The Institute of Medicine has identified the top 17 social and behavioral areas that should be addressed in all electronic health records to improve health outcomes and advance public health research efforts.
The IOM compiled the list as a guide for federal officials who are currently developing criteria for Stage 3 of the meaningful use program for EHRs, slated to begin in 2017.
A 13-member committee, which included physicians as well as experts in health information technology and social determinants of health, compiled a list of "candidate" domains that included sociodemographic, psychological, and behavioral factors. The committee also identified domains related to individual-level social relationships and the effect of neighborhoods and communities.
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The Institute of Medicine recommends addressing 17 social and behavioral areas of a patient’s background when filling out electronic health records.
The candidate domains (in no particular order) are sexual orientation, race/ethnicity, country of origin, education, employment, financial resources strain (food and housing insecurity), health literacy, stress, negative mood and affect, psychological assets (patient engagement, conscientiousness, optimism, and self-efficacy), dietary patterns, physical activity, nicotine use and exposure, alcohol use, social connections and social isolation, exposure to violence, and area socioeconomic and racial/ethnic characteristics.
In selecting the domains, the IOM committee considered the evidence for whether the domains were associated with health outcomes, as well as whether collecting the information in an electronic health record would be useful for treatment and in public health research.
While some of the information, such as race, ethnicity, gender, language, and smoking status, is routinely collected in electronic health records now, the committee included them on the list to ensure they would remain a priority.
The IOM is planning a follow-up report to narrow down the current list and to recommend specific measures for each of the domains. The second report will also look closely at the barriers to collecting this type of social and behavioral information from patients.
mschneider@frontlinemedcom.com
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