brief profile proposal for healthy weight r2 content profile 2015/16 yr 9 presented to the quality,...
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October 2014
Brief Profile Proposal for Healthy Weight R2 Content Profile2015/16 Yr 9
presented to theQuality, Research & Public Health (QRPH)
Planning CommitteeJennifer Foltz, MD, MPH, CDC
Brittani Harmon, DrPH, MHA, CDCLori Fourquet, eHealthSign
October 17, 2014
October 2014
The Problem
The current process of Body Mass Index (BMI) information collectionvia current survey methods is inadequate and inefficient:
No measured data, no child data at local levelsState-level data is not measured height/weight, and not available for childrenLabor intensive/costly
Via EHR Transfer is inadequate and inefficient:Representativeness (not many participating: limited data)Involves inconsistent data capture methodsIs duplicative: in some cases requiring dual entry by the provider into both the EMR and the reporting toolIn some cases involves custom interfacesInconsistent data quality in data entry and communicationData is underreported and underrepresented
These limitations make it very difficult for public health agencies, communities, and
jurisdictions to evaluate progress in their childhood obesity rates.
October 2014
The Problem
Current IHE Healthy Weight (HW) established methods to capture and communicate structured HW information for public health surveillance and care management. Open Issues and harmonization efforts remain that will be the subject of this next release of the Healthy Weight profile. The updates will include:1. Update of behaviors in social history section.
a. Incorporate new LOINC codes b. Add new metrics (e.g. screen time frequencies, food insecurity, etc)c. Replace SNOMED-CT Questions with LOINC questions.d. Review Behaviors
2. Review / incorporate HL7 Nutrition Section for care plans and healthy weight monitoring. 3. Add clarifications for document and message based on testing (e.g. CCD as parent, clarify constraints)
October 2014
Value PropositionFor public health, Improve Quality BMI Surveillance System
Accuracy of Measured dataPopulation representation for all children
TimelinessGranularity down to the local level
For Providers, refine interoperable approach for BMI data collection with minimal burdenEnable feedback to improve the quality of care This Profile release will specifically:
1. Refine ability to capture structured behaviors that align and crosswalk with National and International Healthy Weight initiatives
2. Refine care plan management specifications for healthy Weight enabling interoperability with nutritionists and support for core healthy weight strategies
3. Clarify our specification for implementer
October 2014
Market Readiness
The use of EHR data as a source for BMI quality data is a requirement for US Meaningful Use Core Criteria: Recording of BMI for >50% of patientsMenu Set Option for Reporting to Disease RegistriesQuality Measures:
Body Mass Index Assessment for Children/AdolescentsAdult BMI AssessmentBody Mass Index (BMI) Screening and Follow-UpBreast Feeding
Prioritized in HITECH Act and in National/International initiatives: • Partnership for a Healthier America• Exercise is Medicine• Academy of Nutrition and Dietetics
Continued State interest (32 states engaged in the Healthy Weight Partners Work Group)
CDC in collaboration with Public Health and Research communities will leverage the IHE HW profile to establish pilots with disease registries which will result in deployment opportunities
October 2014
Existing IHE Profiles and Risks
BMI source data uses multiple medical summaries (MS, XPHR, CCD)
HW uses RFD, and specifies a Message and Document Risk of this proposal not being undertaken this cycle?
Loss of momentum started with current HW workLose interest of the CDC Division of Nutrition, Physical Activity, and Obesity (DNPAO), and leveraging other partnersLack of available funding to provide technical resources for profile development in the futureLack of IHE involvement in proposed pilot projectsMiss the window of opportunity Misalignment with National/International HW initiatives
Use CaseCurrent Use Case
Paper patient charts transcribed to paper or web data entry system to collect the measured height and weight information. Due to varying workflow, data collected during the care visit and by the surveillance system is inconsistent impacting both individual and population level data.
Proposed Use CaseThe parents provide a healthy weight behavior assessment including diet, and physical activity behaviors. The clinic captures the patient’s height and weight and determines that the patient should be referred to a community-based obesity program. The healthy weight summary is available to the obesity program including:• Summary of documented elements from visit (Current anthropometrics, behaviors, continuity of
care)• Goal setting (diet, physical activity)• Resources Identified
Information is also provided to the public health surveillance system:• Using HL7 BMI message• Aligned with programmatic workflows (e.g. Immunization Registry)
October 2014
October 2014
Proposed Standards & SystemsHL7
HL7 v2.5.1 Implementation Guide for Height and Weight (DSTU)HL7 CDA Release 2.0
HL7/ASTM CCD
IHEIHE Healthy WeightIHE Retrieve Form for Data Capture (RFD)
Vocabulary StandardsLOINCSNOMED-CT
October 2014
DiscussionWhat level of effort do you foresee in developing this profile?
Small to Medium level of effort
Profile Editor:Lori Reed-Fourquet, [email protected]
e-HealthSign, LLC
Jennifer L Foltz, MD, MPH, [email protected]: Division of Nutrition, Physical Activity, and Obesity (DNPAO)
Brittani Harmon, DrPH, MHA, [email protected] CDC: Division of Nutrition, Physical Activity, and Obesity (DNPAO)