title: Moving electronic medical records upstream: incorporating social determinants of health.
abstract: BACKGROUND
  Knowledge of the biological pathways and mechanisms connecting social factors with health has increased exponentially over the past 25 years, yet in most clinical settings, screening and intervention around social determinants of health are not part of standard clinical care. Electronic medical records provide new opportunities for assessing and managing social needs in clinical settings, particularly those serving vulnerable populations.
  
  
  OBJECTIVE
  To illustrate the feasibility of capturing information and promoting interventions related to social determinants of health in electronic medical records.
  
  
  METHODS
  Three case studies were examined in which electronic medical records have been used to collect data and address social determinants of health in clinical settings.
  
  
  RESULTS
  From these case studies, we identified multiple functions that electronic medical records can perform to facilitate the integration of social determinants of health into clinical systems, including screening, triaging, referring, tracking, and data sharing.
  
  
  CONCLUSIONS
  If barriers related to incentives, training, and privacy can be overcome, electronic medical record systems can improve the integration of social determinants of health into healthcare delivery systems. More evidence is needed to evaluate the impact of such integration on health care outcomes before widespread adoption can be recommended.
authors.affiliation: Department of Family and Community Medicine, School of Medicine, University of California, San Francisco. Electronic address: gottliebl@chc.ucsf.edu.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Gottlieb
authors.affiliation: Research and Development, Health Leads, Boston, Massachusetts.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Tirozzi
authors.affiliation: HealthBegins and the Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Rishi
authors.initials: R
authors.lastname: Manchanda
authors.affiliation: School of Social Welfare, University of California, Berkeley.
authors.forename: Abby R
authors.initials: AR
authors.lastname: Burns
authors.affiliation: National Center for Medical-Legal Partnership, Department of Health Policy, George Washington University School of Public Health and Health Service, Washington, District of Columbia.
authors.forename: Megan T
authors.initials: MT
authors.lastname: Sandel
mesh_terms: D057286:Electronic Health Records; D005240:Feasibility Studies; D006801:Humans; D020380:Needs Assessment; D012017:Referral and Consultation; D064890:Social Determinants of Health; D014481:United States