25 - From Education to Integration: MyChart® Implementation Improves Social Determinants of Health Documentation in a Community Hospital

Publication Number: 2022.25

stacy boden, Medical College of Wisconsin, west bend, WI, United States; Staci Bohling, Froedtert West Bend Hospital, West Bend, WI, United States; Jennifer Konrad, Medical College of Wisconsin, West Bend, WI, United States; Erwin T. Cabacungan, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, United States

Background: Social Determinants of Health (SDOH) significantly influence maternal and infant outcomes; however, documentation remains low, particularly in community hospitals. In November 2021, a quality improvement (QI) initiative was launched in a community hospital Labor & Delivery (L&D) unit to enhance SDOH documentation and strengthen linkage to social resources.

Objective: To increase SDOH documentation for L&D admissions from 4.8% to >60% by December 2024 through iterative PDSA (Plan-Do-Study-Act) cycles focused on staff education, workflow redesign, and MyChart® integration.

Design/Methods: A Key Driver Diagram guided this IRB-exempt improvement framework (Fig. 1). PSDA Cycle 1 involved staff education on importance of SDOH, developing SDOH brochures, designing documentation workflows, and conducting a follow-up staff survey. Cycle 2 used survey results to implement SDOH brochures at prenatal visits and admission, supported by flyers to promote questionnaire completion. From May to December 2023, the project built SDOH questions into Epic's MyChart®, aligning with peak staff survey responses. MyChart® went live in January 2024 (Cycle 3), enabling patients to electronically self-complete SDOH information. Cycle 4 (October 2025) included staff survey to identify residual barriers. Measures: Primary outcome was % of L&D admissions with SDOH documentation; process measures included time, knowledge, and EHR navigation ease; and balancing measures assessed staff comfort asking SDOH questions.

Results: The P-chart showed sustained improvement following MyChart® integration, with documentation rates increasing from 4.8% at baseline to 74% post-implementation, exceeding the 60% target (Fig. 2). Staff survey analysis showed a shift in barriers: pre-MyChart® (August 2022), top concerns were nursing time constraints and lack of perceived benefit; post-MyChart® (October 2025), barriers shifted to workflow issues and forgetting during busy admissions, indicating improved access but ongoing process gaps (Fig. 3). Most staff (97%) knew where to document SDOH, though 14% felt uncomfortable asking, and 13% reported insufficient time for documentation.

Conclusion(s): Integrating SDOH screening into MyChart® and embedding it in nursing workflows substantially improved documentation rates in a community hospital setting. Ongoing strategies, including staff feedback loops and automated EHR prompts, aim to sustain gains and address residual workflow barriers. This initiative demonstrates that combining digital engagement with system-level workflow redesign can meaningfully enhance equitable, patient-centered perinatal care.

Fig. 1. Key Driver Diagram for Improving Social Determinants of Health (SDOH) Documentation in a Community Hospital Labor and Delivery Unit
The Key Driver Diagram illustrates the relationship between the QI's primary aim, key drivers, and interventions to improve SDOH documentation among Labor and Delivery admissions. MyChart® is a registered trademark of Epic Systems Corporation.


Fig.2 P-Chart of SDOH Documentation Rates Among Labor and Delivery Admissions in a Community Hospital (November 2021 - December 2024)
Documentation rates improved after integrating SDOH screening in MyChart® (Epic Systems Corporation). The planning phase from May-Dec 2023 represents a pause in data collection while EHR integration was built. Post-implementation data demonstrate sustained improvement exceeding 60% target.



Fig.3 Pareto Charts of Reported Barriers to SDOH Documentation Before and After MyChart® Integration
Pareto charts display the distribution of reported barriers to SDOH documentation among Labor & Delivery nursing staff before (Aug 2022) and after (Oct 2025) MyChart® integration. The most frequent barriers shifted from time constraints and lack of perceived benefit to workflow and recall challenges, suggesting improved accessibility but ongoing process barriers. Each Pareto chart displays the number of responses per barrier and the cumulative percentage, illustrating the 80/20 pattern that guided subsequent PDSA refinements.
* Others: 1-5. Not conveniently located in the EHR admission navigator as it is in the discharge navigator; 6. It's not a priority when patient is in pain; 7. Awkward to ask on admission; 8. I work nights and patients would rather sleep; 9. None; and 10. Don't feel there are barriers