Reconsidering what is vital about vital signs in electronic health records: Comment on Matthews et al. (2016)
David M Condon, Sara J Weston, Patrick L Hill
*American Psychologist*
Abstract
The inclusion of psychosocial variables into electronic health records provides a unique opportunity for the translation of findings from social, psychological, and behavioral domains into patient care. This commentary is a response to the recommendations of a committee convened by the Institute of Medicine to address this opportunity.
Why we wrote it
Health psychologists have spent years showing that personality and other psychosocial factors go along with health, and it has been hard to turn that work into guidance for clinicians. So we were glad to see Matthews and colleagues describe a path: put psychosocial measures into electronic health records (EHRs), where they can reach patient care and large-scale research. Their article reported recommendations from an Institute of Medicine committee. We agree that this is a good idea and that a recommended panel of measures is needed. We also had three concerns about how the recommendations were built.
What we said
First, the audience is unclear. Words like inclusion and exclusion suggest the recommendations could keep measures out of EHRs. Adding a measure to an EHR costs little, so it seems more sensible to encourage a wide range of measures and let clinicians and researchers choose among them.
Second, the criteria are too restrictive. Requiring every measure to be “actionable” would rule out constructs that are hard to change, and the committee’s example was conscientiousness. That example is a poor fit. Brief interventions can shift conscientiousness, and clinicians already use characteristics we cannot change, such as sex and race, to understand disease risk. Knowing a patient’s conscientiousness could help identify who is least likely to follow a treatment plan. Asking every patient the same 11 items also runs against the push for personalized care. Items that are irrelevant to one patient, or upsetting to them, take up time that could go to other measures.
Third, more people should weigh in. Personality traits predict some diseases and not others, so a single universal panel might drop personality entirely. Clinicians and psychosocial researchers should have a say before a list with lasting consequences is settled.
What it means
We support putting psychosocial measures in health records. We ask that the panel be built with more input and fewer restrictions.