NEJM Perspective: Include Social, Behavioral Data in EHRs

February 21, 2015 in News

HHS should require physicians to ask about patients’ socioeconomic status and behavioral health and record that information in electronic health records as part of Stage 3 of the meaningful use program, according to a perspective published Thursday in the New England Journal of Medicine, Politico‘s “Morning eHealth” reports (Gold et al., “Morning eHealth,” Politico, 2/19).

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments. The Office of Management and Budget received the proposed rule for Stage 3 in January, and the proposal is expected to be approved by OMB sometime this winter (iHealthBeat, 1/6).

Details of NEJM Perspective

The perspective was written by two officials from the Institute of Medicine’s Committee on Recommended Social and Behavioral Domains and Measures for Electronic Health Records:

  • Nancy Adler; and
  • William Stead (Adler/Stead, NEJM, 2/19).

The article was based on a November 2014 IOM report that detailed 12 social and behavioral factors it feels should be included in EHRs.

Reasons for Including Socioeconomic, Behavioral Health Data in EHRs

The perspective argues that gathering patients’ socioeconomic and behavioral health data would save the health care system money and provide more patient-centered, accountable care (“Morning eHealth,” Politico, 2/19).

Specifically, the authors write that incorporating such data into EHRs could:

  • Allow for more accurate diagnoses and better treatment;
  • Improve shared decision making;
  • Help clinicians better identify risk factors;
  • Prompt clinicians to refer patients to public health departments or community agencies that help address specific conditions or issues, such as domestic violence;
  • Expand the health system’s ability to provide services tailored to a population’s specific needs; and
  • Broaden patient context and data available to researchers.

However, the authors note that “challenges [could] arise in using the resulting information,” adding that it would be necessary to pay “special attention to privacy, security and access.”

In addition, while “addressing social and behavioral determinants may require reconsideration of clinical roles and workflows,” the effect on clinicians’ workflow would be “minimal,” as “these factors can be self-reported and some of them need only be assessed at initial intake.”

The authors conclude, “Including a concise panel of standard measures of social and behavioral determinants in every patient’s EHR will increase clinical awareness of the patient’s health status and enable clinical, public health, and community resources to work in concert” (NEJM, 2/19).

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