Using Electronic Health Records to Support Decision-Making in Pediatric Obesity Care

Childhood obesity remains a highly prevalent public health issue and contributes to significant short- and long-term adverse health outcomes. While expert guidance exists to support pediatric obesity-related health care, pediatric primary care clinicians often fail to follow this guidance due to competing priorities within the constraints of a routine well-child care visit. Electronic health records (EHRs) have the potential to improve clinicians' diagnosis and treatment of obesity by providing tools such as reminders and clinical decision support (CDS). Yet, much of the focus in electronic CDS development, research, and funding has been primarily on adult patient populations. EHRs in pediatric settings are behind in terms of well-developed features for use with pediatric populations.

This project will evaluate and compare different tools within EHRs to assist pediatric primary care clinicians with providing higher quality childhood obesity care to help families slow weight gain in children with obesity. These results will be used to develop a “Toolkit” for creating comparable EHR tools in other pediatric primary care settings.

The specific aims of this project are as follows:

• Conduct a cluster randomized controlled trial to assess the comparative effectiveness of EHR-based tools for pediatric obesity in primary care. 
• Utilize mixed methods research with surveys and semi-structured qualitative interviews with clinicians in two health systems to 1) examine the extent to which the EHR tools positively impact clinicians’ awareness, knowledge, and adherence to expert guidance for pediatric obesity management and 2) explore the barriers and facilitators of clinicians using the EHR tools and factors that influence adoption. 
• Develop a stakeholder-informed implementation toolkit to facilitate dissemination and implementation of EHR-based tools to support obesity care in pediatric primary settings. 

Children ages 2 to 17 with a body mass index (BMI) of > 95th percentile will be compared on changes in BMI and measures related to the quality of pediatric obesity care: inclusion of obesity diagnosis in problem list, screening laboratory orders for obesity-related comorbidities, and followup or referral for obesity. At their well-child care visit, a notification for these children will appear in the “Banner Bar” at the top of the EHR screen alerting the clinician that a “PowerPlan” has been automatically suggested by the EHR system and is available for use in the order-entry screen. A PowerPlan is a set of orders and instructional text grouped together under a single title. This feature does not involve a hard stop and will not require the clinician to interact with the PowerPlan. Clinicians in a second intervention arm will additionally receive a “hard-stop alert” when they open the child’s record alerting them that the child meets criteria for obesity based on their age and sex-specific BMI percentile. The hard-stop alert will be a new window in the forefront of the screen interrupting workflow and requiring the clinician to take an action on the alert.

The project team will also use qualitative and quantitative methods to 1) examine the impact of the EHR-based CDS tools for childhood obesity on clinician knowledge and practice and 2) identify and characterize barriers and facilitators of adoption. The findings will be used to improve the features and usability of the CDS tools and to inform the development of the implementation toolkit for dissemination.