Unintended Consequences with HRSN
By Claire White, MS, CHES – Health Promotion Coordinator
Within the past decade, ongoing efforts have been made nationwide to implement social needs screening in healthcare. Where someone grows, lives, and works can impact their health. Identifying these factors can give you a better understanding of what external drivers add to or create barriers around their health. By using a health-related social needs (HRSN) screening tool, like the Hunger Vital Sign, the CMS Screener, or the PREPARE Screening Tool, healthcare providers can determine which resources will be best for their patients to improve their health.
Screenings can identify unmet needs and tailor patient care while implementing social needs; there are several considerations to be mindful of. In addition to identifying these needs, healthcare providers are being asked to document the data being collected, which leads to potential privacy risks for their patients. According to the Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School, “social risk information is sensitive information,” and healthcare professionals may want to consider how they approach the subject moving forward.
The Privacy Policy and Practice Considerations for Social Risk Factor Screening in Health Care Settings by CHLPI is an excellent resource for understanding how your healthcare site may be able to address privacy concerns. Consider this scenario provided in the resource: your patient is a survivor of domestic violence, and they express concern that by disclosing their housing and food instability, this information could be weaponized against them in a custody battle.
Although your intention as their provider was to get them additional support and meet their needs, there is a possibility that it could cause unexpected harm. Under the HIPAA Privacy Rule, covered entities may share protected patient health information in a court order. The social drivers that patients experience do not make them unfit parents, but “depending on what a judge decides about its relevance to the case, social risk information documents in a patient’s medical record may make its way into the custody battle” (CHILPI, 2024).
This does not mean providers should stop screening their patients for social needs, but they should consider integrating harm reduction into the process. The policymakers could consider, but it can also be addressed on a site-by-site basis, whether that be done before implementing a screening process, before screening the patient, following a positive screening, or during the evaluation of the process. Some examples include coding the responses on the patient’s record, discussing the documentation process with patients to see if they are concerned about what is being said, and even monitoring for these harms ahead of time to see if information is repeatedly being shared with external groups like CPS.
Even if your site has privacy protections and security measures already in place, it is essential to reassess these policies and procedures on an ongoing basis to ensure that your organization “acknowledges the potential for unintended consequences and adapt intervention to minimize risk of harm” (CHLPI, 2024), which can be done with the CHLPI interventions stated above. Read the complete CHLPI resource for detailed guidance on specific privacy concerns. If you have any ideas on harm reduction mechanisms, please share them with the Health and Hunger Task Force group.
