Study finds electronic health records do not accurately identify common barriers to health

Fairbanks School of Public Health researchers found that popular electronic health record (EHR) screening questionnaires may miss many patients experiencing housing instability and financial strain.

"More and more health care organizations are interested in screening their patients for social risk factors, or sometimes what are referred to as the social determinants of health," said Joshua Vest, professor of health policy and management at the Fairbanks School, a research scientist at the Regenstrief Institute and co-PI on the study. "This information is often collected within electronic health records, and to help providers target interventions for patients that could lead to improved health."

Commonly used EHR questionnaires screen for housing instability, financial strain and food insecurity. These questionnaires are embedded in the EHR so the provider can identify barriers to a patient's health. An EHR is a digital version of a patient's medical record.

The study surveyed more than 800 adult patients in 11 primary care clinics in Indianapolis, IN, and Gainesville, FL, from January to September 2022. Patients completed both an EHR-based survey and a follow-up questionnaire created by the researchers.

More than 800 patients completed the follow-up questionnaire during their visit or after via phone or email.

Researchers found that the EHR-based survey identified far fewer patients with housing instability or financial strain. The researchers found that for food insecurity, the results between the survey and questionnaire were comparable.

"The primary goal of using an EHR to identify the risk factors of housing instability and financial strain is not being achieved with the current EHR screening method," said Chris Harle, professor of health policy and management at the Fairbanks School, an affiliated scientist at the Regenstrief Institute and co-PI on the study. "Through assessing performance, we can understand the effectiveness of efforts at screening for social risks. We would like to perform further research to understand how best to use such screening tools."

The study, "Accuracy of electronic health record food insecurity, housing instability, and financial strain screening in adult primary care," was published in the Journal of the American Medical Association (JAMA) on February 7, 2023.