An electronic medical record (EMR) prompt improves screening rates for metabolic conditions among children with obesity.

Abstract

This study evaluated the effectiveness of an automated prompt in the electronic medical record (EMR) to increase screening rates for metabolic conditions and referrals to health education and to improve BMI percentile among children with obesity. The intervention used an EMR reminder that provided a panel of lab orders (hemoglobin A1c, lipid panel, and alanine aminotransferase) during clinical encounters among pediatric patients ages 10 to 18 with BMI ≥ 95th percentile. Data on demographics, comorbid conditions, BMI, lab results, and health education referrals were analyzed. Cohorts during the year before (n= 3479) and after (n= 3439) workflow implementation were compared. The distribution of race/ethnicity among children with obesity was 56% Hispanic, 19% White, 11% Filipino, 4% Pacific Islander, 3% Black, and 1% East/South Asian. Orders for metabolic lab tests increased from 2% in the pre-workflow period to 52% in the post-workflow period (p< 0.0001). Completed screening rates improved from 1% to 27% (p< 0.0001). Health education referrals increased from 0.4% to 7% (p< 0.0001). We observed a mean change in BMI percentile of -0.13% (p= 0.06). This study validates the use of an EMR-based prompt to improve metabolic lab screening and health education referrals among children with obesity. During the limited period of follow-up, we found no significant change in BMI percentile.