Determinants of health—like physical activity levels and living conditions—have traditionally been the concern of public health and have not been linked closely to clinical practice. However, if standardized social and behavioral data can be incorporated into patient electronic health records (EHRs), those data can provide crucial information about factors that influence health and the effectiveness of treatment. Such information is useful for diagnosis, treatment choices, policy, health care system design, and innovations to improve health outcomes and reduce health care costs.

Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2 identifies domains and measures that capture the social determinants of health to inform the development of recommendations for the meaningful use of EHRs. This report is the second part of a two-part study. The Phase 1 report identified 17 domains for inclusion in EHRs. This report pinpoints 12 measures related to 11 of the initial domains and considers the implications of incorporating them into all EHRs. This book includes three chapters from the Phase 1 report in addition to the new Phase 2 material.

Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research. The recommendations of Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2 will provide valuable information on which to base problem identification, clinical diagnoses, patient treatment, outcomes assessment, and population health measurement.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE RECOMMENDED SOCIAL AND BEHAVIORAL DOMAINS AND MEASURES FOR ELECTRONIC HEALTH RECORDS
• Reviewers
• Preface
• Acknowledgments
• Abbreviations and Acronyms
• Abstract
• Summary
  • BACKGROUND
  • THE FORMATION AND CHARGE TO THE COMMITTEE
  • THE COMMITTEE'S APPROACH IN PHASE 1
  • PHASE 2: PRIORITIZING DOMAINS AND MEASURES
  • IMPLEMENTATION CHALLENGES
  • LOOKING FORWARD
  • FINDINGS AND RECOMMENDATIONS
  • REFERENCES
• 1. Introduction
  • SOCIAL AND BEHAVIORAL HEALTH AND PSYCHOLOGICAL DOMAINS
  • GROWING USE OF ELECTRONIC HEALTH DATA AND EHRs
  • DEFINING THE EHR SYSTEM
  • MEANINGFUL USE IN EHRs
  • CHARGE TO THE COMMITTEE
  • COMMITTEE'S APPROACH TO ITS TASK
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Selection of Domains for Consideration
  • FRAMEWORKS FOR DOMAIN SELECTION
  • SOCIAL AND BEHAVIORAL HEALTH DOMAINS
  • CRITERIA TO BE USED FOR DOMAIN SELECTION
  • REFERENCES
• 3. Identified Candidate Domains
  • LIFE COURSE PERSPECTIVE
  • SOCIAL AND BEHAVIORAL FACTORS IN THE LIFE COURSE PERSPECTIVE
  • DOMAINS
  • DOMAINS NOT INCLUDED
  • REFERENCES
• 4. Measures Reviewed for Each Candidate Domain
  • MEASUREMENT TERMS
  • SOCIODEMOGRAPHIC DOMAIN MEASURES
  • PSYCHOLOGICAL DOMAIN MEASURES
  • BEHAVIORAL DOMAIN MEASURES
  • INDIVIDUAL-LEVEL SOCIAL RELATIONSHIPS AND LIVING CONDITIONS DOMAIN MEASURES
  • NEIGHBORHOODS AND COMMUNITIES DOMAIN MEASURES
  • SUMMARY OF CANDIDATE DOMAIN MEASURES REVIEWED BY THE COMMITTEE
  • REFERENCES
• 5. Recommended Core Domains and Measures
  • OVERVIEW OF THE CANDIDATE DOMAINS
  • SUITABILITY OF THE MEASURES
  • CONSTRUCTING A PANEL OF MEASURES
  • COMMITTEE FINDINGS AND RECOMMENDED CORE DOMAINS
  • REFERENCES
• 6. Implementation Issues
  • CHALLENGES TO ADDING ANY DATA TO EHRS
  • COLLECTING SOCIAL AND BEHAVIORAL DATA TO INCLUDE IN EHRS
  • COLLECTING SELF-REPORTED DATA
  • STORAGE OF SOCIAL AND BEHAVIORAL DATA IN EHRS
  • PRIVACY PROTECTION ISSUES
  • RESOURCE CONSIDERATIONS
  • LINKING DATA FROM EHRS TO PUBLIC HEALTH DEPARTMENTS AND COMMUNITY AGENCIES
  • ANTICIPATING AND PREVENTING UNINTENDED CONSEQUENCES
  • REFERENCES
• 7. Looking Toward the Future
  • MEASURES IN NEED OF DEVELOPMENT AND MORE RESEARCH
  • IMPLICATIONS OF INCLUDING SOCIAL AND BEHAVIORAL INFORMATION IN EHRS TO STAKEHOLDERS
  • CONTINUING REVIEW OF MEASURES
  • COMMITTEE FINDINGS AND RECOMMENDATIONS
  • CONCLUSION
  • REFERENCES
• APPENDIXES
  • A Domains Reviewed But Not Selected for the Candidate Set
  • B Privacy Concerns Related to Inclusion of Social and Behavioral Determinants of Health in Electronic Health Records
  • C Agendas of Public Meetings
  • D Committee Biographies

This study was supported by Contract No. 16019-7, 55 between the National Academy of Sciences and the Association of State and Territorial Health Officials, Contract No. 11796053 between the National Academy of Sciences and the Blue Shield of California Foundation, Contract No. 18012 between the National Academy of Sciences and the California HealthCare Foundation, Contract No. HHSM-500-2013-00236P between the National Academy of Sciences and the Centers for Medicare & Medicaid Services, Contract No. VA701-14-P-0066 between the National Academy of Sciences and the Department of Veterans Affairs, unnumbered contract between the National Academy of Sciences and The Lisa and John Pritzker Family Fund, Contract No. HHSN2632012000741 TO #27 between the National Academy of Sciences and the National Institutes of Health, Contract No. 70657 between the National Academy of Sciences and the Robert Wood Johnson Foundation, and Contract No. HHSP233201300249P between the National Academy of Sciences and the Substance Abuse and Mental Health Services Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2014. Capturing social and behavioral domains and measures in electronic health records: Phase 2. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.