As one of the original developers of OpenEMR’s configurable SDOH screening module, I’d like to explore the next phase of SDOH functionality within the platform.
Over the coming months, I’d like to focus on researching existing social needs screening and referral models, identifying best practices, and understanding how organizations are currently implementing closed-loop referral systems. My goal is not to immediately build a solution, but first to learn from successful implementations and collaborate with others interested in this space.
One area I believe deserves discussion is maintaining maximum flexibility within OpenEMR’s open-source architecture. While tools such as PRAPARE have become widely adopted standards, embedding proprietary screening instruments directly into software platforms can introduce licensing restrictions and ongoing costs that may conflict with the goals of an open-source community.
I would like to explore a more flexible, standards-based approach that allows organizations to:
-
Create and maintain their own social needs screening questions and workflows
-
Map questions and responses to standardized vocabularies such as LOINC, SNOMED CT, and ICD-10 Z-codes
-
Support reporting, interoperability, and regulatory requirements without dependence on proprietary form licensing
-
Build future referral workflows that can connect patients to community resources using open standards
I am particularly interested in hearing from:
-
Organizations currently using SDOH referral platforms
-
Anyone familiar with successful closed-loop referral implementations
-
Developers interested in contributing to architecture, standards research, workflow design, or interoperability
-
Clinics that have encountered licensing or cost barriers with existing commercial solutions
If OpenEMR can provide the same structured data, interoperability, and workflow capabilities while preserving flexibility and avoiding unnecessary licensing costs, I believe it could become a powerful open-source alternative for social care integration.
I’d welcome discussion, existing examples, research references, and potential collaborators.
2 Likes
Hi Char,
The current OpenEMR SDOH assessment was mainly built to satisfy the ONC/USCDI direction and give us a standardized place in the patient workflow to capture SDOH-related screening data. It is intentionally not as broad as your original work, but I think it can serve as a useful foundation instead of everyone having to start from scratch.
Where I think OpenEMR can help your referral work is in a few areas:
- The existing SDOH assessment can act as the baseline “needs” screen.
- The FHIR Questionnaire/QuestionnaireResponse tooling can support more flexible screening instruments, including your “Opportunity” style questions.
- Responses can be preserved as the completed instrument while still allowing selected answers to become discrete observations or health concerns where appropriate.
- Those findings can then feed into goals, consent, ServiceRequest/referral workflows, and eventually closed-loop referral tracking.
- The same framework could support both patient-requested opportunities and provider-identified needs without forcing everything into one rigid form.
I really like your point from the other forum topic about phrasing. Asking only “what do you lack?” can miss patients who would accept help if it were offered in a less stigmatizing way. An “Opportunity” screen could ask more neutral questions such as whether the patient would like information, support, connection to community resources, or follow-up for food, housing, transportation, utilities, employment, caregiving, education, safety, etc. That could still map into the same SDOH/referral structure when the patient opts in.
My thought is that your referral system could build on the existing OpenEMR assessment and FHIR Questionnaire work rather than replacing it. The ONC assessment gives us a standard base, and your workflow could add the care-navigation/referral layer that makes the data useful in real practice.
I think there is a good path here where the existing SDOH assessment, FHIR questionnaires, and your referral workflow all complement each other.
Since we currently have the capability to import FHIR/LOINC questionnaires it may be worth taking a few minutes researching what questionnaires are available for import concerning SDOH subject.
If you have questionnaires enabled in encounters there is a LOINC search capability to find and import available forms.
Hi @Char_Miller ,
As an example of what I was referring to, here is a FHIR Structured Data Capture (SDC) Questionnaire imported directly into OpenEMR and launched from an encounter.
The questionnaire is dynamically rendered from the FHIR resource rather than being a hard-coded OpenEMR form. It is designed to be context-aware, with Patient and Encounter launch context, and supports response-driven conditional branching. In other words, answers can determine which follow-up questions are presented to the patient or provider.
For example, selecting that the patient would like someone to contact them or help connect them to a service can expose additional questions about preferred contact method and messaging permission. Questions that are not relevant to the patient’s answers remain out of the workflow.
SDC also gives us a path toward context-based prepopulation, calculated values, and more advanced questionnaire logic as support is expanded.
The important part to me is that new assessments can be authored as FHIR Questionnaires, imported, and plugged into the existing OpenEMR questionnaire infrastructure rather than requiring a new custom PHP form for every assessment.
This screenshot is the Opportunity-based SDOH example discussed above, running as an encounter assessment in OpenEMR.
A better view outside an encounter.
1 Like
