Can Electronic Health Records be Used to Articulate Social Workers' Contribution to Care Coordination? Lessons Learned from One Large Urban Pediatric Healthcare Setting

Background and Purpose: Care coordination (CC) is the crux of many widely adopted comprehensive health care strategies designed to improve patient care and population health while simultaneously reducing costs. Despite the integral role of health care social workers (HSWs) within the U.S. health care system, CC research underscores the roles of disciplines other than social work. Given the shifting health and political landscape, it is it is increasingly necessary for social workers to be able to systematically articulate and measure the content, process, and value-added of their contributions to CC and patient care. This paper has three aims: 1) to operationalize and quantify the nature of HSW CC activities conducted in pediatric healthcare settings, 2) to describe the process through which the Electronic Health Record (EHR) was modified to facilitate documentation of specific HSW CC activities, and 3) to identify challenges and opportunities associated with using EHR databases to elucidate the value added of HSW activities to patient outcomes. 

Methods: Over a period of six months, an iterative and consensus-driven process was used to identify and operationalize 23 discrete CC tasks undertaken by HSWs across one large pediatric hospital. Over three workdays, 22 HSWs from 18 unique clinics within the hospital recorded total time spent daily on each identified CC activity. Based on findings from this initial pilot study, the EHR system was modified to include a drop-down menu of 14 discrete CC activities intended to facilitate ease of completion and minimize provider burden. Post-modification, the EHR database was utilized to examine frequencies of HSW CC activities in patient encounters that occurred over a 1 month period. 

Results: In the pilot study, participants spent an average of 78.3% of a typical workday on CC activities, with an average of 8.5 CC tasks conducted per day (range: 2-14). The most frequently performed tasks were facilitating a patient’s multidisciplinary care plan (65.5%), consulting with the patient’s medical team (65.2%), and conducting a biopsychosocial assessment (60.6%). Of the 3812 patient encounters records drawn from the EHR database post-modification, at least one CC task was present in 74.3% of patient encounters, with an average of 1.6 (1.3) tasks per encounter (range 0-8). Overall, facilitating the patient’s multidisciplinary care plan was associated with 43.2% of encounters, medical consultation was associated with 38.9% of encounters, and biopsychosocial assessment occurred in 45.6% of encounters. 

Conclusions and Implications: Taken together, results indicate that CC is a cornerstone of HSW service provision in pediatric health care settings; however, notable discrepancies in the data suggest that HSWs may be documenting CC activities in variable ways. Given that EHR data will be used by hospital leadership to understand HSW interventions and determine needed resources, training in standardized approaches to EHR documentation for frontline HSWs is a much-needed intervention that has the potential to elucidate the value added of HSWs to CC and team-based care.