Capturing Social and Behavioral Domains and Measures in Electronic Health Records Phase 2 (2014) / Chapter Skim
Currently Skimming:
7 Looking Toward the Future
7 Looking Toward the Future
Pages 255-272
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From page 255... ...
has expressed interest in considering the inclusion of more social and behavioral domains in the EHR as a possible Stage 3 Meaningful Use requirement. All of these efforts will be facilitated by a standard set of measures to assess the most relevant domains.
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From page 256... ...
Thus, in making its judgments about what to recommend for inclusion in EHRs, the committee leaned heavily on the current evidence of the link between each domain and health outcomes; the availability of a standard reliable and valid measure of the domain; the clinical usefulness of the measure; the feasibility; and the lack of sensitive information, causing patient discomfort of capturing the measure in the clinical workflow. The committee recognizes that criteria used to evaluate measures of domains may vary in their nature and emphasis depending on the purpose for which they are being used.
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From page 257... ...
For example, in reviewing the evidence related to violence against elders, the U.S. Preventive Services Task Force (USPSTF)
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From page 258... ...
The task force viewed screening for intimate partner violence for women of reproductive age as having moderate net benefit. The committee noted the need for more research regarding screening measures for violence for other populations, as well as the need to identify a common metric for interpersonal violence.
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By relating measures of a domain to a common metric, if specific measures change and new ones develop, the common metric remains. For example, rapid advances are occurring in the development of personal devices and sensors to measure physical activity.
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From page 260... ...
IMPLICATIONS OF INCLUDING SOCIAL AND BEHAVIORAL INFORMATION IN EHRS TO STAKEHOLDERS The use of EHRs is expanding at an increasing pace, and the data that are collected and stored in such records have the potential to improve clinical practice, population health management, and health research, but they may also pose challenges. As a result, the committee considered potential implications for a number of potential stakeholders if its recommendations are implemented.
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From page 261... ...
Research Sponsors Research sponsors will have new opportunities to expand and enrich their research portfolios by supporting research using the data provided by the recommended panel. These measures assess the key determinants of health and provide new types of data in a standard form that can enable novel research.
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From page 262... ...
Second, inclusion will require expanding notions of what constitutes quality and how more enduring characteristics of the individual and elements exogenous to the health care system can, could, and should be incorporated into the quality assessment process. Finally, there may be challenges to incorporating social and behavioral indicators as quality indicators if these are believed by the clinical care professionals and systems to be immutable or considered out of scope of their purview.
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From page 263... ...
The emphasis on standard measures will facilitate definitions of specific fields that product developers and vendors need to create to implement the addition of social and behavioral domains when such data are desired. The committee's recommendations provide guidance on a standard set of domains and measures that may be useful in designing population health product offerings.
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From page 264... ...
Interprofessional education and other training opportunities to create links between public health, medical, nursing, and other health professional education will likely aid efforts to advance the collection and use of social and behavioral information. The committee recognizes that effective population health management adds burden in the short term to the health system, especially to smaller practices.
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From page 265... ...
Having these determinants routinely collected as part of the EHR will enable communities to better understand how these determinants are affecting health and to develop community-wide interventions to improve population health. Greater use of electronic health care data by public health agencies could enable better coordination of efforts and help break down the artificial walls between public health practice and clinical care.
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From page 266... ...
Because the measures need to be useful clinically, some domains require developmental studies regarding effective ways to change social and behavioral factors that lead to improved health. For example, studies on how to improve psychological assets, such as optimism, conscientiousness, and self-efficacy, are needed along with documentation on how such changes affect health and health care utilization.
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From page 267... ...
Employers and payers will need to have the ability to prioritize efforts to address social and behavioral determinants of health and to offer effective programs incorporating social and behavioral determinants of health in their wellness and health promotion programs. TABLE 7-1 Opportunities and Challenges to Integrating Social and Behavioral Determinants of Health into EHRs for Various Stakeholder Groups Stakeholder Group Opportunities Challenges Office of the National • New standards for • Monitoring the process Coordinator for Health data domains that have and outcomes of Information Technology received little attention implementation (ONC)
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From page 268... ...
and evaluation portfolio EHR vendors • Provides guidance on • New EHR functionality systematic inclusion of needed to geocode a standard set of SBDH residential addresses and • Offers insights that link to external data may guide current or sources planned population • Building SBDH data health product offerings capture capabilities that comport with clinical workflows • New ways of analyzing and visualizing SBDH data to support provider population health goals Health care systems • Standard data for • Changes to workflow and accountable care managing individual • Changes in clinical organizations and population health information systems to • Better risk adjustment capture, store, and report for quality assessment data and payment • Providing services to address SBDH needs
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From page 269... ...
issues, including • Standardization of protecting patient privacy measures and complete • Linkage to external data panel sources • Expanded opportunities • Inclusion of patients in for collaborations research teams among social scientists, informaticians, health services, and public health researchers Payers and employers • Standard measures for • Privacy and patient health risk appraisals discomfort concerns and better risk • Need for programs adjustment addressing SBDH identified • Better health in health risk appraisals management of enrolled and employee population
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From page 270... ...
In brief, the committee recommended use of standard measures for four domains that are already being regularly collected (race and ethnicity, tobacco use, alcohol use, and residential address) , and the addition of eight additional domains (educational attainment, financial resource strain, stress, depression, physical activity, social isolation, intimate partner violence [for women of reproductive age]
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From page 271... ...
Recommendation 7-3: The Secretary of Health and Human Services should convene a task force within the next 3 years, and as needed thereafter, to review advances in the measurement of social and behav ioral determinants of health and make recommendations for new stan dards and data elements for inclusion in electronic health records. Task force members should include representatives from the Office of the National Coordinator for Health Information Technology, the Cen ter for Medicare & Medicaid Innovation, the Agency for Healthcare Research and Quality, the Patient-Centered Outcomes Research Insti tute, the National Institutes of Health, and research experts in social and behavioral science.
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From page 272... ...
2014. Comments from the National Institute for Occupational Safety and Health for the IOM Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Re cords.
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