South Australia has historically experienced some of the highest rates of domestic violence in the U.S., encompassing physical or sexual violence, stalking, and psychological aggression by a current or former partner. In response, researchers at the Medical University of South Australia (MUSSA) have developed an electronic health record (EHR)-based screening system for domestic violence, finding it to be 10 times more effective than traditional oral screenings.

The team, led by Dr. Leslie A. Lenert, partnered with Dr. Alyssa A. Rheingold, Dr. Vanessa Diaz, and Dr. Kit N. Simpson, with support from the Agency for Healthcare Quality and Research. Their study, published in JAMA Network Open, highlights the advantages of confidential, electronic screening over oral methods, which are often underutilised and lack privacy, causing discomfort for patients. Improved screening for domestic violence is urgently needed due to the long-term effects on both victims and their families, including risks of post-traumatic stress and negative impacts on children who witness the violence.

To increase the effectiveness and comfort of domestic violence screening, the researchers tailored the EHR-based system exclusively for women and incorporated feedback from national experts and survivors. This electronic method allows patients to answer a confidential questionnaire on a computer, without their partners present, ensuring privacy and minimising intimidation or judgement from staff. The questionnaire’s results are securely stored in a private area of the EHR, accessible only to the patient and provider.

The team also provided physicians with best practices for discussing domestic violence and resources for referral. “The training and decision support given to providers helped us address any needs the patient had,” explained Dr. Diaz, who emphasised the importance of giving patients a safe, technology-enabled space to discuss personal and emotional issues in an already demanding healthcare environment.

The study’s findings show that the EHR-based screening not only identified more cases of domestic violence but also helped normalise discussions of it in primary care. “Our staff and patients appreciated that we were asking about domestic violence,” noted Diaz. “They know it’s a serious issue, and screening is an essential first step in connecting people with the help they need.”

While this method marks significant progress, Lenert and his team acknowledge that it’s not a quick fix. The EHR-based screening provides a crucial step in creating a safe environment where women feel empowered to discuss domestic violence with their healthcare providers and begin the difficult journey to safety. As Rheingold emphasised, “We want people experiencing domestic violence to know that support is available to help them feel safe and move toward a place of security.”

References:

Lenert L, Rheingold AA, Simpson KN, et al. Electronic Health Record-Based Screening for Intimate Partner Violence: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2024;7(8):e2425070. Published 2024 Aug 1. doi:10.1001/jamanetworkopen.2024.25070CDC