Community Health Records Offer IT Approach to Improving Population Wellness

Community health records (CHRs) have the potential to transform the way stakeholders work to improve health at the community level by aggregating local data on the social and physical determinants of health, according to a recent commentary in the American Journal of Public Health.

Deryk Van Brunt, DrPH, penned the commentary as a follow-up to his contributions in “Report to the President: Better Health Care and Lower Costs: Accelerating Improvement Through Systems Engineering,” published by the President’s Council of Advisors on Science and Technology in 2014. Van Brunt's section of the report discussed the importance of community health, and in this follow-up piece he explains how innovative health information technology (IT) tools can help achieve better community health.

To effectively implement health interventions, he argued, stakeholders need to access data on the wide range of social, environmental, and lifestyle variables that influence health in communities. Similar to how electronic health records (EHRs) give clinicians the information they need to make decisions affecting an individual’s health, CHRs would help stakeholders develop targeted, evidence-based interventions to improve the health of a community.

CHRs, Van Brunt suggested, should include measures of clinical health status within a community, such as access to care or the prevalence of cancer or diabetes, but also the social and physical determinants of health, which would include factors like public safety, education, socioeconomic status, and lifestyle behaviors.

He anticipated 2 ways to utilize the CHRs and the data contained in them. The “outside-in” level efforts would occur when stakeholders identify location-based health disparities based on community health data and use those insights to develop interventions for individuals and small groups living in that area. The “inside-out” approach would let healthcare providers select an individual and then devise an intervention or treatment plan for that person based on the health data within that person’s community.

While there have been efforts to gather such data, there is currently no standardized framework for maintaining and presenting the information. The IT standard for CHRs should allow communities to create graphical representations of data, identify trends and disparities, and easily compare their metrics to those of other communities, according to Van Brunt. He pointed to the Institute of Medicine’s efforts to include social and behavioral determinants of health within EHRs as “a great springboard for what could become the CHR—EHR intersection.”

Before CHRs can reach their full potential, Van Brunt wrote, efforts must be made to “greatly reduce the variability in the breadth, granularity, and quality of data available at the local level between states” and to create more standardized program interfaces. He emphasized that the process should be facilitated with input from community stakeholders and include frequent evaluation of successes and challenges.

The commentary concluded with a vision of how CHRs could be used to improve global health by providing opportunities to “observe the relationships between geopolitical and healthcare delivery system measures—at the national and local level—and the output in terms of health, productivity, and quality of life.”