Assessing the Availability of Data on Social and Behavioral Determinants in Structured and Unstructured Electronic Health Records: A Retrospective Analysis of a Multilevel Health Care System
Most US health care providers have adopted electronic health records (EHRs) that facilitate the uniform collection of clinical information. However, standardized data formats to capture social and behavioral determinants of health (SBDH) in structured EHR fields are still evolving and not adopted wi...
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| Vydáno v: | JMIR medical informatics Ročník 7; číslo 3; s. e13802 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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JMIR Publications
02.08.2019
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| ISSN: | 2291-9694, 2291-9694 |
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| Abstract | Most US health care providers have adopted electronic health records (EHRs) that facilitate the uniform collection of clinical information. However, standardized data formats to capture social and behavioral determinants of health (SBDH) in structured EHR fields are still evolving and not adopted widely. Consequently, at the point of care, SBDH data are often documented within unstructured EHR fields that require time-consuming and subjective methods to retrieve. Meanwhile, collecting SBDH data using traditional surveys on a large sample of patients is infeasible for health care providers attempting to rapidly incorporate SBDH data in their population health management efforts. A potential approach to facilitate targeted SBDH data collection is applying information extraction methods to EHR data to prescreen the population for identification of immediate social needs.
Our aim was to examine the availability and characteristics of SBDH data captured in the EHR of a multilevel academic health care system that provides both inpatient and outpatient care to patients with varying SBDH across Maryland.
We measured the availability of selected patient-level SBDH in both structured and unstructured EHR data. We assessed various SBDH including demographics, preferred language, alcohol use, smoking status, social connection and/or isolation, housing issues, financial resource strains, and availability of a home address. EHR's structured data were represented by information collected between January 2003 and June 2018 from 5,401,324 patients. EHR's unstructured data represented information captured for 1,188,202 patients between July 2016 and May 2018 (a shorter time frame because of limited availability of consistent unstructured data). We used text-mining techniques to extract a subset of SBDH factors from EHR's unstructured data.
We identified a valid address or zip code for 5.2 million (95.00%) of approximately 5.4 million patients. Ethnicity was captured for 2.7 million (50.00%), whereas race was documented for 4.9 million (90.00%) and a preferred language for 2.7 million (49.00%) patients. Information regarding alcohol use and smoking status was coded for 490,348 (9.08%) and 1,728,749 (32.01%) patients, respectively. Using the International Classification of Diseases-10th Revision diagnoses codes, we identified 35,171 (0.65%) patients with information related to social connection/isolation, 10,433 (0.19%) patients with housing issues, and 3543 (0.07%) patients with income/financial resource strain. Of approximately 1.2 million unique patients with unstructured data, 30,893 (2.60%) had at least one clinical note containing phrases referring to social connection/isolation, 35,646 (3.00%) included housing issues, and 11,882 (1.00%) had mentions of financial resource strain.
Apart from demographics, SBDH data are not regularly collected for patients. Health care providers should assess the availability and characteristics of SBDH data in EHRs. Evaluating the quality of SBDH data can potentially enable health care providers to modify underlying workflows to improve the documentation, collection, and extraction of SBDH data from EHRs. |
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| AbstractList | Background: Most US health care providers have adopted electronic health records (EHRs) that facilitate the uniform collection of clinical information. However, standardized data formats to capture social and behavioral determinants of health (SBDH) in structured EHR fields are still evolving and not adopted widely. Consequently, at the point of care, SBDH data are often documented within unstructured EHR fields that require time-consuming and subjective methods to retrieve. Meanwhile, collecting SBDH data using traditional surveys on a large sample of patients is infeasible for health care providers attempting to rapidly incorporate SBDH data in their population health management efforts. A potential approach to facilitate targeted SBDH data collection is applying information extraction methods to EHR data to prescreen the population for identification of immediate social needs. Objective: Our aim was to examine the availability and characteristics of SBDH data captured in the EHR of a multilevel academic health care system that provides both inpatient and outpatient care to patients with varying SBDH across Maryland. Methods: We measured the availability of selected patient-level SBDH in both structured and unstructured EHR data. We assessed various SBDH including demographics, preferred language, alcohol use, smoking status, social connection and/or isolation, housing issues, financial resource strains, and availability of a home address. EHR’s structured data were represented by information collected between January 2003 and June 2018 from 5,401,324 patients. EHR’s unstructured data represented information captured for 1,188,202 patients between July 2016 and May 2018 (a shorter time frame because of limited availability of consistent unstructured data). We used text-mining techniques to extract a subset of SBDH factors from EHR’s unstructured data. Results: We identified a valid address or zip code for 5.2 million (95.00%) of approximately 5.4 million patients. Ethnicity was captured for 2.7 million (50.00%), whereas race was documented for 4.9 million (90.00%) and a preferred language for 2.7 million (49.00%) patients. Information regarding alcohol use and smoking status was coded for 490,348 (9.08%) and 1,728,749 (32.01%) patients, respectively. Using the International Classification of Diseases–10th Revision diagnoses codes, we identified 35,171 (0.65%) patients with information related to social connection/isolation, 10,433 (0.19%) patients with housing issues, and 3543 (0.07%) patients with income/financial resource strain. Of approximately 1.2 million unique patients with unstructured data, 30,893 (2.60%) had at least one clinical note containing phrases referring to social connection/isolation, 35,646 (3.00%) included housing issues, and 11,882 (1.00%) had mentions of financial resource strain. Conclusions: Apart from demographics, SBDH data are not regularly collected for patients. Health care providers should assess the availability and characteristics of SBDH data in EHRs. Evaluating the quality of SBDH data can potentially enable health care providers to modify underlying workflows to improve the documentation, collection, and extraction of SBDH data from EHRs. Most US health care providers have adopted electronic health records (EHRs) that facilitate the uniform collection of clinical information. However, standardized data formats to capture social and behavioral determinants of health (SBDH) in structured EHR fields are still evolving and not adopted widely. Consequently, at the point of care, SBDH data are often documented within unstructured EHR fields that require time-consuming and subjective methods to retrieve. Meanwhile, collecting SBDH data using traditional surveys on a large sample of patients is infeasible for health care providers attempting to rapidly incorporate SBDH data in their population health management efforts. A potential approach to facilitate targeted SBDH data collection is applying information extraction methods to EHR data to prescreen the population for identification of immediate social needs. Our aim was to examine the availability and characteristics of SBDH data captured in the EHR of a multilevel academic health care system that provides both inpatient and outpatient care to patients with varying SBDH across Maryland. We measured the availability of selected patient-level SBDH in both structured and unstructured EHR data. We assessed various SBDH including demographics, preferred language, alcohol use, smoking status, social connection and/or isolation, housing issues, financial resource strains, and availability of a home address. EHR's structured data were represented by information collected between January 2003 and June 2018 from 5,401,324 patients. EHR's unstructured data represented information captured for 1,188,202 patients between July 2016 and May 2018 (a shorter time frame because of limited availability of consistent unstructured data). We used text-mining techniques to extract a subset of SBDH factors from EHR's unstructured data. We identified a valid address or zip code for 5.2 million (95.00%) of approximately 5.4 million patients. Ethnicity was captured for 2.7 million (50.00%), whereas race was documented for 4.9 million (90.00%) and a preferred language for 2.7 million (49.00%) patients. Information regarding alcohol use and smoking status was coded for 490,348 (9.08%) and 1,728,749 (32.01%) patients, respectively. Using the International Classification of Diseases-10th Revision diagnoses codes, we identified 35,171 (0.65%) patients with information related to social connection/isolation, 10,433 (0.19%) patients with housing issues, and 3543 (0.07%) patients with income/financial resource strain. Of approximately 1.2 million unique patients with unstructured data, 30,893 (2.60%) had at least one clinical note containing phrases referring to social connection/isolation, 35,646 (3.00%) included housing issues, and 11,882 (1.00%) had mentions of financial resource strain. Apart from demographics, SBDH data are not regularly collected for patients. Health care providers should assess the availability and characteristics of SBDH data in EHRs. Evaluating the quality of SBDH data can potentially enable health care providers to modify underlying workflows to improve the documentation, collection, and extraction of SBDH data from EHRs. Most US health care providers have adopted electronic health records (EHRs) that facilitate the uniform collection of clinical information. However, standardized data formats to capture social and behavioral determinants of health (SBDH) in structured EHR fields are still evolving and not adopted widely. Consequently, at the point of care, SBDH data are often documented within unstructured EHR fields that require time-consuming and subjective methods to retrieve. Meanwhile, collecting SBDH data using traditional surveys on a large sample of patients is infeasible for health care providers attempting to rapidly incorporate SBDH data in their population health management efforts. A potential approach to facilitate targeted SBDH data collection is applying information extraction methods to EHR data to prescreen the population for identification of immediate social needs.BACKGROUNDMost US health care providers have adopted electronic health records (EHRs) that facilitate the uniform collection of clinical information. However, standardized data formats to capture social and behavioral determinants of health (SBDH) in structured EHR fields are still evolving and not adopted widely. Consequently, at the point of care, SBDH data are often documented within unstructured EHR fields that require time-consuming and subjective methods to retrieve. Meanwhile, collecting SBDH data using traditional surveys on a large sample of patients is infeasible for health care providers attempting to rapidly incorporate SBDH data in their population health management efforts. A potential approach to facilitate targeted SBDH data collection is applying information extraction methods to EHR data to prescreen the population for identification of immediate social needs.Our aim was to examine the availability and characteristics of SBDH data captured in the EHR of a multilevel academic health care system that provides both inpatient and outpatient care to patients with varying SBDH across Maryland.OBJECTIVEOur aim was to examine the availability and characteristics of SBDH data captured in the EHR of a multilevel academic health care system that provides both inpatient and outpatient care to patients with varying SBDH across Maryland.We measured the availability of selected patient-level SBDH in both structured and unstructured EHR data. We assessed various SBDH including demographics, preferred language, alcohol use, smoking status, social connection and/or isolation, housing issues, financial resource strains, and availability of a home address. EHR's structured data were represented by information collected between January 2003 and June 2018 from 5,401,324 patients. EHR's unstructured data represented information captured for 1,188,202 patients between July 2016 and May 2018 (a shorter time frame because of limited availability of consistent unstructured data). We used text-mining techniques to extract a subset of SBDH factors from EHR's unstructured data.METHODSWe measured the availability of selected patient-level SBDH in both structured and unstructured EHR data. We assessed various SBDH including demographics, preferred language, alcohol use, smoking status, social connection and/or isolation, housing issues, financial resource strains, and availability of a home address. EHR's structured data were represented by information collected between January 2003 and June 2018 from 5,401,324 patients. EHR's unstructured data represented information captured for 1,188,202 patients between July 2016 and May 2018 (a shorter time frame because of limited availability of consistent unstructured data). We used text-mining techniques to extract a subset of SBDH factors from EHR's unstructured data.We identified a valid address or zip code for 5.2 million (95.00%) of approximately 5.4 million patients. Ethnicity was captured for 2.7 million (50.00%), whereas race was documented for 4.9 million (90.00%) and a preferred language for 2.7 million (49.00%) patients. Information regarding alcohol use and smoking status was coded for 490,348 (9.08%) and 1,728,749 (32.01%) patients, respectively. Using the International Classification of Diseases-10th Revision diagnoses codes, we identified 35,171 (0.65%) patients with information related to social connection/isolation, 10,433 (0.19%) patients with housing issues, and 3543 (0.07%) patients with income/financial resource strain. Of approximately 1.2 million unique patients with unstructured data, 30,893 (2.60%) had at least one clinical note containing phrases referring to social connection/isolation, 35,646 (3.00%) included housing issues, and 11,882 (1.00%) had mentions of financial resource strain.RESULTSWe identified a valid address or zip code for 5.2 million (95.00%) of approximately 5.4 million patients. Ethnicity was captured for 2.7 million (50.00%), whereas race was documented for 4.9 million (90.00%) and a preferred language for 2.7 million (49.00%) patients. Information regarding alcohol use and smoking status was coded for 490,348 (9.08%) and 1,728,749 (32.01%) patients, respectively. Using the International Classification of Diseases-10th Revision diagnoses codes, we identified 35,171 (0.65%) patients with information related to social connection/isolation, 10,433 (0.19%) patients with housing issues, and 3543 (0.07%) patients with income/financial resource strain. Of approximately 1.2 million unique patients with unstructured data, 30,893 (2.60%) had at least one clinical note containing phrases referring to social connection/isolation, 35,646 (3.00%) included housing issues, and 11,882 (1.00%) had mentions of financial resource strain.Apart from demographics, SBDH data are not regularly collected for patients. Health care providers should assess the availability and characteristics of SBDH data in EHRs. Evaluating the quality of SBDH data can potentially enable health care providers to modify underlying workflows to improve the documentation, collection, and extraction of SBDH data from EHRs.CONCLUSIONSApart from demographics, SBDH data are not regularly collected for patients. Health care providers should assess the availability and characteristics of SBDH data in EHRs. Evaluating the quality of SBDH data can potentially enable health care providers to modify underlying workflows to improve the documentation, collection, and extraction of SBDH data from EHRs. |
| Author | Hill-Briggs, Felicia Hatef, Elham Tia, Iddrisu Kharrazi, Hadi Marsteller, Jill Rouhizadeh, Masoud Lasser, Elyse |
| AuthorAffiliation | 7 Department of Acute and Chronic Care Johns Hopkins School of Nursing Baltimore, MD United States 3 Center for Clinical Data Analysis Institute for Clinical and Translational Research Johns Hopkins School of Medicine Baltimore, MD United States 11 Armstrong Institute for Patient Safety and Quality Johns Hopkins School of Medicine Baltimore, MD United States 10 Center for Health Services and Outcomes Research Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States 8 Welch Center for Prevention, Epidemiology & Clinical Research Johns Hopkins University Baltimore, MD United States 2 Johns Hopkins Center for Health Disparities Solutions Baltimore, MD United States 9 Behavioral, Social and Systems Sciences Translational Research Community Institute for Clinical and Translational Research Johns Hopkins School of Medicine Baltimore, MD United States 4 Division of Health Sciences Informatics Johns Hopkins School of Medicine Baltimore, MD |
| AuthorAffiliation_xml | – name: 9 Behavioral, Social and Systems Sciences Translational Research Community Institute for Clinical and Translational Research Johns Hopkins School of Medicine Baltimore, MD United States – name: 2 Johns Hopkins Center for Health Disparities Solutions Baltimore, MD United States – name: 5 Department of Medicine Johns Hopkins School of Medicine Baltimore, MD United States – name: 8 Welch Center for Prevention, Epidemiology & Clinical Research Johns Hopkins University Baltimore, MD United States – name: 11 Armstrong Institute for Patient Safety and Quality Johns Hopkins School of Medicine Baltimore, MD United States – name: 3 Center for Clinical Data Analysis Institute for Clinical and Translational Research Johns Hopkins School of Medicine Baltimore, MD United States – name: 6 Department of Health, Behavior, and Society Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States – name: 10 Center for Health Services and Outcomes Research Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States – name: 1 Center for Population Health IT Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States – name: 7 Department of Acute and Chronic Care Johns Hopkins School of Nursing Baltimore, MD United States – name: 4 Division of Health Sciences Informatics Johns Hopkins School of Medicine Baltimore, MD United States |
| Author_xml | – sequence: 1 givenname: Elham orcidid: 0000-0003-2535-8191 surname: Hatef fullname: Hatef, Elham – sequence: 2 givenname: Masoud orcidid: 0000-0002-9006-6112 surname: Rouhizadeh fullname: Rouhizadeh, Masoud – sequence: 3 givenname: Iddrisu orcidid: 0000-0002-4265-4649 surname: Tia fullname: Tia, Iddrisu – sequence: 4 givenname: Elyse orcidid: 0000-0002-1758-9822 surname: Lasser fullname: Lasser, Elyse – sequence: 5 givenname: Felicia orcidid: 0000-0002-2804-3278 surname: Hill-Briggs fullname: Hill-Briggs, Felicia – sequence: 6 givenname: Jill orcidid: 0000-0002-8458-954X surname: Marsteller fullname: Marsteller, Jill – sequence: 7 givenname: Hadi orcidid: 0000-0003-1481-4323 surname: Kharrazi fullname: Kharrazi, Hadi |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31376277$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Elham Hatef, Masoud Rouhizadeh, Iddrisu Tia, Elyse Lasser, Felicia Hill-Briggs, Jill Marsteller, Hadi Kharrazi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.08.2019. 2019. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Elham Hatef, Masoud Rouhizadeh, Iddrisu Tia, Elyse Lasser, Felicia Hill-Briggs, Jill Marsteller, Hadi Kharrazi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.08.2019. 2019 |
| Copyright_xml | – notice: Elham Hatef, Masoud Rouhizadeh, Iddrisu Tia, Elyse Lasser, Felicia Hill-Briggs, Jill Marsteller, Hadi Kharrazi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.08.2019. – notice: 2019. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: Elham Hatef, Masoud Rouhizadeh, Iddrisu Tia, Elyse Lasser, Felicia Hill-Briggs, Jill Marsteller, Hadi Kharrazi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.08.2019. 2019 |
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| License | Elham Hatef, Masoud Rouhizadeh, Iddrisu Tia, Elyse Lasser, Felicia Hill-Briggs, Jill Marsteller, Hadi Kharrazi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.08.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included. |
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| Title | Assessing the Availability of Data on Social and Behavioral Determinants in Structured and Unstructured Electronic Health Records: A Retrospective Analysis of a Multilevel Health Care System |
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