The Next Step for Truly Comprehensive Care: Incorporate Community ‘Vital Signs’ into Patient Electronic Health Records

FOR IMMEDIATE RELEASE: Monday, Aug. 10, 2015

Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224  

WASHINGTON — Physicians regularly gather data on patients’ physical vital signs, but they likely don’t know much about their patients’ home and community environment. That lack of information is problematic, because factors such as where you live, what you eat, whether you have the chance to exercise and other social or community factors have a significant effect on health.

To address this gap, researchers at the Robert Graham Center propose the development and implementation of “community vital signs” into physicians’ electronic health records, according to Andrew Bazemore, MD, MPH, director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. He and his colleagues are testing the idea by building a system that geocodes patient records and adds community information from the Robert Graham Center’s HealthLandscape database to each patient record. They describe the idea and the groundwork they are laying for such a system in “Community Vital Signs: Incorporating geocoded social determinants into electronic records to promote patient and population health”( in this month’s Journal of the American Medical Informatics Association.

“Incorporating these data into the EHR is only a first step,” Bazemore said. Other steps include determining which community data best predict health outcomes, how to best make this information available and what formats would be most useful to physicians, and which interventions providers can employ in response to the patient’s community vital signs.

With such blended information “all health care professionals could 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,” Bazemore writes.

“For example, the EHR could be programmed to identify all patients on a provider’s panel who live in an area with a high proportion of fast food restaurants and send them information about where they can purchase fresh produce along with recipes for quick, healthy meals. Using data from the Environmental Protection Agency’s Safe Drinking Water Information System, … care teams could be automatically notified of water contamination and equip patients in the affected area with information about how to create safe drinking water (e.g., boiling instructions) or where to find alternative water sources.”

The HealthLandscape geoenhancement application turns a patient address into a coordinate on a map, allowing information about a patient’s community to be joined to his record.  The application allows a clinical data holder to select from 200 of the more than 10,000 variables in the HealthLandscape databanks. The databanks represent state, local, even block-by-block measures on social determinants of health and cover areas such as health economics, the health care workforce, population estimates, education, criminal justice, migration, health care quality indicators, socioeconomics, and social and physical environments. Working with Accelerating Data Value Across a National Community Health Center Network, the Clinical Data Research Network, the Oregon Community Health Information Network (renamed OCHIN as other states joined), and federally qualified health centers, Bazemore and his colleagues are beginning to test the incorporation of HealthLandscape data into EHRs.


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.