Social/Behavioral Health Data Vital to EHRs

Studies showing that the inclusion of social and behavioral health factors in a patient's medical record could prove beneficial have been around for nearly 30 years. But the topic is hot again now that larger numbers of providers are using EHRs as a result of Meaningful Use and the HITECH ACT.
 
The Institute of Medicine's "Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1" report, which was released earlier this month, is the first in a two-part evaluation of how such information can improve healthcare and which specific data elements can and should be included.
 
The agency convened a 13-member committee to take on the topic, as a result of requests by other agencies, including the Office of Behavioral and Social Sciences Research the Blue Shield of California Foundation, the Lisa and John Pritzker Family Foundation, the Robert Wood Johnson Foundation and The Substance Abuse and Mental Health Services Administration. The report was intended to inform and aid the ONC and CMS as they finalize domains for Meaningful Use Stage 3.
 
The IOM committee heard from various social, behavioral and IT experts on why including social and behavioral health data in EHRs is crucial.
 
"Integrating social and behavioral determinates of health into EHRs could allow providers and public health agencies to better describe and monitor patterns of health and outcomes of care for the entire population," according to the report. "[It also] advances data harmonization and has the potential to unleash unprecedented opportunities for health research."
 
For example, physicians could use such data within an EHR to better characterize, understand and identify the causes of health issues and find appropriate interventions that health systems can make to reduce disparities. Also, researchers could use the data to select more appropriate patients for clinical trials.
 
"The addition of these variables has great potential to improve the quality, safety and efficiency of health services delivery to support national goals of improving health and eliminating health disparities," according to the report.
 
The study also points out that the United States is trailing some other countries with regards to spending on social/behavioral care, which includes incorporating such data in a patient's medical record. Countries including England, Denmark, New Zealand and Sweden enable physicians to access some social/behavioral data as part of their patients’ medical records.
 
While the IOM will examine additional data variables in the second study, it did indicate several subsets that should be included in EHRs. It classified these elements into three categories: sociodemographic, psychological and behavioral.
 
The sociodemographic domain should include variables such as sexual orientation, race/ethnicity, country of origin, education, employment, financial resource strain and food and housing insecurity and should be included in a patient's EHR. Health literacy, stress, negative mood and affect, depression, anxiety and psychological assets as well as conscientiousness, patient engagement, activation, optimism and self-efficacy should be included in the psychological domain, according to IOM. And within the behavioral domain, the IOM concluded that dietary patterns, physical activity, nicotine use and exposure, and alcohol use also should be included in a patient's EHR.