Help us document what we already do: Pilot study of clinical decision support tools targeting social risk-informed care

OBJECTIVE: Little is known about how clinical decision support (CDS) tools can support care teams in changing clinical decisions to account for patients' social risks. We piloted a suite of electronic health record (EHR)-based CDS tools designed to facilitate social risk-informed care decisions to assess how the tools were used in practice and how they could be improved. 

MATERIALS AND METHODS: After developing CDS tools through a process involving clinic staff and patient engagement, the tools were implemented in three community health center clinics. Data from staff interviews, observations of meetings with clinic staff, and the EHR were used to understand tool use patterns, and to yield insights that were then used to inform tool revisions. 

RESULTS: The overarching suggestion derived from the study data was that the tools should shift from making care recommendations to instead supporting documentation of social risk-related actions that clinical team members had already taken. Other revisions were guided by four additional insights: the CDS tools should: (1) facilitate documentation in standardized, short formats, (2) make documentation easy and consistent, (3) support work distribution across care team members, and (4) ensure documentation could serve multiple purposes. 

DISCUSSION: The CDS tools were revised to improve usefulness and acceptability for primary care teams in community clinics that serve patients with social risks. Numerous challenges exist in designing tools that can accommodate diverse clinics and workflows. 

CONCLUSION: These findings provide insights on how CDS tools can be optimized for social risk-informed care while minimizing care team burdens.