Capturing Social and Behavioral Domains and Measures in Electronic Health Records Phase 2 (2014) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 21-42
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 21... ...
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 22... ...
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 23... ...
. 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 24... ...
GROWING USE OF ELECTRONIC HEALTH DATA AND EHRs The patient health record, which traces its origin to the Mayo Clinic (Melton, 1996) , the Presbyterian Hospital (Lamb, 1955; Openchowski, 1925)
|
From page 25... ...
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 26... ...
3 included the Health Information Technology for Economic and Clinical Health Act (HITECH) provision, which provided billions of dollars in incentives to use EHR systems to create "significant and measurable improvements" in population health outcomes through a transformed health care delivery system.
|
From page 27... ...
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; monitor and track their illness, treatment, and progress; and learn about the prognosis for their illness (Pagliari et al., 2007)
|
From page 28... ...
. 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 29... ...
. Capturing social determinants of health in EHR data will allow health care providers to better characterize, understand the causes of, and identify appropriate interven BOX 1-2 The Case of Sonia: Kaiser Permanente in Northern California's Domestic Violence Program "Sonia" is a 38-year-old Mexican-American woman who has been married for 20 years, and the mother of two grown children.
|
From page 30... ...
The addition of these variables has great potential to improve the quality, safety, and efficiency of health services delivery and to support national goals of improving health and eliminating health disparities. Research Uses of EHRs The capture of a core set of standard social and behavioral determinants of health as variables in the EHR advances data harmonization and has the potential to unleash unprecedented opportunities for health research.
|
From page 31... ...
Social and behavioral data can describe potentially modifiable conditions that, along with clinical and biological data, can provide more preventive, diagnostic, and therapeutic options for improving individual and population health (Barrett et al., 2013)
|
From page 32... ...
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.5 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 33... ...
. April 2014 also saw the release of the report by the JASON/MITRE Corporation, A Robust Health Data Infrastructure, which noted that "the current lack of interoperability among the data resources for EHRs is a major impediment to the unencumbered exchange of health information and the development of a robust health data infrastructure" (AHRQ, 2014, pp.
|
From page 34... ...
COMMITTEE'S APPROACH TO ITS TASK To meet its charge in Phase 1, the committee first established the rationale for adding social and behavioral domains into EHRs and considered how EHRs may assist providers in their decision making in a way that will result in improved health outcomes for their patients, regardless of Meaningful Use adoption and implementation. The committee held two information-gathering meetings during Phase 1 in order to clarify its statement of task; learn about meaningful use objectives; and hear from other 7 ONC's Meaningful Use Workgroups were being restructured over the summer of 2014, and in July 2014, the HIT Policy Workgroup released its recommendations for Stage 3 Meaningful Use to ONC (Health IT Policy Committee, 2014)
|
From page 35... ...
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 36... ...
"EHRs" are collections of electronic data stored and used by health care providers to manage patients' health. For the purposes of this study, the committee employed a definition on social and behavioral determinants of 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 37... ...
The meeting also allowed the committee to hear from speakers about the best ways to collect information, successes and challenges in linking EHR data between public health departments and other relevant organizations, and how systems can be developed in which data flow freely among all relevant users. A key component was learning about patient privacy protection issues in adding potentially sensitive social and behavioral data elements into EHRs.
|
From page 38... ...
2014. A robust health data infrastructure.
|
From page 39... ...
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 40... ...
no date–b. How can electronic health records improve public and popula tion health outcomes?
|
From page 41... ...
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 42... ...
2013. Strengthening health information infrastructure for health care quality gov ernance: Good practices, new opportunities and data privacy protection challenges.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.