Collection of Social and Behavioral Patient Measures Recommended

The inclusion of 12 measures on the social and behavioral aspects of a patient’s life has been recommended by the Institutes of Medicine (IOM) for inclusion in the Stage 3 meaningful use regulations to be implemented in 2017. The inclusion of these measures in the patient electronic health record (EHR) will allow clinicians to recommend that patients use social and behavioral treatments, such as counseling, smoking cessation programs, or participation in social service programs that will improve the overall health of the patient. The report, Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2, was prepared at the request of several private organizations and government agencies.


The IOM recommends that measures of a patient’s: (1) educational attainment; (2) financial resource strain; (3) stress; (4) depression; (5) physical activity; (6) social isolation; (7) neighborhood median household income; (8) intimate partner violence for women of reproductive age; (9) race and ethnicity; (10) tobacco use; (11) alcohol use; and (12) residential address be included by the Office of the National coordinator of Health and CMS in the Stage 3 meaningful use regulations. The IOM stated that measures of these social and behavioral aspects of a patient already exist and are already being collected by a number of clinicians.

The IOM noted that a majority of this data is self-reported and currently collected by clinicians and as such the inclusion of these measures in the EHR should not add any additional time to a clinician’s encounter with a patient. In addition not all of this data needs to be collected at each patient visit. Some of it does not change over time and it should be sufficient that it is simply contained in the patient’s EHR. Data that describes other measures which change from time-to-time would need to be updated in the patient’s EHR.

Use of Data

The IOM panel noted a concern with the ability to use the data to improve patient outcomes. One issue is that these measures are collected using a variety of different tools and questions. The IOM noted that the adoption of single standardized collection tool would go a long way in making this data more useable to improve health outcomes. The IOM recommended that vendor’s software should be appraised and harmonized to collect this data in a standard manner.

The IOM recommended that the data being collected from these measures be linked to data contained by public health agencies as a means of improving health outcomes. Data in EHR can be used to identify individuals who have come into contact with environmental pollutants, or data can be used to help people find food who may not have the income or resources to obtain sufficient nutrition. Finally this data could be used by public health agencies to assist individual’s enrollment in alcohol and substance abuse treatment programs. The IOM was aware of privacy issues that may arise from these recommended usages of this data and noted that patients should be informed on how the data was going to be used, including any data sharing with public health and welfare agencies.

Additional Measures

The IOM chose these measures because they have the greatest impact on improving health and they are the easiest to implement at this time. The report cautioned that there are a number of other social and behavioral measures that are close to meeting the requirements that would be easy to implement and the use of which would improve a person’s health. In addition the IOM noted that different measures may be more useful at different times. To facilitate this ongoing development and usefulness of social and behavioral measures the IOM recommended that the HHS secretary should convene a task force to review advancements in the measurement of social and behavioral determinants of health and make recommendations for new standards and data elements to be included in medical records.