IOM wants more data logged in EHRs

November 14, 2014 in Medical Technology

The Institute of Medicine has issued a new report calling for standardized social and behavioral data to be included in electronic health records. That may be good for population health research, but could be unwelcome news for system developers, and for physicians who already complain that EHRs are burdensome and distract from care delivery.

“Patient electronic health records provide crucial information to providers treating individual patients, to health systems addressing the health of populations, and to researchers uncovering valuable details on determinants of health and the effectiveness of treatments,” write IOM officials in the report. “Over the past few decades, substantial empirical evidence points to the contribution of social and behavioral factors – such as living conditions and physical activity levels – to functional status and the onset and progression of disease.”

[See also: Docs say how they really feel about EHRs]

While data related to such social and behavioral determinants “have largely fallen under the purview of public health,” according to the study, “until recently, these determinants have not been linked to clinical practice or health care delivery systems.”

Four pieces of sociobehavioral information are already frequently collected in clinical settings: race/ethnicity, tobacco use, alcohol use and residential address.

[See also: Meaningful use criteria 'too high and too many']

Since “the value of this information would be increased if standard measures were used in capturing these data,” IOM recommends that the Office of the National Coordinator for Health IT and the Centers for Medicare Medicaid Services should include them in certification and meaningful use regulations.

But more social and behavioral data from patients would “constitute a coherent panel that will provide valuable information on which to base problem identification, clinical diagnoses, treatment, outcomes assessment, and population health measurement,” according to the report.

As such, IOM suggests that ONC and CMS “include in the certification and meaningful use regulations addition of standard measures recommended by this committee for eight social and behavioral domains.”

These are: educational attainment, financial resource strain, stress, depression, physical activity, social isolation, intimate partner violence (for women of reproductive age), and neighborhood median household income.

“Standardized data collection and measurement are critical to facilitate use and exchange of information on social and behavioral determinants of health,” according to the study. “Most of these data elements are experienced by an individual and are thus collected by self-report.”

However, “currently, EHR vendors and product developers lack harmonized standards to capture such domains and measures.”

Toward that end, IOM suggests, ONC’s “electronic health record certification process should be expanded to include appraisal of a vendor’s or product’s ability to acquire, store, transmit, and download self-reported data germane to the social and behavioral determinants of health.”

[See also: IOM report: Behavioral health needs say in NHIN]

Among its other recommendations:

  • National Institutes of Health should develop a plan for advancing research using social and behavioral determinants collected in EHRs. The Office of Behavioral and Social Science Research should coordinate this, ensuring input across the many NIH institutes and centers.
  • The Secretary of Health and Human Services should “convene a task force within the next three years, and as needed thereafter,” to review the progress of the measurement of these determinants, and “make recommendations for new standards and data elements for inclusion” in EHRs. This task force should include representatives from ONC, CMS, NIH, the Agency for Healthcare Research and Quality, the Patient-Centered Outcomes Research Institute and “research experts in social and behavioral science.”
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