Capturing Social and Behavioral Domains in Electronic Health Records Phase 1 (2014) / Chapter Skim
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"Meaningful use" in a health information technology context refers to the use of EHRs and related technology within a health care organization to achieve specified objectives. Achieving meaningful use also helps determine 1 Public Law 111-5.
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Expansion beyond the traditional medical 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. 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 FORMATION AND CHARGE TO THE COMMITTEE The Office of Behavioral and Social Sciences Research and other institutes of the National Institutes of Health partnered with the Association of State and Territorial Health Officials, Blue Shield of California Foundation, California HealthCare Foundation, Centers for Disease Control and Prevention, CMS, The Lisa and John Pritzker Family Fund, the Robert Wood Johnson Foundation, and the Substance Abuse and Mental Health Services Administration requested that the Institute of Medicine (IOM)
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3. What are the possibilities for linking EHRs to public health departments, social service agencies, or other relevant non–health care organiza tions?
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Throughout the study, the term "domain" is used to refer to determinants of health, which could include health conditions that, in turn, influence other health outcomes. DOMAINS AND CRITERIA Several existing conceptual frameworks identify categories of health determinants and the ways in which they link to mortality as well as to disease onset and progression.
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The result reduced the number of domains constituting the candidate set for which the committee found sufficient evidence of relevance and utility to consider for inclusion in all EHRs. Given the limited time that the committee had to complete the Phase 1 report in order for its recommendations to be useful for Meaningful Use Stage 3 deliberations, it was not possible to apply the full list of criteria to all of the potential domains before these decisions had to be made.
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Behavioral Domains • Dietary patterns • Abuse of other substances • Physical activity • Sexual practices • Tobacco use and exposurea • Exposure to firearms • Alcohol use • Risk-taking behaviors (Distractive driving and helmet use) in its Phase 2 report and these may be tailored to specific populations, as guided by use of the life course perspective.
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Most of the domains excluded from this candidate set simply lacked an adequate evidence base to support routine capture of these data. By limiting the recommended domains to those for which there is a reasonable evidence base, the committee is confident that the list of domains and the measures that follow in the committee's next report, if implemented, will provide crucial data to providers, health systems, and researchers, in turn providing the most appropriate strategies toward improving the health status of Americans.
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