February 8, 2023

JAMA study finds electronic health records do not accurately identify common barriers to health

Joshua Vest and Chris Harle

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, PhD, professor of health policy and management at the Fairbanks School, a research scientist at the Regenstrief Institute and co-principal investigator of 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.

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 screening questionnaire 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, PhD, professor of health policy and management at the Fairbanks School, an affiliated scientist at the Regenstrief Institute and co-principal investigator of 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.”

“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) February 7, 2023. In addition to Drs. Vest and Harle, Wei Wu, PhD, Department of Psychology, IUPUI, is a co-author.

About the IU Richard M. Fairbanks School of Public Health
Located on the IUPUI and Fort Wayne campuses, the Indiana University Richard M. Fairbanks School of Public Health is committed to advancing the public’s health and well-being through education, innovation and leadership. The Fairbanks School of Public Health is known for its expertise in biostatistics, epidemiology, cancer research, community health, environmental public health, global health, health policy and health services administration.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.


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