As family physicians face growing pressure to collect data on patients' social determinants of health, a group of researchers suggests there is a simple path: pulling "community vital signs" into electronic health records (EHRs) using only patients' addresses.
In a paper titled "'Community Vital Signs': Incorporating Geocoded Social Determinants Into Electronic Records to Promote Patient and Population Health,"(jamia.oxfordjournals.org) published recently in the Journal of the American Medical Informatics Association, researchers advocate incorporating publically available community-based data directly into patients' EHRs.
Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, was the lead author of the commentary, which is based on ongoing tests with partners at the OCHIN health information network and Oregon Health & Science University in Portland.
The authors note in their paper that social factors, which they call community vital signs, are strong predictors of health. These include a neighborhood's socioeconomic and environmental conditions, population density, and ethnic components, among other factors. Such information is available through the U.S. Census, local government records or other data-collection programs.
- Authors of a recently published paper suggest a simple way to incorporate broad community-based data into electronic health records.
- "Community vital signs" include the socioeconomic and environmental conditions, population density, and ethnic components of patients' neighborhoods.
- The data could help physicians have more informed discussions with patients.
Including such community-level information in health records using only a patient's address -- no patient interviews -- would not require additional staff time and could assist with population health efforts.
The authors refer to use of such data as "context-based care," whereby a physician or other health care professional can offer more informed advice based on a patient's social environment. For instance, Bazemore said, it could help when a physician wants to talk about exercise with a patient whose neighborhood might be unsafe for walking, or it could facilitate a conversation about finding healthy food in an area with a high proportion of fast food restaurants.
One data resource, HealthLandscape,(www.graham-center.org) turns a patient address into a coordinate on a map, allowing information about his or her community to be added to the record. Users can select from 200 of the more than 10,000 variables in the HealthLandscape data.
"By geocoding patient records and joining them with publically available data, as we are demonstrating with our Oregon partners, we see a future where health care is provided in a community context," Bazemore said. "Community vital signs would allow health care professionals to see a patient knowing not just her blood pressure, pulse, respiratory rate and temperature, but also whether she lives in the presence of poverty, healthy food and water sources, walkable streets and parks, and has social capital -- or how these add up to predict increased risk of morbidity, early mortality, or other adverse health outcomes."
"The technology and data sources are already available, and we hope to contribute to building an evidence base on the effective use of such information to change patient and community health outcomes," he added.
Community data are being integrated into EHRs as part of a pilot project at several federally qualified health centers, say the authors.
In a 2014 report, the Institute of Medicine (now the National Academy of Medicine) recommended incorporating 11 social and behavioral factors into EHRs. Rather than manually entering recommended factors such as stress, depression and financial resources, the researchers propose using broader population health data that already exist.
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