Nurses Take Step Forward!

An article at takes a big step in the right direction, concerning making Electronic Health Records (EHR) more valuable in the provision of health care. The American Academy of Nursing issued a policy statement that EHR “are incomplete and potentially insufficient for use in population health management programs when they are missing social and behavioral data…”

Thought Emotion Behavior

Thought Emotion Behavior

The policy statement is general, in terms of applying to population groups, and I cannot argue with that, but I can say that their point is especially valid when dealing with the healthcare needs of seniors.

The article states that,

Largely ineligible for the EHR Incentive Programs and somewhat ignored by mainstream primary care health IT developers, behavioral health providers have been slower to adopt EHR technology that might facilitate health information exchange…

Even ACOs that put a premium on HIE and EHR interoperability rarely integrate behavioral health data into the patient record: a recent survey found that less than half of ACOs have access to behavioral health records from their community partners.

The weakness in the policy statement is that it still refers, overwhelmingly, to clinicians. For many, many seniors with chronic medical conditions, it is not the clinicians that are going to be there, daily, to observe and be able to report on behavioral health. It is the caregivers who support them, both family caregivers and professional ones.

This is implicitly acknowledged by the American Academy of Nursing:

Clinical care currently accounts for only 20 percent of health outcomes. To improve care and population health outcomes, healthcare providers must address other factors, including social determinants of health. To do this, we must first focus on addressing the variability in capturing and documenting social determinants in order to use this health data to benefit patients.

OK, so let’s take that statement and look at its very logical conclusion. The data about behavioral health is not going to come primarily from clinicians, whether that is doctors, nurses, psychologists, psychiatrists or whomever. The need the data, but they are not going to originate a lot of it.

For many seniors, they need to work with family and professional caregivers – training them, establishing protocols that reflect the role of the caregivers. The concept of the “medical home” needs to be revised and extended to reflect a team that includes non-clinical care providers, as well as the typical clinician members. Until that happens, the data situation – and the healthcare provided – will not improve.

Your thoughts?

Best wishes. Bert


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