Evaluation of Flowsheet Documentation in the Electronic Health Record for Residence, Living Situation, and Living Conditions

Social determinants of health (SDOH) are important considerations in diagnosis, prevention, and health outcomes. However, they are often not well documented in the EHR and found primarily in unstructured or semi-structured text. Building upon previous work, we analyzed all flowsheet data in 2013 for information related to the SDOH topic areas of Residence, Living Situation, and Living Conditions. Overall, 91 rows were identified as being related to the topics areas resulting in 604,616 unique observations. Individual rows contained SDOH data often covered multiple concepts especially free-text entries. These data included most often references to the residence, residence details, and with whom the patient lives. Very few contained living condition references. Additionally, there was significant duplication and inconsistency of row labels, as well as variation in value list content for rows collecting the same concepts. Our findings demonstrate significant opportunities to improve and achieve better standardization in documentation around these SDOH.