How “Psychosocial Vital Signs” in Electronic Medical Records Can Improve Medical Care and Public Health

A health checkup involves some standard measures of physical health that any patient can find familiar: Height, weight, blood pressure, and so on. And medical professionals routinely ask about some behavioral measures such as alcohol and tobacco use. Medical and public health experts know there are many more social and behavioral aspects of people’s lives that have a direct impact on how healthy they are, and that taking those details into account can yield better diagnoses and treatments for individuals. If that information can be aggregated and collected at a population scale, it can also guide development of better-designed health care systems and improved population-wide health outcomes.

However, there is currently no standard agreement on which behavioral and social information medical professionals should collect from patients, and no systemic use of these measures in the U.S. health care system.

Today, a committee convened by the Institute of Medicine of the National Academies (IOM), released a set of recommendations of 12 social and behavioral measures that should be collected as part of patients’ electronic health records. Ana Diez Roux, MD, PhD, MPH, dean of the Drexel University School of Public Health, served on the IOM committee which developed the recommendations for these “psychosocial vital signs.” The committee made its selections based on criteria including the strength of the evidence that a given domain is associated with health; the usefulness of measuring the domain for research and for individual and population health; and the availability of standard and valid ways of measuring the domain, among other factors.

The domains and measures the IOM committee recommends collecting as part of electronic health records are:

• Alcohol use
• Race and ethnicity
• Residential address
• Tobacco use & exposure
• Census tract-median income
• Depression
• Education
• Financial resource strain
• Intimate partner violence
• Physical activity
• Social connections & social isolation
• Stress

The committee also weighed practical considerations of the changes in clinical practice required to collect these measures.

“The inclusion of social and behavioral data routinely into electronic health records can lead to real transformations in the ways in which doctors use information to diagnose and treat patients, and is also of enormous value for understanding the health of populations and what we can do to improve health for all,” said Diez Roux. When health data systems are designed to collect information about social factors including financial challenges and social isolation, not only are physicians better informed about the underlying determinants of their patients’ health, but data in aggregate can be de-identified and used by city and regional public health departments to better understand their populations’ broader needs.