Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Social, Behavioral Data Must Be Included in EHRs, Nurses Say

By Jennifer Bresnick

- Electronic health records are incomplete and potentially insufficient for use in population health management programs when they are missing social and behavioral data, states the American Academy of Nursing in a new policy brief and call to action. 

Population health management and electronic health records

Without collecting data on patient behaviors and the impacts of socioeconomic circumstances on clinical health, providers are operating with an incomplete picture of the challenges patients face outside of the organization’s purview.

Primary care providers, including those operating under patient-centered medical home (PCMH) or accountable care organization (ACO) models, have struggled to build health information exchange connections with behavioral health providers and social service organizations. 

Despite the widespread recognition that socioeconomic and mental health data are important for population health management, several significant systemic barriers have prevented EHRs from becoming the comprehensive tools necessary for true population health management.

Largely ineligible for the EHR Incentive Programs and somewhat ignored by mainstream primary care health IT developers, behavioral health providers have been slower to adopt EHR technology that might facilitate health information exchange.  While pending legislation may expand meaningful use eligibility to psychologists and inpatient psychiatric hospitals, the majority of behavioral health facilities remain isolated from the primary care ecosystem. 

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Even ACOs that put a premium on HIE and EHR interoperability rarely integrate behavioral health data into the patient record: a recent survey found that less than half of ACOs have access to behavioral health records from their community partners.

This situation is unacceptable for healthcare providers who hope to take a holistic approach to patient management, the American Academy of Nursing says.  “There is strong evidence that social and behavioral factors influence health; however, they may not be addressed in clinical care for shared decision-making,” said American Academy of Nursing CEO Cheryl Sullivan.

“It is imperative that all stakeholders in health care collaborate to include this information in electronic records, including EHR vendors, health systems, providers, and funders.”

The Academy calls on the healthcare industry to enact the Institute of Medicine’s 2014 recommendations for integrating behavioral and social data into the electronic health record, urging stakeholders to recognize that “timing for action is now.”

“Clinical care currently accounts for only 20 percent of health outcomes,” the issue brief notes. “To improve care and population health outcomes, healthcare providers must address other factors, including social determinants of health. To do this, we must first focus on addressing the variability in capturing and documenting social determinants in order to use this health data to benefit patients.”

The Academy identifies three major roadblocks that have thus far prevented the healthcare industry from focusing sufficiently on adding behavioral and social health determinates to electronic health records.

A “lack of commitment to standardization of clinical practice, documentation, and data” has prevented the healthcare industry from making progress towards achieving the goals of healthcare reform.  “An overarching barrier is the reliance on technology platforms at the expense of practice platform to achieve the Triple Aim of improving the patient experience of care, improving the health of populations and reducing the capita of cost of health care.  Not understanding the necessity of balancing the technology-practice platform polarity is a major barrier to appreciating and adopting standardization of practice standards and data,” the brief says.

Poor EHR usability and inconsistent workflows are also problematic, giving rise to patient safety hazards, gaps in care coordination, and other fundamental deficiencies.  “Patient and clinician safety depends on the sound design of health IT including usability, interoperability and assuring the appropriate balance of standardization and customization,” the report states.  “Poor ease of use and customization can prevent the development of a widespread solution such as a national standard to capture social and behavioral determinants of health in EHRs.”

Lastly, there is a need for increased patient engagement, empowerment, and trust, the Academy says.  “Respectful engagement” with patients is key to crafting patient privacy policies that foster an environment of trust around sensitive behavioral health data while allowing clinicians to access the information they need for informed decision making. 

The Academy urges EHR vendors, health systems, and clinicians to collaborate on developing standards that will enable providers to collect behavioral and social determinates of health that can be readily integrated into EHR workflows. 

Stakeholders must work together to create connections between social and behavioral healthcare organizations and the primary care ecosystem in order to develop a richer portrait of patient challenges and needs. 

By implementing an industry-wide effort to better integrate socioeconomic and behavioral health data into EHR technologies, stakeholders “will begin to address the global changes that must be made in clinical practice to assure EHRs capture and permit sharing of contextual patient information, promote shared decision-making, enhance appropriate inter-professional planning/providing of health care services and facilitate monitoring of patterns of health and outcomes of care for entire populations,” the brief concludes.


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