IOM Recommends Including Social/Behavioral Determinants in Electronic Health Records

On November 13, the Institute of Medicine (IOM) released Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2, which recommends a “concrete approach to including social and behavioral determinants in the clinical context to increase clinical awareness of the patient’s state, broadly considered, and to connect clinical, public health, and community resources for work in concert.” The report’s recommendations takes into consideration the “substantial empirical evidence of the contribution of social and behavioral factors to functional status and the onset, progression, and effective treatment of disease [that] has accumulated over the past four decades.”

The study was conducted by IOM’s Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records within the Board on Population Health and Public Health Practice. Nancy Adler, University of California, San Francisco, and William Stead, Vanderbilt University, served as its co-chairs and brought together social and behavioral scientists with clinical and public health practitioners and information technology experts.

The Committee found that four social and behavioral domains of health are already frequently collected in clinical settings: alcohol use, tobacco use and exposure, race/ethnicity, and residential address. It recommended that eight additional domains/measures also be included:

(1)   Education
(2)   Stress
(3)   Depression
(4)   Physical activity
(5)   Census track-median income
(6)   Financial resource strain
(7)   Intimate partner violence
(8)   Social connections and social isolation.

The study was requested by the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research (OBSSR), together with the Centers for Disease Control and Prevention (CDC), Center for Medicare and Medicaid Services, the Substance Abuse and Mental Health Services Administration, the Department of Veteran Affairs, the Robert Wood Johnson Foundation, Blue Shield of California Foundation, the California Healthcare Foundation, and the Lisa and John Pritzker Family Foundation. It was a two-phase study designed to identify social and behavioral domains and their measures for inclusion in electronic health records (EHRs).

The value of the information would be increased if standard measures were used capturing these data. The report also emphasizes that the addition of social and behavioral data to EHRs will enable novel research, and the impact of the research is likely to be greater if guided by federal prioritization activities. Accordingly, the Committee recommended that the NIH Office of the Director “develop a plan for advancing research using social and behavioral determinants of health in electronic health records.” It is recommended that OBSSR coordinate this plan with the input across the NIH institutes and centers.

Also among the Committee’s recommendations is that the Secretary of Health and Human Services convene a task force within the next three years, and as needed thereafter, to review advances in the measurement of social and behavioral determinants of health and make recommendations for new standards and data elements for inclusion in EHRs.

Looking toward the future, the report explains that the measures that merit inclusion in EHRs are those that “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 discovering the pathways that link social and behavioral factors to biological functioning, disease processes, and mortality that may inform new treatments and interventions,” requiring accurate and useful data.

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