A new report from the Institute of Medicine advocates incorporating standardized social and behavioral data into electronic health records.
While determinates of health such as physical activity levels and living conditions have been a concern of public health agencies, these determinants have generally not been closely linked to actual clinical practice, according to the report.
The Patient Protection and Affordable Care Act and the move toward accountable care organizations provide impetus for creating policy and business frameworks for coordinated action, with electronic health records as a unifying nervous system, report authors argue.
IOM committee members included social and behavioral scientists, clinical and public health professionals and information technology experts to identify and recommend the types of social and behavioral information that should be included in EHRs, as well as barriers to inclusion and solutions. The inclusion and use of such data in an EHR should foster better clinical care of individual patients and of populations, and enable more informative research on the determinants of health and the effectiveness of treatments. In short, the committee recommends a series of psychosocial vital signs to be entered into EHRs.
The new report is the second phase of an effort to capture social and behavioral data in EHRs. The first report identified 17 domains--or data sets--considered to be good candidates for inclusion in EHRs. The second report identifies 12 measures related to 11 of the domains and considers the implications of including them in EHRs.
The 12 measures are alcohol use, race and ethnicity, residential address, tobacco use and exposure, census-tract median income, depression, education, financial resource strain, intimate partner violence, physical activity, social connections and social isolation, and stress. Attached to each measure are one or more specific questions that should be asked, along with the frequency of screening and follow-up activity. A priority of selected measures was that they be interoperable.
Report authors recommend that the domains and measures be included in certified EHRs and as meaningful use objectives. Since most of the recommended measures are self-reported and can be collected directly from the patient on paper or via a computer, gathering such data does not need to add to clinicians time, according to the report. Some may be found in sources related to the patient, such as EHRs from other institutions and personal health records. Once the data are in the patients EHR, providers and health systems should act upon the available information.
The new report, Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2, is available here.
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