Performance of an EMR screening tool for social determinants of health

Objectives: We aimed to compare the Epic^® social determinants of health (SDOH) "wheel" to validated SDOH questionnaires in the domains of transportation security and financial toxicity to determine its accuracy in risk stratifying patients. Methods: We enrolled patients presenting to orthopaedic clinics at an urban tertiary care center, the University of Chicago Medical Center. Patients completed two validated surveys (the COmprehensive Score for financial Toxicity (COST) questionnaire and Transportation Security Index (TSI) questionnaire) and their Epic equivalents. The sensitivity and specificity of each Epic domain was calculated using validated questionnaires as the gold-standard. Results: 203 patients completed the transportation surveys while 199 completed the financial toxicity surveys. In the domain of financial toxicity, Epic's sensitivity and specificity were 35% 53%, respectively. In the domain of transportation security, Epic's sensitivity and specificity were 53% and 94%, respectively. Conclusions: The Epic SDOH wheel demonstrated poor sensitivity in both domains studied, suggesting limitations in its ability to serve as an effective screening tool.