Characteristics of a Comprehensive Electronic Health Record Model in Primary Health Care and Implementation Strategies:A Scoping Review
Abstract
Introduction: The integration of social determinants of health (SDH) into electronic health records (EHRs) is key to strengthening primary health care (PHC). However, there are barriers related to the lack of standardized models, limited interoperability, and usability issues.
Methodology: A scoping review was conducted following the PRISMA-ScR guideline. Databases such as PubMed, ProQuest, Scopus, Google Scholar, and Lilacs were consulted, including studies in English and Spanish published in the last ten years.
Results: A total of 837 records coming from databases (n=787) and other methods (n=50) were identified. After removing duplicates and applying specific criteria, 28 studies were included in the final review. The analysis of these studies revealed a shortage of standardized models that integrate social determinants of health (SDH) into electronic health records (EHRs). While it is true that individual efforts were identified in different regions, such as the implementation of specific tools (PRAPARE, AHCS), the lack of interoperability and the absence of a unified framework continue to pose significant challenges.
Conclusions: It is necessary to advance in the construction of an EHR model with a focus on PHC that guarantees the effective integration of SDH, optimizing usability and interoperability. This would contribute to improving equity and quality in health care.
Keywords: Electronic Health Records; Primary Health Care; Social Determinants of Health; Time Management; Health Information Interoperability.
Downloads
References
1. International Organization For Standardization. Health informatics - Electronic health record - Definition, scope and context. Defin Electron Heal Rec [Internet]. 2005 [Citado 6 Aug 2023]; 205(60):27. Disponible en: https://www.iso.org/obp/ui/#iso:std:iso:tr:20514:ed-1:v1:en
2. Garzón Rivera JA, Obando Rosero CD. Propuesta de historia clínica en atención primaria integral en salud (APIS) con enfoque en determinantes de la salud. Primera fase. Atención para enfermedades crónicas prevalentes respiratorias, enfermedad pulmonar obstructiva crónica y asma [Internet]. Bogotá D.C.: Repositorio UNbosque; 2016 [Citado 6 Aug 2023]. Disponible en: http://hdl.handle.net/20.500.12495/5791
3. OPS/OMS. Sistemas de Información para la Salud (IS4H) [Internet]. Washintong: OPS/OMS; 2023. [Citado 6 Aug 2023]. Disponible en: https://www.paho.org/es/temas/sistemas-informacion-para-salud-is4h
4. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev [Internet]. 2022 Jun ;18(2):e1230. Disponible en: https://doi.org/10.1002/cl2.1230
5. Bello LD, Conde VP, Cortés J, Murcia AE, Rincon A del pilar, Velandia AA. Consolidación de un conjunto mínimo de datos para una historia clínica electrónica en atención primaria integral en salud enfocada en determinantes de la salud. Rev salud bosque [Internet]. 2018 [Citado 6 Aug 2023];8(1):71–81. Disponible en: https://revistas.unbosque.edu.co/index.php/RSB/article/view/2496
6. Hatef E, Rouhizadeh M, Tia I, Lasser E, Hill-Briggs F, Marsteller J, et al. Assessing the availability of data on social and behavioral determinants in structured and unstructured electronic health records: A retrospective analysis of a multilevel health care system. JMIR Med Informatics [Internet]. 2019 Jul [Citado 6 Aug 2023];7(3). Disponible en: https://medinform.jmir.org/2019/3/e13802/PDF
7. Barreto K. Historia clínica integral en atención primaria de salud con enfoque en los determinantes sociales de salud. Atención integrada a las enfermedades prevalentes en la primera infancia. Rev Salud Bosque [Internet]. 2018 [Citado 6 Aug 2023].;8(2):23–34. Disponible en: https://revistas.unbosque.edu.co/index.php/RSB/article/view/2491
8. Rogers CK, Parulekar M, Malik F, Andciara Torres A. A Local Perspective into Electronic Health Record Design, Integration, and Implementation of Screening and Referral for Social Determinants of Health. Perspect Heal Inf Manag [Internet]. 2021 [Citado 6 Aug 2023];19. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9123531/pdf/phim0019-0001g.pdf
9. Garies S, Liang S, Weyman K, Ramji N, Alhaj M, Pinto AD. Developing an AI Tool to Derive Social Determinants of Health for Primary Care Patients: Qualitative Findings From a Codesign Workshop. Ann Fam Med [Internet]. 2024 Jul [Citado 6 Aug 2023].;22(4):317–24. Disponible en: https://www.annfammed.org/content/annalsfm/22/4/317.full.pdf
10. Buitron de la Vega P, Losi S, Sprague Martinez L, Bovell-Ammon A, Garg A, James T, et al. Implementing an EHR-based Screening and Referral System to Address Social Determinants of Health in Primary Care. Med Care [Internet]. 2019 [Citado 6 Aug 2023].;57(6):S133–9. Disponible en: www.lww-medicalcare.com
11. Jiménez Carrillo M, Fernández Rodker J, Sastre Paz M, Alberquilla Menendez-Asenjo Á. ¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria? Aten Primaria [Internet]. 2021 Jan [Citado 6 Aug 2023];53(1):36–42. Disponible en: https://www.sciencedirect.com/science/article/pii/S0212656720300408?via%3Dihub
12. Aguirre N. Historia clínica electrónica en Bogotá: percepciones desde la atención primaria. Rev Salud Bosque [Internet]. 2018 [Citado 6 Aug 2023];8(2):35–48. Disponible en: https://revistas.unbosque.edu.co/index.php/RSB/article/view/2492
13. Sood N, Stetter C, Kunselman A, Jasani S. The relationship between perceptions of electronic health record usability and clinical importance of social and environmentaldeterminants of health on provider documentation. PLOS Digit Heal [Internet]. 2024 Jan [Citado 6 Aug 2023];3(1). Disponible en: https://journals.plos.org/digitalhealth/article?
id=10.1371/journal.pdig.0000428
14. Pinto AD, Glattstein-Young G, Mohamed A, Bloch G, Leung FH, Glazier RH. Building a Foundation to Reduce Health Inequities: Routine Collection of Sociodemographic Data in Primary Care. J Am Board Fam Med [Internet]. 2016 May [Citado 6 Aug 2023];29(3):348–55. Disponible en: https://www.jabfm.org/content/jabfp/29/3/348.full.pdf
15. Cook L, Espinoza J, Weiskopf NG, Mathews N, Dorr DA, Gonzales KL, et al. Issues With Variability in Electronic Health Record Data About Race and Ethnicity: Descriptive Analysis of the National COVID Cohort Collaborative Data Enclave. JMIR Med Informatics [Internet]. 2022 Sep [Citado 6 Aug 2023];10(9). Disponible en: https://medinform.jmir.org/2022/9/e39235/PDF
16. Nguyen C, Barkin S. Where standardized meets personalized when integrating social determinants of health into the electronic health record. Pediatr Res [Internet]. 2022 Jun [Citado 6 Aug 2023];91(7):1645–6. Disponible en: https://doi.org/10.1038/s41390-021-01686-1
17. Stemerman RA, Kitzmiller R, Krishnamurthy A, Arguello J, Mazur L, Brice J. Machine learning approaches to identifying social determinants of health in electronic health record clinical notes [Internet]. Carolina del norte: The University of North Carolina; 2020 [Citado 6 Aug 2023]. Disponible en: https://cdr.lib.unc.edu/concern/dissertations/2b88qm842?locale=en
18. Barth O, Anderson B, Jones K, Nickles A, Dawkins K, Burnett A, et al. An Innovative Approach to Using Electronic Health Records Through Health Information Exchange to Build a Chronic Disease Registry in Michigan. Prev Chronic Dis [Internet]. 2024 [Citado 6 Aug 2023];21. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11192498/pdf/PCD-21-E41.pdf
19. Mehta S, Lyles CR, Rubinsky AD, Kemper KE, Auerbach J, Sarkar U, et al. Social Determinants of Health Documentation in Structured and Unstructured Clinical Data of Patients With Diabetes: Comparative Analysis. JMIR Med Informatics [Internet]. 2023 [Citado 6 Aug 2023];11. Disponible en: https://medinform.jmir.org/2023/1/e46159/metrics
20. Rodoreda-Pallàs B, Lumillo-Gutiérrez I, Catalina QM, Escarrer ET, Juncadella JS, Fraile VM. Recording of Social Determinants in Computerized Medical Records in Primary Care Consultations: Quasi-Experimental Study. JMIR Form Res [Internet]. 2023 [Citado 6 Aug 2023];7. Disponible en: https://formative.jmir.org/2023/1/e41706
21. Rieger EY, Anderson IJ, Press VG, Cui MX, Arora VM, Williams BC, et al. Implementation of a Biopsychosocial History and Physical Exam Template in the Electronic Health Record: Mixed Methods Study. JMIR Med Educ [Internet]. 2023 [Citado 6 Aug 2023];9. Disponible en: https://mededu.jmir.org/2023/1/e42364/
22. Gold R, Bunce A, Cowburn S, Dambrun K, Dearing M, Middendorf M, et al. Adoption of social determinants of health ehr tools by community health centers. Ann Fam Med [Internet]. 2018 Sep [Citado 6 Aug 2023];16(5):399–407. Disponible en: https://www.annfammed.org/content/annalsfm/16/5/399.full.pdf
23. Albert SM, McCracken P, Bui T, Hanmer J, Fischer GS, Hariharan J, et al. Do patients want clinicians to ask about social needs and include this information in their medical record?. BMC Health Serv Res [Internet]. 2022 Dec [Citado 6 Aug 2023]; 22(1). Disponible en: https://link.springer.com/article/10.1186/s12913-022-08652-5
24. Mbwambo E, Mandari H. Acceptance of Interoperable Electronic Health Record (EHRs) Systems: A Tanzanian e-Health Perspective Systems: A Tanzanian e-Health Perspective. J Int Technol Inf Manag [Internet]. 2023 [Citado 6 Aug 2023];32(1):96–121.
25. Wark K, Cheung K, Wolter E, Avey JP. “Engaging stakeholders in integrating social determinants of health into electronic health records: a scoping review.” Int J Circumpolar Health [Internet]. 2021[Citado 6 Aug 2023];80(1). Disponible en: https://www.tandfonline.com/doi/epdf/10.1080/22423982.2021.1943983?needAccess=true
26. Bunce A, Donovan J, Hoopes M, Gottlieb LM, Krancari M, Gold R. Patient-Reported Social Risks and Clinician Decision Making: Results of a Clinician Survey in Primary Care Community Health Centers. Ann Fam Med [Internet]. 2023 Mar [Citado 6 Aug 2023];21(2):143–50. Disponible en: https://www.annfammed.org/content/annalsfm/21/2/143.full.pdf
27. Gold R, Cottrell E, Bunce A, Middendorf M, Hollombe C, Cowburn S, et al. Developing Electronic Health Record (EHR) strategies related to health center patients’ social determinants of health. J Am Board Fam Med [Internet]. 2017 Jul [Citado 6 Aug 2023];30(4):428–47. Disponible en: https://www.jabfm.org/content/jabfp/30/4/428.full.pdf
28. Sheikh A, Anderson M, Albala S, Casadei B, Franklin BD, Richards M, et al. Health information technology and digital innovation for national learning health and care systems . The Lancet Digital Health [Internet]. 2021 [Citado 6 aug 2023];3:e383–96. DIsponible en: https://www.thelancet.com/action/showPdf?pii=S2589-7500%2821%2900005-4
29. Laster R. Improving the Department of Veterans Affairs Medical Centers Electronic Health Record Implementation [Internet]. Washington: Walden University; 2024 [Citado 6 Aug 2023]. Disponible en: https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=18328&context=dissertations
30. Palacio AM, Suarez M, Yanisa Toro D, Seo D, Garay D, et al. Integrating Social Determinants of Health into the Electronic Health Records of a Large Health System: A Qualitative Perspective. Perspect Heal Inf Manag [Internet]. 2018 [Citado 6 Aug 2023];1:e6903a. Disponible en: https://www.proquest.com/openview/be5708fd2ace1fea896e0a0007e6903a/1?pq-origsite=gscholar&cbl=51400
31. Raji S. Regional Integration: Physician Perceptions on Electronic Medical Regional Integration: Physician Perceptions on Electronic Medical Record Use and Impact in South West Ontario Record Use and Impact in South West Ontario [Internet]. Ontario: The University of Western Ontario; 2020 [Citado 6 Aug 2023]. Available from: https://ir.lib.uwo.ca/etd/7980/
32. Bechtel N, Jones A, Kue J, Ford J. Evaluation of the core 5 social determinants of health screening tool. Public Health Nurs [Internet]. 2021 Dec [Citado 6 Aug 2023];39(2):438–45. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/phn.12983
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Jose Santiago Sarmiento Herrera, Zulma Jackelin Pintor Infante, María Angelica Solano Villamil, Cristhian Camilo Martínez Torres
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) antes y durante el proceso de envío, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
http://creativecommons.org/licenses/by-nc/4.0/
