Table 3.

Barriers and facilitators of integrating SDOH data into EHRs

Category	Barriers	Facilitators
Domain Indicators	Conflicting priorities between SDOH data frameworks Differing SDOH needs and priorities between service populations Provider liability to respond to certain disclosures	Relevant to patients, providers, public health Clinically actionable in care setting (e.g. can refer to internal or external resources) Exclude domains that require immediate attention from provider (e.g. domestic violence, alcohol, depression)
Screening and Measurement	Wording that that retraumatises, stigmatises, or shames patients	Culturally sensitive Translated to relevant languages User friendly (e.g. screener <10 min to finish, ~3 measures per indicator) Good psychometrics (e.g. validity, reliability, sensitivity to change) Low-cost or free to implement
Screener Data Collection Methods and Procedures	Disruption of clinical workflows Low use of online patient portals for data entry Staff may be exposed to secondary trauma	Administer screener during down time (e.g. in waiting room, online before visit) Make data available to provider during appointment Staff training and support
Patient-Provider Relationships	Low health literacy Low socio-economic status	Data sparks conversations and promotes shared decision-making
Health System	Providers can be frustrated to screen for issues they are not trained to help with Delays in or lack of data accessibility to providers and administrators Complex data security needs Limited interoperability between EHR systems	Providers who help patients meet their SDOH needs may feel empowered and have increased job satisfaction SDOH data can identify unmet needs in service populations and guide new partnership formation SDOH data are vital to patient-centred medical homes, patient-centred outcome research, and precision medicine research and applications Consider establishing a steward to manage SDOH data and report to clinical leadership
Payers	Many reporting standards (e.g. HEDIS) do not require SDOH data Providers may have difficulty applying ICD-10 Z-codes to specific, actionable, SDOH issues	UDS already requires collecting many SDOH data points Switching from fee-for-service to value-based reimbursement improves ability to bill for SDOH-related services and other preventative care Vendors are working with insurance companies, governments, and health systems to better integrate SDOH into their EHR