Holistic Care Requires Data Infrastructure beyond EHRs

Because current electronic health records are not focused on exchanging information across the continuum of care to nonmedical providers, adata infrastructure is needed that goes beyond EHRs to share data with community-based organizations across clinical settings and social services. That is the finding of a Health IT Policy Committee workgroup that met on Tuesday.

“EHRs do a great job of capturing information from clinical encounters in the ambulatory setting at a hospital but don’t do a good job of getting all the other kinds of data about the whole person that impact health,” said Paul Tang, chair of the HITPC’s Advanced Health Models and Meaningful Use Workgroup at the June 23 meeting.

Tang argued that what’s required is a broad expansion of the traditional medical “continuum of care” to encompass all of the entities and individuals within a community that influence an individual’s health, emphasizing that social, psychological, and behavioral factors—such as family support systems, stress, housing, nutrition, income, and education—explain far more about an individual’s health outcomes than the results of medical care.

Also See: Should EHRs Include Social/Behavioral Data?

“Integrating these types of approaches with EHR-based systems will require a broader focus from EHR vendors, which are still tied to medical/episodic based needs,” according to the workgroup’s recommendations.

Tang asserted that “what is needed is a way to link the data that belongs to an individual—and no other data that belongs to other individuals.” He made the point that “we don’t really want to be spreading the whole [medical] chart around to everybody,” and that there’s “probably some limited amount of information about an individual that goes to key stakeholders because it not only would expose us to privacy risk but it also would overwhelm the data recipient.”

When it comes to privacy, Tang said that part of the challenge is the sharing of information between HIPAA-covered entities and non-HIPAA covered community-based organizations. “Advanced health models that seek to bring together new sources of data will need to effectively manage a variety of privacy issues to ensure adherence to current law and robust protection for patient information,” according to the workgroup. “These considerations relate to HIPAA statutes governing health information, as well as interactions between HIPAA and other federal and state privacy laws governing other settings, such as schools.”

The workgroup recommended that the Department of Health and Human Services and Office of the National Coordinator for Health IT “promote greater standardization of clinical data across systems utilized by all service professionals for better coordination of care for individuals,”and that HHS/ONC shouldarticulate a “strategy to promote greater interoperability between human services standards and standards used by clinical systems.” The workgroup also recommended promoting greater standardization for social determinants of health data and related performance measures impacting individual health.

In addition, the workgroup recommended accelerating the implementation of “dynamic shared care planning models that incorporate planning information from both clinical and non-clinical services,” as well as exploring “better individual matching strategies to facilitate aggregation of data across clinical and non-clinical settings and other high-priority use cases.”