A new study from the Institute of Medicine argues that the inclusion of social and behavioral health domains in electronic health records is vital to providing crucial information to providers treating individual patients, to health systems concerned about the health of populations, and to researchers involved in determining the effectiveness of treatment.

The report, the first of a two-phase study conducted by a 13-member IOM committee, identifies: specific domains to be considered by the Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid Services; criteria that should be used in deciding which domains should be included; identification of core social and behavioral domains to be included in all EHRs; and any other domains that should be included for specific populations or settings defined by age, socioeconomic status, race/ethnicity, disease, or other characteristics.

The domains are put into the following categories: socio-demographic, psychological, behavioral, individual-level social relationships, and neighborhoods and communities.  

"Expansion beyond the traditional information collected in EHRs to include social and behavioral health determinants requires the identification and application of criteria for determining what domains should be included in all EHRs and for specific populations," state the authors. "The rapid adoption of EHRs and the exigent Meaningful Use Stage 3 criteria formulation by the ONC and CMS add urgency to this effort." 

The report is "intended to inform and aid the ONC and CMS in finalizing domains for Meaningful Use Stage 3." However, the committee that put together the report acknowledges that "ONC and CMS will likely need to move forward with their decision making on objectives and measures for Meaningful Use Stage 3 before release of the committee's Phase 2 report."

According to recommendations adopted last month by the Health IT Policy Committee, patient information would be captured and used in order to reduce health disparities in Stage 3 of the EHR meaningful use program. Demographics and patient information is among the 19 objectives in the approved Stage 3 recommendations. 

Under this objective, the certification criteria to achieve the goal of reducing health disparities would be the ability to capture occupation and industry codes, as well as sexual orientation, gender identity, and disability status. However, George Hripcsak, co-chair of the HIT Policy Committee's Meaningful Use Workgroup, said capturing the information should not be mandatory.

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