How automating SDOH screenings can improve patient outcomes at scale

Access to healthy food, stable housing, and reliable transportation may not seem relevant to health care, but social needs like these can account for as much as 80% of health outcomes. When a patient’s social needs aren’t met, it is exponentially more challenging to provide them with the right care at the right time. 

Identifying and addressing social determinants of health (SDOH) can improve patient outcomes. However, with the median length of a physician visit spanning just 18.9 minutes, you may wonder how your physicians can have a meaningful conversation about these factors in such a short time. 

The answer lies in automating your SDOH questionnaires to help you identify and address social risk factors at scale. Through automation, AI Agents can conduct SDOH outreach via the patient’s preferred communication channel, capture and process the responses, enter data back into the EHR, and perform relevant follow-up outreach, leaving your physicians with more time to tailor interventions to address each patient’s specific needs.

Existing SDOH screening tools

Without automation, SDOH screening typically requires significant manual effort from staff. Here's how the process often works:

1. Paper or in-person questionnaires: Staff administer SDOH questionnaires during check-ins, over the phone, or in person, either verbally or using printed forms.
2. Manual data entry: After collecting responses, staff must manually enter the information into the electronic health record (EHR), which can be time-consuming and prone to error.
3. Inconsistent screening: Without automation, it's difficult to standardize and consistently screen all eligible patients, leading to gaps in data collection.
4. Tracking and follow-up: Staff are responsible for monitoring who has completed the screening, identifying unmet social needs, and coordinating follow-up like social work referrals — all handled manually across different systems or spreadsheets. This takes valuable staff time.
5. Limited scalability: As patient volumes increase, it's challenging for staff to manage comprehensive SDOH screenings for every patient, limiting the reach and effectiveness of the program.

Manual SDOH screening is labor-intensive, inconsistent, and hard to scale. Additionally, many patients end up falling through the cracks if they don’t complete the questionnaire or if they feel uncomfortable answering questions about sensitive topics in a public setting. These challenges make SDOH screening a strong candidate for automation.  

Improving workflows with automation 

Instead of using staff time to carry out these tasks, they can be simplified, streamlined, and ultimately almost completely automated through the use of AI Agents. In healthcare organizations, AI Agents act as a digital workforce, completing tasks on behalf of your staff and integrating seamlessly with your existing systems. 

Here’s how the SDOH screening process is transformed with the use of AI Agents:

• Patient outreach and engagement: Intelligent Agents can reach out to patients across various channels such as SMS, voice AI, web apps, or patient portals to deliver the SDOH questionnaire in a user-friendly format. It can also be sent in different languages to meet your patients’ needs.
• Data collection and integration: When patients complete the questionnaire, the AI Agents use natural language processing (NLP) and document processing to extract and structure the responses. This structured data is then automatically entered into the EHR, eliminating the need for manual data entry by staff.
• Workflow automation: With intelligent automation, the journey doesn’t stop at capturing the data — responses can trigger additional automated customized workflows to suit each patient's needs. For example, if a patient indicates food insecurity, an Intelligent Agent may initiate a referral to a community resource or notify a care coordinator for follow-up. 
• Targeted interventions: Care teams can use the captured SDOH data to identify high-risk patients and pursue targeted care interventions, leading to improved care outcomes and reduced health disparities. 

Automation streamlines the SDOH process at every step, working through related workflows and providing valuable insights for your care team, while also providing them with more time in the day to provide the next steps in high-quality patient care. 

Better patient access, empowerment, and outcomes 

Automation provides value to care teams by capturing SDOH data, integrating results directly into the EHR, and triggering follow-up workflows intelligently. The results? Streamlined outreach and intervention, improved health outcomes—especially among vulnerable or underserved groups, better quality metrics, and overall reduced manual effort in patient assessments and referrals. 

Since automating its SDOH screenings with Notable’s AI Platform, Sturdy Health has seen a 55-60% completion of SDOH and depression screenings, with positivity rates on those screenings increasing from under 2% before launch to a stable 5% today. This indicates a greater willingness to share sensitive information when filling out forms privately at home rather than in person.

Most importantly, automating SDOH screenings supports and empowers patients to get the care they need quickly and efficiently. 

Ready to learn more about how Notable can transform your SDOH work? Let’s chat!