An Institutes of Medicine (IOM) committee has issued new recommendations that electronic health records (EHRs) should include social and behavioral data on patients in addition to medical data. However, the IOM does not address the potential patients sensitivities and security issues in including this data.

Basing its finding on multiple studies documenting the impact of social and behavioral factors on overall health and disease progression, the IOM committee selected 17 initial information domains that it then plans to narrow down to a smaller list by its Phase 2 report. Some of this information is already required by meaningful use-certified EHR systems, such as smoking status. However, many are new and could potentially represent personal information patients would consider even more private than their medical information. Examples include:

• Sexual orientation
• Financial resource strain, such as food and housing insecurity
• Exposure to violence, including past violence like childhood abuse and neglect
• Education and health literacy
• Socioeconomic and race/ethnic characteristics of the neighborhood/community where the patient lives

Research strongly supports the IOM report authors’ view that allowing doctors to consider this information alongside traditional medical and health data like lab results and physical exam notes is important and could greatly improve care and outcomes. Indeed the IOM report authors go as far as recommending that these social and behavioral information domains be included in stage 3 meaningful use criteria for EHRs.

However, EHRs can be compromised through both internal and external security breaches and inclusion of this potentially very private information could increase the exposure risks of patients and the liability providers might face for failing to keep this information private.

In addition, EHRs that allow patients to view most or all of the same information their physicians see are growing in popularity, and it is uncertain how patients would react to seeing information in the record that says they are uneducated or live in a “bad” neighborhood.

The full IOM report — “Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1” — is available free online.