Capturing Social and Behavioral Domains and Measures in Electronic Health Records Phase 2 (2014) / Chapter Skim
Currently Skimming:
6 Implementation Issues
6 Implementation Issues
Pages 237-254
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 237... ...
Responsibility for addressing social and behavioral determinants of health that surface as problematic in the EHR generally fall outside of the traditional health care system. However, to the degree that addressing these determinants reduces near-term health care utilization, such as hospital readmissions, as well as improves health and reduces future health care service utilization, the investment of time and resources will be well worth it.
|
From page 238... ...
. Programs exist, such as the federally funded regional extension center program, to provide clinical teams with assistance in purchasing and implementing EHRs, training staff, and addressing how teams use EHRs in practice (Hsiao and Hing, 2012; Hsiao et al., 2014)
|
From page 239... ...
. COLLECTING SOCIAL AND BEHAVIORAL DATA TO INCLUDE IN EHRS Data for EHRs can potentially be collected in many ways.
|
From page 240... ...
Interviews during clinical encounters afford a measure of professional oversight but also add time and complexity to the encounter. The clinical team needs to decide whether the questions are best asked by the administrative staff, physician, nurse practitioner, physician's assistant, or another health professional.
|
From page 241... ...
With the addition of each clinic, a tailored integration was developed to meet that clinic's needs particularly related to clinic flow and provider feedback and differences in electronic health records. As part of CNICS, HIV-infected pa tients across the United States have completed the assessment approximately 34,000 times providing a wealth of clinically relevant data to improve clinical care, and population health, and to facilitate clinical research (Crane, 2014)
|
From page 242... ...
The clinical team needs to consider the time during the course of an encounter that is most appropriate to collect or review the information. Some clinics start patient appointments 20 to 30 minutes in advance of the physician encounter to provide enough time for completion of self-reported data before the physician visit begins.
|
From page 243... ...
Elements of the EHR that document patient history and progress notes may be unstructured narrative or structured as text insertions into structured forms or numeric data. While rich narrative may be the best way to tell parts of the patient story or a clinician's assessment of medical information and its meaning, structured data and standardized measurement are needed to enhance retrieval, analysis, and interoperability to support clinical care, population management, and clinical research (Fridsma, 2013)
|
From page 244... ...
Appendix B provides a more robust description of privacy protection issues. As described earlier, select elements for some determinants of health may be found in other sources related to the patient, such as EHRs from other institutions; personal health records, third-party data integrators, such health risk appraisals gathered by insurers or employers or clinical data registries, community agency datasets, national surveys, and datasets from other sectors like retail.
|
From page 245... ...
PRIVACY PROTECTION ISSUES Risks to the patient in some sensitive areas such as substance use or violence represent considerable challenges to collecting data. A recent pilot project examining interstate behavioral health data exchange demonstrated that some privacy concerns need to be addressed to facilitate exchange of sensitive behavioral data nationwide (Parker et al., 2014)
|
From page 246... ...
With the above protections in place, routine collection of these types of potentially sensitive data may not only provide important information for diagnoses and treatment but may have the additional benefit of normalizing or destigmatizing discussion of sensitive issues in clinical practice. RESOURCE CONSIDERATIONS The business model for capturing social and behavioral domains and measures into the EHR has yet to be fully realized because few examples exist.
|
From page 247... ...
Clinical team • Who should ask each of the Mitigation involves adaptation of questions? workflow and clinical strategies, • What is the best way to state including the question?
|
From page 248... ...
LINKING DATA FROM EHRS TO PUBLIC HEALTH DEPARTMENTS AND COMMUNITY AGENCIES Linking data from EHRs to local public health departments and community agencies provides several advantages to patients, providers, and the broader community. Information can flow in both directions.
|
From page 249... ...
As mentioned in earlier chapters, public health agencies can use geocodable data to create neighborhood and community health information maps that overlay information on health outcomes (e.g., obesity, diabetes, cardiovascular disease) with neighborhood characteristics (e.g., walkability, food index scores, poverty level)
|
From page 250... ...
They might feel that their doctor has compromised the confidentiality of their health record if they receive a call from the health department asking them about their history of a contagious disease, such as a specific food-borne illness. These risks can be mitigated by ensuring that patients are notified about shared data and the roles that health departments play in safeguarding community health.
|
From page 251... ...
2014. Comments from Heidi Crane from the Madison HIV Metabolic Clinic on HIV clinical care, assessment, and electronic health records to the IOM Committee on Recommended Social and Behavioral Domains and Measures for Electronic Health Re cords.
|
From page 252... ...
2012. Harmonized patient-reported data elements in the electronic health record: Supporting meaningful use by primary care action on health behaviors and key psychosocial factors.
|
From page 253... ...
2014. Electronic health records: Design, implementation, and policy for higher-value primary careers for higher-value primary care.
|
From page 254... ...
Presentation by Health Leads to the Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records. Washington, DC: Institute of Medicine.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.