Capturing Social and Behavioral Domains and Measures in Electronic Health Records Phase 2 (2014) / Chapter Skim
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Pages 3-20
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From page 3... ...
These include the relatively poor health status of the U.S. population despite high -- and possibly unsustainable -- investments in health care and new incentive structures through the Patient Protection and Affordable Care Act such as accountable care organizations which reward health systems for achieving better health with less use of costly medical services.
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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 the National Institutes of Health, together with the Association of State and Territorial Health Officials, the Blue Shield of California Foundation, the California HealthCare Foundation, the Centers for Disease Control and Prevention, CMS, the Department of Veterans Affairs, The Lisa and John Pritzker Family Foundation, the Robert Wood Johnson Foundation, and the Substance Abuse and Mental Health Services Administration, requested that the Institute of Medicine (IOM) conduct a two-phase study to identify social and behavioral domains and their measures for inclusion in electronic health records.
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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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For this study, the committee uses the term candidate to refer to the core domains (the third item of the Statement of Task) because the specific task during Phase 1 was to identify domains that should be considered by ONC for Stage 3 Meaningful Use.
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Chapter 3 of the report and the criteria presented above are intended to serve as resources to support their drafts and final decisions. Committee's Key Conclusions in Phase 1 In addition to developing criteria for selecting domains and measures to recommend for inclusion in all electronic health records, the major focus of Phase 1 was identifying a candidate set of domains relevant for all individuals.
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born § Education § Employment § Financial resource strain (Food and housing insecurity) Psychological Domains § Health literacy § Negative mood and affect § Stress (Hostility and anger, hopelessness)
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Most of the domains excluded from the final candidate set simply lacked an adequate evidence base to support routine capture of these data. (See Appendix A for more information on domains not selected.)
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Informed by these ratings, the committee reached consensus on four domains that are currently being collected in many clinical settings and eight domains that are not yet routinely collected. Table S-3 summarizes the 11 domains and 12 measures that compose the selected panel and the number of questions in each measure.
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Candidate Domains Applied criteria: strength of 17 Domains Selection association with health; and clinical, population health, and research usefulness Measure Identification Domain workgroups 17 Domains/31 Measures conducted literature reviews of measures Measure set identified based on psychometric properties Parsimonious Applied criteria: readiness 11 Domains/12 Measures Measurement Panel (standard measure, Construction feasibility, lack of sensitive information) ; usefulness for inclusion in the EHR; and overall committee judgment NOTE: EHR = electronic health record; SBD = social and behavioral determinants.
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For example, sensors which record data for review and upload to the EHRs if appropriate -- while not without their own limitations -- may eliminate or reduce the need for having to ask individuals about behaviors such as exercise or sleep. Select measures for some determinants of health may be found in other sources related to the patient, including EHRs from other institutions; personal health records; health risk appraisals gathered by insurers, employers, or clinical data registries; community agency datasets; national surveys; and datasets gathered by third-party data integrators such as retail.
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For example, data in EHRs can enable public health practitioners to identify groups of persons affected by environmental pollutants and identify areas that may need environmental mitigations. Clinicians can use geocoded environmental data to coach individual patients on risk mitigation or to tailor treatment.
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will enable: • More effective treatment of individual patients in health care settings, • More effective population management for health care systems and for public health agencies, and • Discovery of the pathways that link social and behavioral factors to functioning, disease processes, and mortality that may inform new treatments and interventions. The committee's judgments and recommendations necessarily reflect not only the current status of knowledge about the social and behavioral determinants of health and of the measures of the identified domains of health determinants, but also a tactical decision of the committee to put forward at this time a parsimonious initial set of social and behavioral domains and measures for inclusion in EHRs.
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Finding 5-2: The addition of selected social and behavioral domains, together with the four domains that are already routinely collected, constitute a coherent panel that will provide valuable information on which to base problem identification, clinical diagnoses, treatment, outcomes assessment, and population health measurement. Recommendation 5-2: The Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Med icaid Services should include in the certification and meaningful use regulations addition of standard measures recommended by this com mittee for eight social and behavioral domains: educational attainment, financial resource strain, stress, depression, physical activity, social isolation, intimate partner violence (for women of reproductive age)
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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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The addition and standardization of a parsimonious panel of social and behavioral measures into EHRs can help spur policy, system design, interoperability, and innovation to improve health outcomes and reduce health care costs. REFERENCES AHRQ (Agency for Healthcare Research and Quality)
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