Abstract
Background: Social determinants of health (SDOH) significantly influence health outcomes, yet their integration into electronic health records (EHRs) remains inconsistent. This study examines the current state of SDOH documentation in EHRs, identifies barriers and facilitators, and evaluates the impact on clinical decision-making and patient outcomes. Methods: A mixed-methods approach was employed, combining a systematic review of literature from 2017–2023 (n=45 studies) with a retrospective analysis of EHR data from three healthcare systems (2019–2023). Descriptive statistics, logistic regression, and thematic synthesis were used. Results: Only 34% of patient records contained any SDOH data, with housing instability (12%) and food insecurity (9%) most common. Standardized screening tools were used in 22% of cases. Logistic regression showed that documentation of SDOH was associated with increased odds of referral to social services (OR 2.45, 95% CI 1.98–3.02). Key barriers included time constraints (cited by 68% of clinicians), lack of interoperability (55%), and privacy concerns (41%). Facilitators included leadership support (72%) and integration with community resource platforms (61%). Conclusions: Despite progress in recognizing SDOH importance, substantial gaps remain in systematic documentation and use. Addressing workflow, technical, and policy challenges is critical for realizing the potential of SDOH-informed care.