Substantial empirical evidence of the contribution of social and behavioral factors to functional status and the onset and progression of disease has accumulated over the past few decades. Traditionally, research and interventions on social and behavioral determinants of health have largely been the purview of public health which has focused on disease prevention and maintenance of the public’s health. Health care systems, in contrast, have focused primarily on the treatment of disease in individual patients, and, until recently, social determinants of health have not been linked to clinical practice or health care delivery systems. Electronic health records (EHRs) provide crucial information to providers treating individual patients, to health systems about the health of populations, and to researchers about the determinants of health and the effectiveness of treatments. The Health Information Technology for Economic and Clinical Health Act and the Patient Protection and Affordable Care Act place new importance on the widespread adoption and meaningful use of EHRs.
The IOM was asked to form a committee to identify domains and measures that capture the social determinants of health to inform the development of recommendations for meaningful use of EHRs. In its Phase 1 report, the committee identifies the social and behavioral domains that are the best candidates to be considered in all EHRs; specifies criteria that should be used in deciding which domains should be included; and identifies any domains that should be included for specific populations or settings defined by age, socioeconomic status, race/ethnicity, disease, or other characteristics.
Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1, released on April 8, 2014, has been updated with editorial and content changes. Substantive content changes are now footnoted in the revised report. Additionally, an updated version of the first three chapters of the report are included in Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2, which was released on November 13, 2014. The Phase 2 report is the committee’s final report and identifies a parsimonious panel of domains and measures that is comprehensive, interoperable, and efficient, which the committee recommends for inclusion in all electronic health records.