Abstract
Background/Aims Pediatric obesity is the most common, preventable chronic disease. Multiple guidelines concur that systematic, routine strategies are required to monitor body mass index (BMI) to identify overweight (>85th% BMI) and obese (>95th% BMI) children (ages 2–18), to intervene and provide follow up. This study reports on how health system leaders use electronic health records (EHR) and clinical decision intelligence support (CDIS) to track age specific BMI% and tailor pediatric care for obesity interventions.
Methods Between 1996–2001, Geisinger Health System adopted a common EHR platform to link 41 primary care clinics in 31 rural and urban counties in central-NE PA. In 2007, Geisinger created CDIS as an EHR-enterprise data warehouse. Every 24 hours, CDIS IT extracts data from our EHR, including heights and weights captured in industry standard format [(Health Level 7 (HL7)]. We used the CDC SAS scripts from the CDC growth chart website to calculate BMI% for age, sex for 2010 well child visits (WCV).
Results In 2010, 32,443 unique children had WCV. BMI% was recorded for 92%: 5,255 (16%) were overweight defined as BMI >85–94.99% and 5,413 (17 %) were obese (BMI>95th%). A majority of the obese children (80%) had 2–16 visits with BMIs>95th%.
Discussion In 2010, 33% of children ages 2–18 with documented EHR WCV had BMI> 85th% overweight/obese. These results led to the 2011 GHS initiative where each night, CDIS extracts data to calculate BMI% and update a list of obese children that is monitored by physician leaders and practice sites. CDIS then loads an alert to fire at the child’s next visit to provide physicians with guidelines including automated order sets, recommended screening labs, and referral information to weight management programs. For the 2012 initiative, CDIS will identify and monitor infants ages 0–2 with WHO weight/length ratio >95th%. Parents will be surveyed about their child’s diet and physical activity. They will also receive age appropriate, simple written and verbal education materials based on the American Academy of Pediatrics Bright Futures 5-2-1-0 daily goals: 5–13 servings vegetables/fruits,
