Response to: Pros and cons of pulling behavioral and social data into EHRs [Government Health IT]

Mike Miliard Editor of Healthcare IT News posted an item:

Pros and cons of pulling behavioral and social data into EHRs

To put my reply in context here is the start of Mike's post:

Should more types of health data figure into electronic health records?

On the one hand, the Institute of Medicine put out a call for doing just that on the grounds that behavioral and social data can benefit population health practices to ultimately improve the care of individual patients. For physicians who already complain that EHRs are burdensome and distract from care delivery, on the other hand, the idea of making electronic records more complex, perhaps even cluttered, will inevitably be unwelcome news. ...

Talk about a work in progress? How long does it take to get this right? Of course health and social care data is always ongoing, as governments change, policy, medicine, local government, social care, technology and society too.

As Mike notes for many physicians the EHR is already burdensome. My context is quite different being nursing, mental health, and crisis-oriented in the community. I've defined small research-based datasets in the past and it is a fascinating pursuit. Trying to have the data defined and reporting ready before the 'door opens'. Doing this retrospectively is no fun at all.

At work when I visit someone in a residential care or nursing home, do I record this as 'home', or 'community' in the absence of the aforementioned categories? Is this ageism?

Is there a digital dividend to come to the physician's aid? Surely increasingly the physical measurements and observations in medicine, surgical... can be automatically captured, disseminated and presented accordingly? Surely, it is possible today to bring in other data as the context changes? If we can autofill on words, we should be able to auto-fill the dataset as context shifts? There are many algorithms out there already 'alive and countin-the-clickin'  in the milliseconds.

It seems Mr Miliard is writing about one way to define 'integrated care'?

It isn't just 'public health' though;
it must combine, be inclusive of - 'public mental health'.

The focus of the article is the Institute of Medicine's report:

Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2

Mike lists eight domains from the report and these are mapped to Hodges' model below:

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

educational attainment, stress, depression	physical activity, stress
social isolation, intimate partner violence (for women of reproductive age)	financial resource strain, neighborhood median household income

I've included stress twice as there are at least two forms: anxiety - internal; and environmental - external.