Use of Electronic Medical Records Increases Rates of Obesity Diagnosis and Counseling

Evidence-based strategies to prevent and manage childhood and adolescent obesity in primary care include periodic measurement of weight and height, plotting body-mass index (BMI) on growth charts, and exercise and nutritional counseling. To determine if an electronic medical record (EMR) initiative at a large health maintenance organization (HMO) helped standardize pediatric weight management and counseling, researchers analyzed data from 2007 through 2010 for an average of 240,000 annual outpatient visits in children aged 2 to 17 years.

As part of the initiative, which began in 2008, BMI and BMI-for-age percentile were automatically displayed on a growth chart when height and weight were recorded in the EMR. For BMIs >85th percentile, the EMR provided an alert about counseling, screening for related conditions, and referral to an internal program to promote family lifestyle change. An online continuing education course was also developed to improve diagnosis and counseling of childhood obesity, including guidance about how to talk with parents about their child's weight, assess readiness for change, and set goals for changing family behavior. As of 2011, 33% of pediatricians in the HMO had completed the course.

The percentage of children with recorded height and weight measurements increased significantly, from 66% before the initiative to 94% in 2010. Among children and adolescents who were overweight or obese, documentation in the EMR increased significantly from 12% in 2007 to 61% in 2010. Documentation of counseling for exercise and nutrition also increased significantly from 1% in 2007 to 50% in 2010.