Integration of nursing classifications into electronic health record (EHR) systems can enhance the management of social determinants of health (SDOH) and promote health equity, according to a JAMIA article. The study demonstrates that standardized nursing classifications effectively address SDOH domains, but their utilization in EHRs is limited. The lack of nursing informaticist involvement and federal policies hinder integration. Incorporating nursing classifications into EHRs would enable targeted interventions and improve patient outcomes by addressing SDOH needs.
A recent article in JAMIA highlights the scarcity of electronic health record (EHR) integration of nursing classifications for managing social determinants of health (SDOH). Integrating these classifications into EHRs could significantly contribute to promoting health equity by improving the documentation of SDOH.
To assess the value and comprehensiveness of standardized nursing classifications (SNCs), researchers mapped three key classifications – NANDA International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) – to five SDOH domains/objectives outlined in Healthy People 2030. The researchers collectively referred to these three classifications as “NNN.”
The study revealed that the nursing classifications effectively addressed all SDOH domains/objectives, with many SNC terms aligning with multiple domains/objectives. Other classifications, such as the Omaha System, also encompass SDOH components. Leveraging these classifications within EHR systems facilitates streamlined tracking and addressing of an individual’s SDOH.
However, the authors emphasize that NNN surpasses the mere identification and tracking of SDOH; it enables intervention and ongoing monitoring of progress toward goals. By employing NANDA-I to identify problems or needs within nursing or interdisciplinary care plans, clinicians are responsible for devising means to address the identified issues. NIC provides evidence-based interventions, while NOC offers measurable outcomes, ensuring comprehensive care.
Despite the potential benefits, the authors note that EHR systems have not extensively embraced these classifications due to the limited involvement of nursing informaticists in health IT standards development. The absence of federal policies in the United States, unlike in some European countries, regarding the use of standardized nursing languages further compounds the issue.
Consequently, current EHR systems predominantly focus on flowsheets featuring checkbox-based tasks and assessments, making the work of nurses in problem identification, intervention planning, and outcome measurement invisible. The lack of SNCs in documentation systems implemented by EHR vendors leads to missed opportunities in effectively addressing SDOH needs, including those arising from recent pandemics.
The authors assert that if SNCs, with their assessment and management of SDOH, were readily available and regularly utilized within the nursing process of care, there should be greater integration of these classifications into EHRs. This integration would enable targeted interventions and resolution of SDOH-related issues, ultimately improving patient outcomes.
