Karen Nitkin

Date: 11/14/2019

Learning about the lives of his patients helps internist Danny Lee provide better care. So he asks them: Do you have access to transportation? Do you struggle to make ends meet? How often do you talk with friends or family members?

Until recently, Lee and other Johns Hopkins providers documented this social, behavioral and economic information in the notes section of the Epic electronic medical records system. Now, a Social Determinants of Health (SDOH) Wheel in Epic makes the information easier to see and use.

The SDOH Wheel shows 10 domains, each representing a factor that can influence health: financial resource strain, transportation needs, alcohol use, depression, intimate partner violence, social connections, physical activity, tobacco use, stress and food insecurity.

Based on patient answers to questions such as how often they drink alcohol or interact with others, the panels turn green to indicate low risk, yellow for moderate risk or red to signal cause for concern.

“It’s important to see that wheel,” says Lee. “We have wonderful doctors and therapists who take care of our patients and send them on their way. And then what happens? They come back. Maybe they couldn’t get to a doctor’s appointment or couldn’t afford their medication.”

The information can be collected by physicians, nurses, nurse practitioners, social workers or other members of the care team. Clinicians can also assign the questions to patients through their MyChart portal.

As a result, a graphic that is easily visible in the patient’s chart. Patients can see the answers to the questions, but not the wheel itself, says Brent Melanson, Epic information technology director for inpatient applications.

2. hovering a cursor over each domain, care team members can see the relevant patient responses, as well as changes over time.

The SDOH Wheel was launched in July for ambulatory clinicians and in October for inpatient and emergency department clinicians. It will be part of the electronic medical record system at Johns Hopkins All Children’s Hospital when the Florida hospital begins using Epic in late 2020.

The feature does not generate referrals or recommend next steps. It does, however, include a link to the Aunt Bertha community resource site, so clinical staff members and providers can search by ZIP code for services such as food pantries and transportation assistance.

“I think the wheel will enhance our ability to provide family-centered care,” says Barry Solomon, chief of the Division of General Pediatrics and Adolescent Medicine, and professor of pediatrics.

“Clinicians and staff have been asking about patient’s social needs and determinants for a long time, but we haven’t had a good place to document this information in the electronic medical record where it can be easily visible to others,” says Solomon, who serves on a work group bringing the SDOH Wheel to Johns Hopkins.

“This new Epic feature highlights the importance of assessing SDOH during clinical encounters using a team-based approach,” he says. “Addressing these important factors can help us reach the ultimate goal of improving health outcomes of our patients.”