"The start of something that I hope could be greater": Health information technology tools for social care

Federal policies and professional guidelines in the United States increasingly encourage and incentivize health systems to collect and meaningfully respond to patients' social risks. In response, many health systems employ health information technology to implement, standardize, and scale these social care activities. We created and evaluated electronic health record tools to support the collection and documentation of social risk information, and the integration of this information into clinical decision-making; the National Academies of Sciences, Engineering, and Medicine labels these activities Awareness and Adjustment. Our realist-informed evaluation explored how, why, and for whom the tools did/did not support the use of social risk information in care planning in community health centers. The five-year study was completed in 2024. The dataset consisted of 41 meeting observations, 36 clinician and staff interviews, and regular team discussions regarding tool use at participating clinics. Analysis involved cyclical data querying to identify mechanisms underlying tool (non) acceptance and (non)use. Findings highlighted the importance of aligning technology to the values underlying professional identity - in this case, the value assigned to patient-centered care. Clinicians and staff perceived that Awareness tools enhanced their ability to provide patient-centered care, which led to increased uptake. In contrast, participants often felt that the Adjustment tools superseded clinician autonomy, failed to support direct patient care, and disrupted patient-clinician relationships contributing to low motivation for use. These results may be specific to the ways in which clinicians serving low-income communities conceptualize their role in social-medical integration; similar work should be undertaken in other healthcare settings.