Programmed EHR alerts show mixed results in pediatric obesity study
EHR alerts show some promise in changing physician behavior when treating overweight and obese children, but they are “no magic bullet” to helping patients overcome weight issues, according to a University of California at Davis study published in the American Journal of Medical Quality.
Researchers added obesity-related alerts to EHRs at the UC Davis Health System’s outpatient clinic, which sees about 12,000 patient each year, and provided a one-hour training session with physicians to improve compliance.
Highlighted in bright yellow on the screen, the alert notified physicians when a patient’s weight hit the 85th percentile mark, which is considered overweight. The alert then guided physicians through a series of steps to address weight issues, and prompted them to bring up issues regarding diet, exercise, screen time and other behaviors associated with obesity. The alert would help physicians document these discussions, order lab results, refer patients to dietitians and schedule follow-ups, according to the study.
The research team concluded that the alerts led to significant, but not dramatic improvements. Some findings:
- The alerts increased the proportion of children diagnosed as overweight or obese from 40 percent in the pre-alert group to 57 percent in the alert group
- Lab tests for diabetes and dyslipidemia increased from 17 to 27 percent
- Follow-up appointment scheduling went from 24 to 42 percent
- Referrals to dietitians remained static at 13 percent
“I think this study sounds a cautionary note,” said Ulfat Shaikh, lead researcher, pediatrician and director of healthcare quality at the UC Davis School of Medicine. “Any kind of electronic record approach must be combined with other interventions, such as real-time feedback and using opinion leaders to carry the message. We need to address EHR alerts in the larger context of clinical practice.”