For all EHR Users: SDOH/HRSN Screenings and Referrals

Presenter: Keisha Haynes-Leith, Clinical Quality Specialist

About This Event

This training covers Social Determinants of Health (SDOH) and Health-Related Social Needs (HRSNs), their differences, and their role in patient care and quality improvement. Participants will review the NYS DOH Accountable Health Communities (AHC) Screening Tool and learn screening techniques, communication tips, and best practices for integrating it into clinical workflows. Topics also include conducting and documenting SDOH/HRSN screenings in the EHR (eClinicalWorks and MDLand), using templates, documenting G-codes and ICD-10-CM Z-codes, and tracking screenings completed. Participants will learn to manage SDOH/HRSN referrals using platforms like Unite Us and FindHelp, close the referral loop, and build sustainable workflows across staff, CHWs, and Social Care Networks. The session also covers ICD-10-CM coding for SDOH/HRSNs and how documentation and reporting can strengthen care coordination and support value-based care.

What You’ll Learn

The training will cover the following topics in eClinicalWorks MDLand:

1. What are SDOH?
2. What are HRSNs?
3. How do SDOH/HRSNs differ?
4. NYS AHC Screening Tool
5. Screening Techniques and Tips
6. Screening using the EHR
   1. eClinicalWorks
      1. Creating the template
      2. Using the template
      3. Documenting the G Code and Z-Code(s)
      4. Reporting on the # of screenings
   2. MDLand
      1. Using the template
      2. Documenting the G Code and Z-Code(s)
      3. Reporting/tracking the # of screenings
7. SDOH/HRSN Referrals
   1. Using a platform to create and send a referral
      1. Unite Us
      2. FindHelp
   2. Closing the patient referral loop
   3. Reporting/tracking the # of referrals
8. SDOH/HRSN Workflows
   1. Practice staff
   2. CHW
9. Understanding Social Care Networks (SCN)
10. Understanding ICD-10-CM Codes

Who Should Attend

This training is ideal for medical practice staff and leaders who use or support MDLand, including:

• Clinicians (physicians, nurse practitioners, physician assistants)
• Nurses and care managers
• Medical assistants
• Pharmacists and behavioral health staff
• Quality improvement and population health staff
• Practice office managers and administrators

Participants should have basic familiarity with eClinicalWorks and MDLand and an interest in increasing Social Needs Screening to identify Health Related Social Needs.