Friday, November 21, 2014 IOM: Physical Activity Measures Should Be Among Standard 'Social and Behavioral' Domains Tracked on EHRs The Institute of Medicine (IOM) is recommending that future electronic health records (EHRs) include patient "social and behavioral data"—including data on physical activity—acquired through a set of 12 measures. The 300-plus page report, "Capturing Social and Behavioral Domains and Measures in Electronic Health Records," makes the case for the Centers for Medicare and Medicaid Services (CMS) to include the measures as part of the EHR certification and meaningful use regulations. Data on 4 of the domains—alcohol use, tobacco use and exposure, race/ethnicity, and residential address—are already being widely collected, the report states. But additional domains should be included, each with its own measures—education, financial resource strain, stress, depression, physical activity, social connections/isolation, exposure to violence/intimate partner violence, and neighborhood compositional characteristics. The IOM report describes "a large body of empirical evidence" around the dose-response relationship between physical activity and improved physical and mental health throughout the lifespan, with "little evidence that an upper threshold exists." Authors write that not only is the relationship strong enough to be worth collecting data, the very act of obtaining this information from patients at outpatient visits is associated with "significant, yet small, changes in patient weight loss and [plasma glucose concentration] levels compared [with] those who were not asked about their physical activity levels." Authors of the report recommend that 2 "Exercise Vital Signs" questions from the US Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System be used as the standard measures for physical activity in EHRs. The 2 questions are: On average, how many days per week do you engage in moderate to strenuous exercise (like walking fast, running, jogging, dancing, swimming, biking, or other activities that cause a heavy sweat)? On average, how many minutes to you engage in exercise at this level? Authors also reviewed the International Physical Activity Questionnaire, a 9-question form, finding it "acceptable" but "more time consuming" than the 2-question measure. The report noted that the additional domains would likely add to costs, and that these costs would largely fall to providers. However, the report asserts, the long-term benefits would be significant. "The US health system has achieved technological advances but lags behind other countries in population health outcomes," write the report's authors. "Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research." APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs. Additionally, APTA has long supported the promotion of physical activity and the value of physical fitness, and is involved with the National Physical Activity Plan (NPAP), where the association has a seat on the NPAP Alliance board. The association also offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.