More than 50 percent of the factors that make us healthy or unhealthy are actually not related to healthcare at all. In fact, our lifestyle and living environment make up the majority of the determinants of health for a population. Factors such as income, education, physical activity levels, housing and eating habits collectively affect health in a much more significant way than factors related to the access to, and quality of, health care services.
And yet – at least for the majority of communities in the United States – we do not adequately collect, share and utilize data and best practices on these lifestyle and environmental factors to improve the health of our populations. While there is the formal collection of certain diseases and conditions through public health and healthcare delivery, much of what we can call “community health” data is collected less formally, if at all. And even when data is collected, these factors often lack a common structure or set of standards that would greatly improve their utility. I recently argued for creating community health records in order to more systematic approach to improving the social and physical determinants of health, which I’ll explain in more detail here.
What are community health records?
Community health records (CHRs) are a cousin of electronic medical records (EMRs, used by clinical teams) and personal health records (PHRs, used by individuals and families). They are curated sets of population-level indicators that describe the health and quality of life of a geographic community, including trends, disparities and the ability to compare metrics with those of other communities.
The diagram below illustrates the relationship between these three types of records. While there is a degree of overlap, the data included in CHRs are very different from data in either EMRs or PHRs. For instance, a CHR may include measures of community access to healthy foods, crime rates, public transportation efficiency and economic factors. Data in CHRs can provide insights into the health issues in our communities.
There are two approaches to using CHRs:
- The “outside-in” approach – Geographic community health data can be presented and visualized to help stakeholders prioritize targeted interventions to small groups and individuals to improve health and quality of life. For instance, the record could show geographic hotspots, or concentrated clusters of risk and poor health outcomes. Over time, a knowledge base of effective and cost-effective best practices for community health interventions can be developed that address specific community health profiles.
- The “inside-out” approach – CHR data can assist with flagging and helping individuals; for example informing a single-parent, pregnant woman living in poverty that she needs a routine set of prenatal checkups at a location to which she has no available transportation is destined to be ineffective. CHR data could provide the basis of a “vulnerability index,” which could be integrated into an EHR to help clinicians understand circumstances in which a patient lives. These indices could deliver insights to health professionals of the more complete set of education or services individuals may require for effective prevention and treatment of their health and medical conditions.
Click here for Deryk Van Brunt’s article in the American Journal of Public Health, “Community Health Records: Establishing a Systematic Approach to Improving Social and Physical Determinants of Health.”
Why are community health records needed now?
CHRs are needed more than ever as healthcare continues to shift from a volume-based to a value-based system. As organizations begin to take on increasingly more financial risk for the health of populations – via accountable care organizations and other value-based reimbursement mechanisms – CHRs and community health interventions can be used in tandem with traditional clinical data and transformation initiatives to prioritize areas of need, drive reengineering process improvement and improve health.
The health of a population can be improved most effectively if we define and use CHRs – imagine trying to improve clinical care today without an EMR! The United States needs to define a CHR that establishes a community health data standard – one that is interoperable with the health, human and social service ecosystem, and easily accessible and usable for a variety of different stakeholders working to improve health and quality of life.