Editor’s Note: Dr. Ella Perrin (she/her/hers) is a resident physician in pediatrics at Naval Medical Center San Diego. Her interests include disordered eating, obesity, decreasing weight stigma and bias, and the field of hospital medicine. The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Dr. Perrin declares no conflicts of interest. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Screening forms play a big role in many pediatric practices, as they allow clinicians to collect more data on patients and their families in a short amount of time, so that they can provide more individualized, targeted care than their brief appointment times would otherwise allow.
One area where screening tools are commonly used is in the assessment for psychosocial risk factors and needs (food insecurity, maternal postpartum depression, etc.), which disproportionately affect historically marginalized communities. While these screenings have historically been conducted via paper questionnaires, technology is leading practices to shift toward electronic-based screening tools, such as iPad questionnaires, which can be uploaded directly into the electronic medical record.
Electronic and paper screenings have both been shown to have increased disclosures when compared to verbal screenings in both primary care and emergency department settings, but the difference in disclosure rates between paper and electronic screenings is unknown.
In an article being early released in Pediatrics this week, entitled “Social Needs Screening via Electronic Tablet in Pediatric Primary Care,” Dr. Michelle Gorecki and colleagues from Cincinnati Children’s Hospital utilized 3 pediatric primary care clinics’ transition from paper to electronic screening tools to assess whether rates of health-related social need (HRSN) disclosures (food insecurity, transportation issues, etc.) and referrals placed to social work and medical legal partnership differed for the months leading up to versus after the transition in screening modality (10.1542/peds.2024-065918).
There were several significant findings:
- For all 3 sites, electronic screenings were more likely to identify a HRSN than paper screenings.
- An analysis comparing the period before versus after the electronic screen roll-out found that 2 of the 3 clinics had significantly increased odds of HRSN disclosure after electronic screen implementation. Disclosure rates at the third site had already been increasing prior to the switch to electronic screening, which is probably why the rates after the switch were not statistically different.
- Increased HRSN disclosures were associated with increased referrals to both social work and the medical legal team. This increase was explained by the transition to electronic screening.
While this study has a few limitations (study locations at only a few metropolitan clinics, the electronic survey only being available in English), its results are clear: providing electronic screenings to families increases disclosure of HRSN by caregivers and subsequent referrals to help access resources. Perhaps there is a feeling of increased privacy with electronic screenings, or perhaps the electronic questions feel less daunting because they appear one at a time.
When families feel comfortable with disclosing their social needs, it allows pediatric clinicians to provide families with targeted resources to address aspects of health that can otherwise go unrecognized in clinic visits.
This study provides a compelling reason for practices to move toward an electronic screening system to improve patient care and promote health equity.
