IOM argues for including social, behavioral data in EHRs

Amassing electronic health-record information on patients' social influences and behavioral habits can help improve their health status, argues a new report from the Institute of Medicine.

The IOM has developed six criteria that can be used to determine whether information on a patient's social and behavioral determinants should be gathered and kept in their EHR. The guidelines are in the first of two reports on the topic.

“Unfortunately, such information is currently captured insufficiently, or not at all, in most electronic health records,” the report stated. “The inclusion of social and behavioral determinants of health data in EHRs will provide useful information to health care providers and patients, helping to provide the most appropriate strategies toward improving the health status of Americans.”

The criteria are: the strength of evidence that the information is associated with health; the usefulness of the information, measured for the individual, population, and research; whether the information can be standardized and represented in a reliable and valid manner; whether it can be feasibly provided by patients and collected by providers, taking into consideration time, technology and cost; the sensitivity of the information; and whether the data are accessible from another source.

In its initial report, the IOM used the first two criteria—strength and usefulness of evidence—to identify “17 domains that are best suited for consideration for inclusion in all EHRs,” according to a brief about the full report (PDF).

The domains include: sociodemographic information, such as race and ethnicity; psychological status, including stress levels, depression, anxiety or other negative mood forms; behavioral information, such as physical activity and tobacco or alcohol use; social relationships and living conditions, such as whether the individual is exposed to violence; and information about individuals' neighborhoods or communities, based on geocodable data on socioeconomics, race or other ethnic characteristics.

The second IOM report will apply all six criteria to create a second list of recommended domains.

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