Why Mixed Messages with the Social Determinants of Health

by Tiffany Ferguson, LMSW, CMAC, ACM
Published on Feb 20, 2023

This article appeared on RACmonitor.com on February 20, 2023

There appears to be an overlap of messages concerning the social drivers of health in the EMR.

The Centers for Medicare & Medicaid Services (CMS) continues to prioritize efforts with an emphasis on health equity, with greater data reporting and recommended capture of z-codes. I am seeing a lot of mixed messages, with overlap in the electronic medical record (EMR) regarding social determinants and social drivers of health (SDoH).

Social “determinants” is our documentation to support z-codes, while social “drivers” includes our documentation of quality measures for CMS’s value-based purchasing initiatives. I urge EMR vendors and health systems to develop a collaborative and non-siloed approach to capture this information.

How often do we look at information in the EMR for which details have been provided in a similar fashion and are documented in multiple locations? The goal should always be to identify the best location for where important personal information can be found and route everything back to the source of truth in the record. For instance, take a patient’s address.

As a case manager, I often update and find details of this information as we discuss home location with the patient; instead of putting this detail in my note, I ensure that it goes back to the source of truth in the record, the patient’s demographic section.   

When adding questions that meet the needs for quality reporting for the five domains of social drivers of transportation, utilities, personal safety, housing, and food insecurity, let’s look at what is already in the record and what can be adjusted to easily match existing workflow. Then let’s ensure that this information is available for all parties.

For instance, if the details of a patient’s living condition are impacting the care plan, that information should be accessible not only to the care team, but also the coding team, to ensure that they can appropriately capture these details. A collaborative session may be helpful, involving clinical documentation improvement (CDI), coding, nursing informatics, quality, and case management, to review the details in the record regarding the SDoH and where this information can be found.

Coding and quality can provide input on the specifications they may need that would help them clearly understand the impact of a particular social determinant on the hospitalization.

In most case management documentation templates, although not consistently used, are fields listing patient limitations or barriers to discharge. These include check boxes and comments for such factors as language barriers, limited social support, and financial stressors.

This information can help guide the coding team, and if any questions arise, via conversations with utilization review or the attending, it is perfectly okay to secure chat or query the case manager for clarification to ensure that we capture these details.

Are you reviewing case management documentation to capture z-codes related to the SDoH?

Programming note: Listen to Tiffany Ferguson’s live reporting on SDoH today on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer.