EHRs Now Expanding to Include Social and Behavioral Data

social and behavioral

Behavioral and mental health professionals have been key witnesses to how social and behavioral factors contribute to patient’s overall health. In one of a series of actions by the US government to elevate the role of social, behavioral and mental health in  mainstream medicine, the Institute of Medicine (IOM) has released its report: Capturing Social and Behavioral Domains and Measures in Electronic Health Records.

To date, US Electronic Health Records (EHRs) have been largely void of tracking related to the social and behavioral determinants of health. The current action by the IOM is fueled by the growing understanding that the inclusion of a minimal number of important social and behavioral domains of health has the potential to significantly improve clinical decision making and patient care. It is also believed that the accumulation of this data will allow EHRs to be used to provide an essential database of information for public health measures and clinical research to improve care.

Which Behavioral & Social Data will be Included in EHRS? 

The IOM report explains how criteria for inclusion have been carefully considered by the IOM, based on the strength of evidence that the domain is associated with health status, the usefulness of the domain for clinical decision making between patient and provider, monitoring population health and making health care related policy decisions, and conducting clinical and population health research.

Once domains were selected, measures for these domains were included based on reliability and validity, feasibility (i.e. burden to administer and score), sensitivity of the information requested, and if the measure was available from another source.

Social & Behavioral Domains Previously Being Collected:
  1. Tobacco use
  2. Alcohol use
  3. Race/Ethnicity
  4. Residential address (for geocoding of various neighborhood and community determinants)
New Social & Behavioral Domains to Be Collected:
  1. Education level
  2. Financial resource strain
  3. Stress
  4. Depression
  5. Physical activity
  6. Social isolation
  7. Intimate partner violence
  8. Neighborhood median household income (obtained from residence)

While these 12 domains will be used, the IOM report makes it clear that others will be considered as more evidence is reviewed. Individual health systems are also being allowed to add additional domains and measures discussed in the report if relevant. 

Measuring Domains

Health systems using the IOM panel of behavioral and social health determinant indicators can also benchmark information about the patients they serve against nationally representative samples of the U.S. population drawn from the U.S. Census, the National Health Interview Survey, and the National Health and Nutrition Examination Survey

Advancing Research in Population Health

The report notes that the paradox of the U.S. healthcare system (high morbidity and mortality despite the highest health expenditures) is now being recognized as partially attributable to social and behavioral factors. The current effort to include social and behavioral factors in data collection about patients then, is reflective of the changing understanding of healthcare in the US. 

The formal recognition of the essential role of social and behavioral factors in the US healthcare system is becoming more salient. The inclusion of social and behavioral determinants of health within the EHR provides an important resource for a variety of population health research questions. In addition to the obvious benefits of adding these datasets to population health research, it is also believed that the collection of social and behavioral measures will improve the awareness of these factors as being fundamental drivers of health among  patients, healthcare providers, healthcare systems, and policymakers. The good news for behavioral and mental health specialists is that we can expect an increasing number of changes across mainstream healthcare to reflect the foundational role being played by the social and behavioral sciences in the mainstream health care.

Want to Be Involved?

To join a group of advocates working internationally to include evidence-based changes to the evolving Electronic Health Record, consider joining the HL7  Task Force organized by the Coalition for Technology in the Behavioral Sciences (CTiBS). Information about this effort and how to apply for inclusion can be found on the CTiBS.org website.

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