Capturing Social and Behavioral Domains in Electronic Health Records


Social and behavioral determinants of health have historically been the purview of public health, which is focused on the well-being of populations. Health care delivery systems, in contrast, have focused primarily on the treatment of disease in individual patients, largely ignoring most social determinants of health.

Increasingly, however, providers are finding that patients have better health outcomes when information about social and behavioral barriers is known and used to inform treatment approaches. Electronic health records (EHRs) are one means of collecting and communicating this information at the point of care.

Expanding the traditional information collected in EHRs to include social and behavioral determinants is timely, given new incentives that focus on the “meaningful use” of EHRs, but it is no less difficult. With support from CHCF and other funders, the Institute of Medicine (IOM) has begun to identify domains and measures that should be included in EHRs in the future.

In the Phase 1 report (April 2014), the IOM specifies criteria that should be used to decide which domains will be required in the third stage of the meaningful use incentive program. The report also nominates a specific set of social and behavioral domains that should be considered for inclusion in all EHRs, as well as a set that should be considered for specific populations or settings defined by age, socioeconomic status, or other characteristics.

In the Phase 2 report (November 2014), the IOM focuses on 12 measures related to the candidate domains introduced in the Phase 1 report, and considers the implications of incorporating them into all EHRs.

The Phase 1 and 2 reports are available on the IOM website through the External Links below.