Health IT & Pediatric Obesity Management

Abstract

Source: McDonald J, Goldman RE, O’Brien A, et al. Health information technology to guide pediatric obesity management. Clin Pediatr (Phila). 2011; 50(6): 543– 549; doi: 10.1177/0009922810395131Researchers from several New England institutions sought to ascertain pediatricians’ current approach to obesity screening and management, familiarity with and use of expert recommendations (the Expert Report1) and use of health information technology (HIT) in obesity screening and management, and suggestions for potential HIT innovations. They conducted in-depth telephone interviews, using open-ended questions, with primary care pediatricians from two multisite group practices with ethnically diverse patients in the Boston area.The 32 participating pediatricians averaged 24 years post-medical school graduation. Their estimates for the percentage of their patients over 2 years old with a body mass index (BMI) of at least 95th percentile were: between 5% and 20% reported by 46%; between 20% and 30% reported by 44%; and over 30% reported by 9% of respondents. Nearly all respondents were unfamiliar with the specific content of the Expert Report; while most included elements of the recommendations in their approaches to obese patients, few participants reported routinely ordering recommended tests, and some stated tests were not useful and/or possibly harmful (if a test returns as normal the family might not appreciate a need to make a behavioral change). Most cited the use of growth charts to start discussions with families, followed by an individualized approach to counseling and management, but few felt confident in their management of childhood obesity.The two group practices surveyed use an electronic health record system from a single vendor (EPIC) for documentation, prescribing, and order entry. Participants reported using growth charts and trend information for viewing serial weights. One practice had an obesity order set that helped with documentation and continuity, but thought it was too complex (“multiple clicks”) and not clinically useful.When asked about helpful HIT interventions, most proposed alerts and links to algorithms incorporating expert recommendations. However, there were many concerns that overuse of alerts would result in provider distraction and alert fatigue. Other suggestions included: tailored education materials; links to community resources for physical activity; patient-specific panels of laboratory screening tests; an obesity dashboard to keep track of patients; and information on specialty referrals.The authors conclude that an electronic alert to clinicians for patients with elevated BMI may have strong acceptance among pediatricians if it incorporates other functions in high demand, including links to educational materials, local resources, and other tools related to physical activity and nutrition.Dr Kim has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Childhood obesity is a priority in the American Academy of Pediatrics’ Agenda for Children2 and is also important in comparative effectiveness research because of its “high prevalence…, associated co-morbidities and the need for testing of available prevention and treatment strategies.”3 Successful management of childhood obesity, on individual and population levels, will require aligning personal and public health efforts.At the patient care level such alignments include: a) translation of research findings into usable diagnostic, therapeutic, and preventive methods and tools; and b) incorporation of these into common and widespread practice that produces measurable results. The former requires assimilation of published evidence into explicit and actionable recommendations and guidelines,4 while the latter requires effective design of structures and processes of care to guide, reinforce, and integrate patient management to implement best practices.HIT can provide functionalities (guided data collection, automated calculation, alerts and reminders, linked education for patients and clinicians, registries, audits, and performance feedback) to support best practice in direct patient care. However, its design, implementation, and deployment must align with clinical and cognitive workflows of providers (and patients).These researchers determined at least one alignment of practitioners’ reported use of HIT with published recommendations: the use of electronic growth charts to calculate serial BMI. However, they also found variances in practitioners’ knowledge and implementation of the Expert Report recommendations, including their laboratory testing practices.HIT has great potential to enhance early diagnosis and effective treatment of pediatric obesity and assess physicians’ adherence to expert recommendations. Iterative exploration of how clinicians and patients interact with information tools and systems of care can leverage the power of HIT to address the complex and chronic problems of childhood obesity.Readers should not confuse recommendations based on expert consensus (referenced below1) with evidence-based clinical practice guidelines. All too often expert consensus has been refuted when evidence became available. We desperately need evidence to guide our management and prevention of childhood obesity, but in the meantime we look to experts for advice.