Electronic Health Records

Adoption & Implementation News

Should Meaningful Use Capture Social, Behavioral Health?

By Kyle Murphy, PhD

IOM wants 12 standard measures social and behavioral domains measures of social and behavioral determinants included in meaningful use requirements.

- The Institute of Medicine (IOM) has identified a dozen standard measures social and behavioral domains ┬ámeasures of social and behavioral determinants for the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) to consider including as meaningful use requirements, according to a new report.

“Substantial empirical evidence of the contribution of social and behavioral factors to functional status and the onset, progression, and effective treatment of disease has accumulated over the past 4 decades. Yet efforts to improve health care, advance population and public health, and develop and apply social and behavioral research remain largely separate from one another,” the authors of the report maintain.

The report addresses the questions IOM tasked the Committee on Recommended Social and Behavioral Domains and Measures for Electronic Health Records with answering as part of a two-phase consensus study:

  • What specific measures under each domain specified in Phase 1 should be included in EHRs? The committee will examine both data elements and mechanisms for data collection.
  • What are the obstacles to adding these measures to the EHR and how can these obstacles be overcome?
  • What are the possibilities for linking EHRs to public health departments, social service agencies, or other relevant non-healthcare organizations? Case studies will be considered of where this has been done and how issues of privacy have been addressed.

The IOM Committee on Recommended Social and Behavioral Domains and Measures for Electronic Health Records has two recommendations for the ONC and CMS comprising 12 social and behavioral domains:

Recommendation 5-1: The Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Medicaid Services should include in the certification and meaningful use regulations the standard measures recommended by this committee for four social and behavioral domains that are already regularly collected: race/ethnicity, tobacco use, alcohol use, and residential address.

Recommendation 5-2: The Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Medicaid Services should include in the certification and Meaningful Use regulations addition of standard measures recommended by this committee for eight social and behavioral domains: educational attainment, financial resource strain, stress, depression, physical activity, social isolation, intimate partner violence (for women of reproductive age), and neighborhood median-household income.

In the first phase of the study, the committee was charged with identifying specific domains and criteria for the ONC to consider as part of Stage 3 Meaningful Use. The task also involved identifying core social and behavioral domains, including those specific to populations or settings defined by age, socioeconomic status, race/ethnicity, disease or other characteristics, to be included in all EHRs.

A prepublication copy of the IOM report is available here.

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