Using Electronic Health Records to Better Understand Social Work Practice in Integrated Health Settings

Background and Purpose: Electronic health records(EHR) are used in approximately 75% of all U.S. healthcare settings and can be utilized to describe content of practice and communicate plans of care across a team of providers. Despite broad implementation, EHRs have not been routinely used to collect data on social work (SW) practice. Also, EHR data has not been used to understand the shifting roles and functions of social workers (SWs) in integrated health settings. SWs are often deployed to identify and positively impact patients’ social determinants of health, as well as perform interventions from brief behavioral health treatment to care management to referrals for community services. Although SWs are now a critical part of interprofessional teams, there is limited information about their documentation practices in primary care clinics. This mixed-methods study determined how and to what extent SW practice is documented in EHRs in integrated primary care and will elucidate the process of extracting EHR data to determine the content and scope of SW encounters in these settings. 

Methods: This exploratory study had two aims: (1) To determine SWs EHR documentation procedures in primary care settings; and (2) To describe the content and scope of SW practice documented in the EHR at an integrated primary care clinic. To accomplish these aims, the study was conducted in two phases. In phase 1, three focus groups (N=27) with SWs representing 20 primary care clinics across a health system were conducted. Focus groups utilized a semi structured interview guide to facilitate discussion on use of EHR and barriers and facilitators to EHR documentation. After transcription of the focus groups a thematic content analysis was performed by two coders. Phase 2 included an abstraction and annotation of EHR notes of a random sample of 60 primary care patients who had a SW encounter between 2016—2017. Information on SW practice interventions (e.g., referral, standardized assessment, brief behavioral health intervention) and communication with team members were abstracted from the EHR note. After data abstraction, notes were analyzed using qualitative content analysis for key themes by a team of three reviewers. 

Results:  Four major themes emerged from the focus groups as part of Phase 1: (1) “How” SWs document their practice in the EHR; (2) Note “types” vary; (3) Difficulty capturing practice into a medical note, and (4) Notes used to communicate across team. In phase 2, 985 SW notes were abstracted and annotated for 60 patients. On average, each patient had 16 SW notes (ranging from 2-52 notes). Major themes from Phase 2 abstraction identified EHRs frequently document SW referral and coordination of services; “supportive counseling” reported as a common intervention; the flow of communication between providers was iterative; and the major role of telephone check-ins. 

Conclusions and Implications: The capacity to use EHR data to study SW practice and contributions to integrated teams has high potential for improving healthcare services and understanding the roles that SWs play in integrated settings. Future research utilizing EHRs and implications for SW practice and research