in daily practice. This study investigates clinicians' strategies for working with SDOH data and the challenges confronting SDOH standardization. Drawing on ethnographic observation, interviews with patients and clinicians, and systematic review of patient EHRs-all at an urban teaching hospital in the US Midwest-we analyze three strategies clinicians deploy to integrate SDOH data into patient care. First, clinicians document SDOH using "signal phrases," keywords and short sentences that help them recall patients' social stories. Second, clinicians use other technology or face-to-face conversations to share about patients' SDOH with colleagues. Third, clinicians fold discussion of SDOH with patients into their personal relationships. While these local strategies facilitate personalized care and help clinicians minimize their computer workload, we also consider their limitations for efforts to coordinate care across institutions and attempts to identify SDOH in EHRs. These findings reveal ongoing tensions in projects of standardization in medicine, as well as the specific difficulty of standardizing data about SDOH. They have important clinical implications as they help explain how clinicians may attend to patients' SDOH in ways that are not legible in patient records. This paper is also relevant for policy at a time when mandates to include SDOH data in health records are expanding and strategies to standardize SDOH documentation are being developed.
人们对在电子健康记录 (EHR) 中标准化健康的社会决定因素 (SDOH) 数据越来越感兴趣，但对于临床医生在日常实践中如何记录 SDOH 知之甚少。本研究调查了临床医生处理 SDOH 数据的策略以及 SDOH 标准化面临的挑战。本研究在美国中西部的一家城市教学医院进行了人种学观察、患者和临床医生访谈以及对患者电子健康记录的系统回顾，分析了临床医生将 SDOH 数据整合到患者护理中的三种策略。首先，临床医生使用“信号短语”、关键词和短句来记录 SDOH，这些短语和短句有助于他们回忆患者的社会故事。其次，临床医生使用其他技术或面对面交流与同事分享患者的 SDOH。第三，临床医生将与患者讨论 SDOH 纳入他们的个人关系中。虽然这些本地策略有助于个性化护理，并帮助临床医生最小化他们的计算机工作量，但我们也考虑了它们在跨机构协调护理的努力以及在 EHR 中识别 SDOH 的尝试中的局限性。这些发现揭示了医学标准化项目中的持续紧张局势，以及 SDOH 数据标准化的具体困难。它们具有重要的临床意义，因为它们有助于解释临床医生如何以在患者记录中不可读的方式关注患者的 SDOH。在要求将 SDOH 数据纳入健康记录的政策背景下，本文也具有相关性，同时正在制定标准化 SDOH 文档的策略。
