Ethical Approaches Needed for Social Needs Screening
Healthcare providers are screening patients and families for social needs, including housing instability, food insecurity, and difficulty paying for utilities. The idea is clinicians then can connect patients in need with appropriate community resources. However, there could be some unintended consequences, warns Zoe Bouchelle, MD, a fellow at the National Clinician Scholars Program at the University of Pennsylvania.
Bouchelle and colleagues were grappling with how to manage data from a recently implemented social needs screening program in a way that supports and protects patients and families.
“Right now in healthcare, there is a lot of interest and investment in social needs screening. It’s occurring at the same time as a dramatic increase in electronic health information sharing through the 21st Century Cures Act,” explains Bouchelle, an attending physician at Children’s Hospital of Philadelphia. Through patient portals, patients and families can immediately access their health records. “If social needs data are not documented, stored, and shared responsibly, it could harm patient and provider trust, violate families’ safety and confidentiality, or even contribute to bias in clinical practice,” Bouchelle warns.
In a recently published paper, Bouchelle and colleagues argued it is essential for healthcare organizations engaged in social needs screening to carefully consider how to avoid potential unintended harms.1 The authors offered these ethical considerations:
• Organizations must be thoughtful about screening families and documenting the information. Families may believe they are going through repeated screenings and excessive questioning about their social needs.
“This itself can cause trauma and harm patient-provider trust,” Bouchelle says.
• Organizations must understand where any potential EHR loopholes exist to keep sensitive data safe. “This requires organizations to work closely with informaticists to understand the nuances of how the EHR works,” Bouchelle notes.
• Organizations should monitor patterns of racism and bias that could result from documentation and sharing social needs. Training to ensure providers are aware of the potential for bias is one way to address this.
“Providers should also collect data as they implement social needs screening — for example, data on disparities in referrals to child protective services — so that they can identify and address any emerging patterns of bias,” Bouchelle recommends.
1. Bouchelle Z, Bowers M, Vasan A. Ethically managing social needs data in an era of enhanced electronic health information sharing. Pediatrics 2023;151:e2022059046.
Healthcare providers are screening patients and families for social needs, including housing instability, food insecurity, and difficulty paying for utilities. The idea is clinicians then can connect patients in need with appropriate community resources. However, there could be some unintended consequences.
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