Community Vital Signs Should Be Part of Every Patient's EHR

Although physiologic vital signs tell healthcare providers a great deal about their patients’ health status, providers need, but don’t have ready access to, information about their patients’ neighborhoods.

“Physicians rarely enter an examination room without access to a patient’s blood pressure, pulse, respiratory rate, and temperature, pieces of information so key to informing health decisions that they are called ‘vital signs,’” Lauren Hughes, MD, MPH, MSc, and Andrew Bazemore, MD, MPH, wrote in the Journal of the American Board of Family Medicine. The authors are analysts at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, a Washington, DC-based group that is affiliated with the American Academy of Family Physicians.

Although physiologic vital signs tell healthcare providers a great deal about their patients’ health status, providers need, but don’t have ready access to, information about their patients’ neighborhoods. Community vital signs such as poverty level, education attained, or employment status could be independent social determinants of health, or they could be indices of these factors, the authors say, and can thus influence healthcare decisions.

Information about patients’ neighborhoods should be a part of every patient’s electronic health record (EHR) because knowing a neighborhood’s “vital signs” will tell healthcare providers much about their patients’ ability to sustain a healthy lifestyle.

In 2014 the Institute of Medicine and the National Quality Forum recommended that EHRs include social determinants of health data. However, it is difficult to gather socioeconomic and health behavior data directly from patients, the authors point out. Using aggregated community-level information about the neighborhoods patients live in is a more reliable and less difficult way to integrate clinical and social data, because there is now widespread access to “big data” and geospatial technologies that can create the community vital signs referred to in the article.

Community vital signs can be generated by already-available population health data at the level of zip codes, census tract, or city block and then linked to patient address data from EHRs. The linked data would be imported into the EHR, and could help primary care practitioners understand the context in which their patients reside so that clinical interventions could be tailored more precisely to public health and neighborhood factors.

The authors cite the Chicago-based HealtheRx project as an example of a patient-centered community services initiative in which each patient’s EHR generates a customized map of local health and social resources that is individually tailored to the patient’s address and diagnosis.

Place matters to personal and population health, the authors conclude.

“Neighborhood-level social determinants of health have begun to shape local public health and policy interventions, and it is now time for family physicians to harness the power of community vital signs to improve the health of patients and communities,” they wrote.