Incorporating More Social and Behavioral Data Into an EHR

You all have seen the stats about how our social and behavioral data is a much bigger predictor of our health and wellness than the 15 minutes of data that’s collected during a doctors visit. When people talk about the out of control costs of US healthcare, they often point to these stats and talk about how we have to focus on factors outside of our current healthcare system if we really want to bend the cost curve.

If in fact we had a true healthcare system that was trying to treat the health of a patient and not the symptoms, then we’d take a much more serious look at the social and behavioral determinants of health. The shift in healthcare is to try and make this a reality and to shift the current reimbursement model to one that pays our healthcare organizations to keep the patient healthy and not just treat their chief complaint.

With this in mind, I was intrigued by this IOM report on Capturing Social and Behavioral Domains and Measures in Electronic Health Records. In the report (there are actually 2 phases of the report) they identify 17 areas that influence a patient’s health and wellness. Then, they narrowed it down to 11 domains to consider incorporating into all EHRs.

You can take a look at the report to find all the details of their findings. However, I found their list of 17 social and behavioral domains that influence your health and wellness absolutely fascinating. Here’s the list:

Sociodemographic Domains

• Sexual orientation
• Race and ethnicity
• Country of origin/U.S. born or non-U.S. born
• Education
• Employment
• Financial resource strain: Food and housing insecurity

Psychological Domains

• Health literacy
• Stress
• Negative mood and affect: Depression and anxiety
• Psychological assets: Conscientiousness, patient engagement/activation, optimism, and self-efficacy

Behavioral Domains

• Dietary patterns
• Physical activity
• Tobacco use and exposure
• Alcohol use

Individual-Level Social Relationships and Living Conditions Domains

• Social connections and social isolation
• Exposure to violence

Neighborhoods and Communities

• Neighborhood and community compositional characteristics

As we start to see EHR vendors move from digital filing cabinets to actually keeping a population healthy, I’m going to be watching how they incorporate all of this social and behavioral health data into the EHR.

I think you could break out every one of these domain areas and create a company around collecting this data which could then be made to be consumable by an EHR vendor. In fact, if you look at the world of healthcare IT startups we already see a lot of companies that are working in these areas. The most obvious is the dietary patterns and physical activity domains. How many hundreds of healthcare IT startup companies are working on quantifying those areas of our lives? A wise entrepreneur might look at this list and find a less obvious area where they could improve people’s health.

My biggest takeaway from this list: Healthcare still has such an amazing opportunity to improve health. We’ve barely just begun to tap into this data.