The American Academy of Nursing (AAN) stated in a recent policy brief that social and behavioral health data needs to be included in electronic health records (EHR) to improve patient care and population health outcomes.
The AAN policy brief urges collective action from multiple stakeholders, including EHR vendors, health systems and clinicians, to collaborate on developing standards for capturing social and behavioral determinants of health (SBDH) and then integrating that data into the EHR.
“Clinical care currently accounts for only 20 percent of health outcomes,” the policy brief states. “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.”
In a 2014 report, the Institute of Medicine (IOM) made similar recommendations and the AAN calls on the healthcare industry to follow the IOM’s 2014 recommendations for integrating behavioral and social data into the EHR. The IOM’s Phase 2 recommendation calls for implementation of a standardized assessment panel of approximately 20 questions addressing issuess such as alcohol use, physicial activity, stress and depression, that could be incorporated into the EHR.
“Despite strong evidence that social and behavioral factors influence health, they have not been consistently addressed in clinical care,” the AAN states in the policy brief.
The AAN specifically calls on EHR vendors to provide mechanisms for documenting IOM recommended social and behavioral health data and calls on clinicians to take a stand on adopting SBDH common assessement standards.
Behavioral health providers, including psychatric hospitals, have been much slower to adopt EHR technology and are currently ineligible for the Medicare and Medicaid EHR Incentive Programs. With the aim of better integrating behavioral health and primary care, proposed legislation, the Helping Families in Mental Health Crisis Act of 2015 (HR 2646), expands meaningful use elgibilty to mental health providers. The bill includes several provisions related to the adoption of health data exchange and health information technology.
In the policy brief, the AAN identified several barriers that have prevented the healthcare industry from incorporating social and behavioral health data into EHRs, including a “lack of commitment to standardization of clinical practice, documentation and data.”
Poor EHR usability also has been an issue. “Usability and clinical application design of EHR technology has long been a concern for nureses at the point of care which calls for more clinician engagement and research into the designs of systems,” the report states.
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