The "Digital Pre-Check" model embedding the social determinants of health (SDOH) screening within the pre-visit digital intake process—by placing the questions within the SMS or email registration link sent to the patient 24 hours prior to their appointment—provides opportunities for efficient management of high-volume clinics. In essence, the physician has access to the captured data (as it is now in the EHR) before the patient ambulates into the office for the appointment. This allows them to utilize clinical time for intervention as opposed to data gathering throughout the encounter. The Single-Question Power Screener I propose utilizes the "Hunger Vital Sign" as the baseline for determining an individual's economic stability. The single best question to ask is, "In the past 12 months, have you ever been worried that you would run out of food before you had enough money to buy more?" This question is very sensitive and serves as a primary surrogate for measuring an individual's overall financial and housing instability, thus allowing us to quickly identify those patients who are at risk. EHR Z-Code and Referral Automation We utilize an automated EHR Z-code trigger system. When a patient identifies food or transportation insecurity in their digital intake, the system automatically suggests the appropriate ICD-10 code (i.e., Z59.41 for food insecurity; Z59.82 for transportation insecurity). Closing the Loop As soon as the Z-code is entered in the EHR, the system creates a localized resource listing, which is printed and provided to the patient with their discharge summary. By embedding this process into the standard workflow for every patient, we ensure that all identified patient needs will be accompanied by available resources without requiring the physician to access other databases or complete a manual referral process.
The "Waiting Room Tablet" Strategy: By using the "Waiting Room Tablet" approach, we avoid impeding throughput by allowing all SDOH (Social Determinant of Health) screenings to occur on tablets in the waiting area of the outpatient wellness center. Patients can answer sensitive questions concerning food insecurity, domestic violence, and other topics without the pressure of a clinician being present. The results are sent to the clinical lead immediately, thus allowing the team to provide a "warm hand-off" to the social worker or case manager during the same appointment as the initial assessment. The Economic Stability Screener: I have found that utility assistance is typically the most reliable way to reveal distress. Specifically, I ask the following question: "Have you had your utilities disconnected in the last 12 months or had concerns that your utilities were going to be disconnected due to your inability to pay your utility bills?" By asking this question, patients often feel they can speak to me about other financial difficulties they might not want to discuss in an open manner. EHR Z-Code Efficiency: By making the Z55-Z65 code groups (which include socioeconomic and psychosocial circumstances) a requirement for each intake in the administration of the claim, we have developed a process to guarantee 100% compliance with SDOH screening. This ensures data capture without adding any additional burden to the physician's clinical documentation workflow. Building the Referral Loop: The best tool for establishing the referral loop is the "Community Resource Hub," which links directly to the patient portal. This means when a patient has a record of a Z-Code for food insecurity (Z59.41), the Community Resource Hub is automatically updated with the patient's location and the closest food banks, including their hours. This provides patients with immediate, actionable information while the clinician works with them on the medical aspect of their visit, allowing for maximum outpatient throughput.
In my health clinic I have volunteers that give out screeners to our patients to complete as they wait for the doctor to be seen. The screeners are super quick to complete, and they are on a tablet, so filling them out is super organized and simple. We found a lot of patients who needed help with housing, immigration and other psychosocial issues, and then we were able to connect them with our social worker for further assistance. Aleksey Aronov AGPCNP-BC Adult Geriatric Primary Care Nurse Practitioner - Board Certified VIPs IV https://vipsiv.com New York, NY