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1 Introduction
Pages 9-28

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From page 9...
... However, efforts to address health disparities among groups in the United States are not the only reason to consider social and behavioral determinants of health. In the past few years, the relatively poor health status of the U.S.
From page 10...
... Across all countries, those that had the highest ratio of spending on social services to spending on health care had the best population health statistics. Traditionally, research and interventions on the social and behavioral determinants of health have largely been the purview of public health, which has focused on prevention of disease and the maintenance of the public's health.
From page 11...
... . Changes in policy affecting incentives for new approaches to health care delivery included in the Patient Protection and Affordable Care Act1 and other policy innovations are encouraging the formation of more coordinated systems that have a greater capacity to address the social and behavioral needs of individual patients and to pay more attention to public health (HHS, no date)
From page 12...
... They provide crucial information to providers treating individual patients, to health systems about population health, and to researchers about the determinants of health and the effectiveness of treatment. The inclusion of social and behavioral domains in EHRs is vital to all three.
From page 13...
... An EHR system's decision-making tools include data-driven alerts and reminders, order sets, displays to visualize information, calculators, list EHRS2 EHRS1 External links Ancillary links Legacy paper records Electronic health records FIGURE 1-1  The legal patient record may comprise electronic and paper information from several sources. In the simplest case, a health provider may be served by a single electronic health record system (EHRS)
From page 14...
... The data in EHRs are useful tools for health care providers, including hospitals and health care centers, so they may track patient health and illnesses, medical procedures and prognosis, family histories, and laboratory results. Further, EHRs enable computer-based decision support during order entry and prescribing medication.
From page 15...
... Networks can also use those data to set reminders on when a patient is due for preventive screenings and alerts on contraindications on medications, among other more administrative functions. While numerous challenges exist, the BOX 1-1 The Case of Veronica: Including Community Health Workers, Advocacy Groups, and Citizens to Promote Healthy Neighbors "Veronica," a patient of Dr.
From page 16...
... An informed and actively involved patient can be more engaged in disease self-management and is better able to adhere to the recommendations of his or her health care provider recommendations. Patients who have access to personal health data can obtain their laboratory results, receive drug and appointment alerts, record their nonprescribed medicines and treatments, and can monitor and track their illness treatment and progress, and learn about the prognosis for their illness (Pagliari et al., 2007)
From page 17...
... . Even though both types of ACOs would benefit by incorporating and addressing social and behavioral determinants of health, those with the latter perspective are more likely to incorporate a broader view of the determinants of health including social services, public health, and environmental factors (Noble and Casalino, 2013)
From page 18...
... Conventional clinical trials, pragmatic clinical trials, clinical epidemiology, and health services research will benefit from enhanced electronic datasets. EHRs can also enable the conduct of registrybased randomized clinical trials (RRCTs)
From page 19...
... compared with that required for a traditional clinical trial and was completed within a shorter period of time (Lauer and D'Agostino, 2013; National Heart, Lung, and Blood Institute, 2013)
From page 20...
... Deliberations within the HIT Policy Committee and its workgroups address the balance among moving as quickly as possible because of the urgency of achieving health care reform, the desire to improve patient outcomes, and the timing of incentives (which were front loaded) , and moving more slowly because of limited capabilities in currently available EHR systems, the time needed to implement EHR systems, the realities of small clinical practices, and the desire to learn from previous experience with Meaningful Use before new stages are defined.4 As of October 2013, about one-half of eligible professionals and two-thirds of eligible hospitals had achieved Meaningful Use Stage 1, which represents a huge improvement over the 2009 baseline level of achievement (King and Adler-Milstein, 2013)
From page 21...
... Together, they requested that the IOM convene a committee of experts "to identify domains and measures that capture the social determinants of health to inform the development of recommendations for Stage 3 meaningful use of electronic health records (EHRs) ." A 13-member committee was selected to address the charge.
From page 22...
... The committee used the Ovid Embase, Ovid Medline, and Web of Science search engines, setting limits and using in its search specific medical subject headings terms in their search pertinent to components of social and behavioral determinants of health. Given the vast literature on the range of social and behavioral determinants of health, systematic reviews were used when possible.
From page 23...
...  Specify criteria that should be used in deciding which domains should be included, 3.  Identify core social and behavioral domains to be included in all EHRs, and 4.
From page 24...
... . health used in the National Research Council's report Proposed Revisions to the Common Rule for the Protection of Human Subjects in the Behavioral and Social Sciences (NRC, 2014)
From page 25...
... 2012. Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States.
From page 26...
... no date–b. How can electronic health records improve public and popula tion health outcomes?
From page 27...
... Presentation to the Health IT Policy Committee. http://www.healthit.gov/facas/sites/faca/files/MUWG_Stage3_13_Sep_4_ FINAL_0.pdf (accessed February 1, 2014)
From page 28...
... 2007. Potential of electronic personal health records.


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