REDCap electronic survey raw data file.

The data used in this submission was collected via a secure REDCap survey at Penn State College of Medicine and Penn State Health. The authors have provided access to the raw CSV file of the data in this supplementary information file. (CSV)</p

Demographics.

Social and environmental determinants of health (SEDH) data in the electronic health record (EHR) can be inaccurate and incomplete. Providers are in a unique position to impact this issue as they both obtain and enter this data, however, the variability in screening and documentation practices currently limits the ability to mobilize SEDH data for secondary uses. This study explores whether providers’ perceptions of clinical importance of SEDH or EHR usability influenced data entry by analyzing two relationships: (1) provider charting behavior and clinical consideration of SEDH and (2) provider charting behavior and ease of EHR use in charting. We performed a cross-sectional study using an 11-question electronic survey to assess self-reported practices related to clinical consideration of SEDH elements, EHR usability and SEDH documentation of all staff physicians, identified using administrative listserves, at Penn State Health Hershey Medical Center during September to October 2021. A total of 201 physicians responded to and completed the survey out of a possible 2,478 identified staff physicians (8.1% response rate). A five-point Likert scale from “never” to “always” assessed charting behavior and clinical consideration. Responses were dichotomized as consistent/inconsistent and vital/not vital respectively. EHR usability was assessed as “yes” or “no” responses. Fisher’s exact tests assessed the relationship between charting behavior and clinical consideration and to compare charting practices between different SEDHs. Cumulative measures were constructed for consistent charting and ease of charting. A generalized linear mixed model (GLMM) compared SDH and EDH with respect to each cumulative measure and was quantified using odds ratios (OR) and 95% confidence intervals (CI). Our results show that provider documentation frequency of an SEDH is associated with perceived clinical utility as well as ease of charting and that providers were more likely to consistently chart on SDH versus EDH. Nuances in these relationships did exist with one notable example comparing the results of smoking (SDH) to infectious disease outbreaks (EDH). Despite similar percentages of physicians reporting that both smoking and infectious disease outbreaks are vital to care, differences in charting consistency and ease of charting between these two were seen. Taken as a whole, our results suggest that SEDH quality optimization efforts cannot consider physician perceptions and EHR usability as siloed entities and that EHR design should not be the only target for intervention. The associations found in this study provide a starting point to understand the complexity in how clinical utility and EHR usability influence charting consistency of each SEDH element, however, further research is needed to understand how these relationships intersect at various levels in the SEDH data optimization process.</div

REDCap electronic survey supporting documentation data file.

The data used in this submission was collected via a secure REDCap survey at Penn State College of Medicine and Penn State Health. The authors have provided access to the supporting documentation in this supplementary information file. (CSV)</p

Summary of SDH perceptions regarding clinical consideration (vital to care), consistent charting, and ease of charting.

Fig 1 demonstrates the percentage of physicians who included social determinants of health (SDH) in their clinical considerations (i.e. if they indicated that SDHs were vital to their care) and the percentage of physicians who consistently charted on SDHs. The figure also demonstrates the percentage of physicians who indicated that the SDH was easy to chart.</p

Charting of SDH factors based on perceived importance and ease of charting in EHR.

Charting of SDH factors based on perceived importance and ease of charting in EHR.</p

Summary of EDH perceptions regarding clinical consideration (vital to care), consistent charting, and ease of charting.

Fig 2 demonstrates the percentage of physicians who included environmental determinants of health (EDH) in their clinical considerations (i.e. if they indicated that EDHs were vital to their care) and the percentage of physicians who consistently charted on EDHs. The figure also demonstrates the percentage of physicians who indicated that the EDH was easy to chart.</p

Charting of EDH factors based on perceived importance and ease of charting in EHR.

Charting of EDH factors based on perceived importance and ease of charting in EHR.</p