A new Institute of Medicine report outlining how measures of a patient's social and behavioral condition should be added to electronic health record system requirements is a necessary step in transforming how care is delivered.
In order to adopt the principles of population health management, care providers need to know things such as whether a patient is socially isolated or a past victim of intimate partner violence.
The IOM report, called "Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2," is designed in large part to give CMS guidance on how to potentially include such measures in meaningful use Stage 3 requirements.
"Taken together, we think the benefits of including the recommended measures in all EHRs will enable far more effective treatment of individuals," as well as more effective management of population health, said Nancy Adler, co-chair of the IOM committee that produced the report, speaking during a webinar on the topic. Adler, who also is a professor of psychiatry and pediatrics, and director of the Center for Health and Community at the University of California, San Francisco, said another benefit of collecting the data would be for use in research.
The IOM settled on 12 measures for inclusion in meaningful use requirements, four of which are already widely tracked: alcohol use, home address, race/ethnicity and tobacco use. The IOM also recommends that MU require information to be collected on depression, education, exercise, exposure to violence for women of reproductive age, financial strain, neighborhood median income, social isolation and stress.
"I think it is a great idea," said Linda Reed, R.N., vice president of behavioral health and integrative medicine and CIO, Atlantic Health, in an emailed comment. Atlantic Health has emphasized to its primary care physicians that behavioral health assessment tools should be used with patients that have significant issues.
"Depression screening is a no-brainer, as we now know how prevalent depression is and the impact it can have on all aspects of health," Reed said.
Despite all the work that went into the report's conclusions, the difficult part will be getting already overburdened physicians and other providers to actually collect the information and take action based on the patient's needs.
"Just including these fields in the EMR does not mean physicians will ask the questions or understand the answers," Reed said. Many are uncomfortable asking questions on the subject because they are unsure how to treat them, or unequipped to do so given the resources needed to treat the patient.
"Having this information as part of the patient assessment is important, but so is having the resources and ability to take action," Reed said.