Manisha Parulekar knew her aging patients needed extra support outside the walls of her clinic. The division chief of geriatrics at New Jersey’s Hackensack University Medical Center, she had been paying attention to emerging research that suggested insecurity around food, housing, and other social factors can determine up to 80% of a person’s health.
But in 2016, Parulekar knew it would be a hard sell to integrate that complexity into care. Asking all the right questions to gauge a patient’s social and economic needs could easily take up a whole 20-minute office visit, especially if a doctor had to navigate a new piece of software to fill out the answers. “As a clinician, I knew that if I wanted this to be done for every single patient at the time of the visit, it had to be in the electronic health record,” Parulekar said. “Somehow it had to be automated.”
So Parulekar became part of a growing effort at the hospital — and health care systems around the country — to simplify screening for social needs and make it a regular part of care. Today, the greater Hackensack Meridian Health network is a case study in the evolution of integrated social determinants of health programs. The system has built two separate platforms into its electronic health record to help providers collect information about social needs from its patients. As of July, it had used that information to refer patients to community health resources more than a million times.
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