In two national surveys, we found that while most physicians—particularly primary care physicians—indicated that it was somewhat or very important to be able to view external SDOH information in the EHR, fewer physicians felt that having access to SDOH data was very important. The perceived value of SDOH varied by specialty, with fewer surgical specialists rating access to external SDOH data as very important. EHR SDOH documentation rates were relatively high among physicians overall, especially among family medicine physicians. However, rates of documentation using structured methods were lower, with about one-third of physicians and about half of family medicine physicians reporting using structured methods. Those working in medical or surgical specialties were less likely to document overall and using structured methods than primary care physicians.

Variation in the documentation and use of SDOH data by specialty may be due, in part, to differences in perceived importance of accessing external SDOH data in the EHR which suggests there are opportunities to promote structured documentation and use of SDOH data in a variety of clinical settings. For instance, lower perceived importance of external SDOH data among surgeons relative to other types of physicians contrasts with known associations between SDOH and post-operative outcomes.21 While some SDOH screening and referral interventions occur in surgical settings,22,23 many current efforts are focused in primary care settings.24 Given that SDOH may play a role in post-operative outcomes, educating surgeons regarding the value of SDOH data in surgical and specialty settings may be beneficial. Future work should assess capacity for and interest in providing screening and referrals in specialty settings. In interpreting these findings, it should be noted that other members of the healthcare team, including community health workers, nurses, care coordinators, case managers, and social workers, may be more likely to conduct SDOH screening and offering resources to address social needs than physicians.25,26 This may be due to workflow design, including having more time with patients or conducting screening during the rooming process. However, physicians play an important role in using SDOH data to adjust medical care decisions to accommodate social circumstances and to offer resources to address social needs.3

Not surprisingly, physicians who had a higher proportion of vulnerable patients were more likely to indicate that access to external SDOH data was very important. We also show that family medicine physicians who reported having the necessary resources in their clinics to address social needs were more likely to believe that access to external SDOH data was very important. Furthermore, perceptions regarding having the necessary resources to address social needs were also associated with greater collection and use of SDOH data, and identifying resources and making referrals. Having in-clinic resources for screening and referrals, education about the impact of SDOH on health, and training on how to address social needs may be important facilitators of conducting screening and using that information to inform clinical decision-making and to make referrals.15 Those serving high proportions of marginalized patients may practice in resource-constrained environments, and thus, attention must be paid to ensure that patients have access to screening and referral resources regardless of where they seek care.27 Physicians who serve vulnerable populations may have limited access to resources to address social needs, which in turn may perpetuate existing inequities.27

Sharable structured SDOH data helps to ensure physicians have access to the timely and accurate data about patients’ needs. Recent studies have demonstrated that EHR SDOH documentation may underestimate the prevalence of SDOH.4,28 We affirm prior work indicating that documentation of SDOH occurs frequently via free-text notes, while the use of structured data capture tools remains limited.6 In addition to primary care, those practicing in clinics engaged in value-based care or served a higher proportion of vulnerable groups were more likely to document using a structured method. Variation in SDOH documentation practices suggests the need for outreach to increase SDOH documentation rates among certain physician populations, such as specialists, as SDOH documentation has been shown to be important for care coordination29,30 and to support efforts to assist patients with social needs or adjust medical care decisions based on social circumstances.3 Additionally, there are several standards in development which will require SDOH screening and referrals to address social needs, which may increase adoption of structured SDOH EHR documentation approaches.31

Efforts to increase structured SDOH documentation will be important to facilitate exchange and use of SDOH data.31,32(p19) Value-based payment models and incentives are beginning to encourage the collection and use of these data,32(p19) and starting in 2024, Medicare is requiring screening of all inpatients for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety.33,34 As more patients are regularly screened for SDOH, structured SDOH documentation will be important for quality measurement and reporting, and indeed, several SDOH-focused quality measures under development will require reporting on the prevalence of SDOH screening.31,35,36,37,38,39,40 Additionally, structured SDOH data may be used in clinical decision support algorithms to support tailoring medical decisions based on patients’ social needs41 and in community resource referral platforms to facilitate referrals to local resources.42 The increased prevalence of SDOH screening, and subsequent documentation of SDOH in the EHR, spurred by the new Medicare inpatient screening requirement further underscores the need to support all types of physicians on healthcare teams with resources to best make use of these data to support patients.

Our findings suggest there is opportunity to improve structured data collection and use of SDOH data to address social needs. In recognition of the urgent need to create a more integrated health and social care system that can effectively meet patients’ needs and improve equitable opportunities for attaining health and well-being, the U.S. Department of Health and Human Services recently released a Call to Action urging clinicians—including primary care physicians and specialists—to consistently screen and identify patients with social needs using diagnosis codes, and to leverage partnerships with community-based organizations and community care hubs that can help facilitate care coordination and service delivery to address social needs.43 Further research is necessary to determine how best to support clinicians as reporting on SDOH screening and referrals become increasingly required or strongly encouraged through financial incentives.31

This study has several limitations that must be considered. First, all included physician documentation measures relied on respondent self-report and may not reflect all documentation efforts in each clinic. Furthermore, these measures do not provide indication of frequency nor volume of EHR SDOH documentation or methods used. While the survey provides insight into the different types of methods used for SDOH documentation, it is unclear how often each of these methods is used for documentation.

We show that while many physicians value having access to SDOH data from outside sources, fewer physicians consider these external data to be “very” important. While most physicians document SDOH data, yet fewer use structured methods, limiting opportunities for exchange or use of these data to connect patients to resources. Physicians’ perceived value and documentation practices varied by specialty, availability of resources to address social needs, participation in value-based care, and patient population vulnerability, suggesting there are myriad factors potentially affecting the documentation and use of SDOH data. As efforts are underway to develop tools to help inform medical care decisions and provide services to address social needs, it is critical to ensure physicians have access to complete and accurate EHR SDOH data and have the resources they need to effectively use data captured through screening.