IOM committee recommends social, behavioral measures for MU Stage 3

The Institute of Medicine Committee on Social and Behavioral Domains and Measures for EHRs formally presented recommendations to the Health IT Policy Committee (HITPC) calling for the inclusion of certain standard measures for social and behavioral domains in federal certification and incentive programs.

“The committee included recommended measures that will enable more effective treatment for individual patients, identifying depression and inadequate physical activity and diabetes, more effective population management and enhanced opportunities for research to support new treatments and intervention,” said William W. Stead, MD, chief strategy officer and associate vice president at Vanderbilt University, at the meeting.

Stead, who led the committee with George Hripcsak, MD, MS, chair of the department of biomedical informatics at Columbia University, said the committee analyzed a number of frameworks that looked at downstream and upstream determinants of health.

These models distinguish between characteristics that influence health that reside at five levels: socio-demographic; psychological; behavioral; social relationships and living conditions; and physical and social environment.

The committee utilized the following criteria to identify candidate domains: strength (on an individual, population health and research levels); usefulness; reliable and valid measures; sensitivity; feasibility; and accessibility. They shared with the HITPC the following recommendations:

• ONC and the Centers for Medicare & Medicaid Services (CMS) should include in the certification and MU requirements the standard measures recommended by this committee for four social and behavioral domains that are already regularly collected: race/ethnicity, tobacco use, alcohol use and residential address.
• ONC and CMS should include in the certification and MU regulations the addition of standard measures for eight social and behavioral domains: educational attainment, finance resource strain, stress, depression, physician activity, social isolation, intimate partner violence for women of reproductive age and neighborhood median-household income.
• The ONC’s EHR certification process should be expanded to include appraisal of a vendor or product’s ability to acquire, store, transmit and download self-reported data germane to the social and behavioral determinants of health.
• The Office of the Director of the National Institutes of health should develop a plan for advancing research using social and behavioral determinants of health collected in EHRs.
• The Secretary of Health & Human Services should convene a task force within three years to review advances in the measurement of social and behavioral determinants of health.

The recommendations will be considered by ONC. Read the official IOM report.