1. Katherine Shary RD, LD Child Wellness Program Coordinator
Community and Clinical Linkages Aligning WIC nutritionist and primary care pediatricians on obesity prevention counseling strategies
Katherine Shary RD, LD
Child Wellness Program Coordinator
Hello everyone. My name is Katherine Shary and today I want to talk to you about an innovative pilot project we are conducting at Children's Healthcare of Atlanta around Community and Clinical linkages between Georgia WIC and primary care pediatricians. The goal of this collaboration is to reduce childhood obesity by bringing these to community and clinical partners together to increase coordination of care for their patients and how we at children's have helps facilitate this process by development of tools and trainings.

2. Strong4Life
Strong4Life is a Wellness initiative developed by Children’s Healthcare of Atlanta to help reduce obesity in Georgia. Strong4Life is in multiple facets of the community. Today I am going to focus on how we are helping to tackle overweight and obesity through our early intervention programs, we have developed a website with great resources for parents of all types of children. Specifically what I am going to talk about today is how we are working with pediatricians offices and WIC clinics (Women, Infant, and Children) by arming them with the same tools to help facilitate the difficult topic of childhood obesity.
The tools that you see here are offered (free of Charge) to pediatricians and WIC clinics once they take our live interactive Motivational Interviewing Training. Our goal is to have consistent messaging in the community so pediatric healthcare providers and WIC nutritionist are on the same page and giving the same advice to parents and families. Some of the tools that we offer is the health Habits Assessment where lets the provider know how the child is doing the 4 healthy habits which is on this handout (point to it). The 4 HH are- make half your plate fruits and veggies, be active, drink more water, and limit screen time. Our HH are simple and actionable. We also have one our favorite pieces from the toolkit which is this color coded BMI chart so instead of saying your child is overweight or obese we use terms like yellow zone and red zone. One of our main points during our training is for families to make positive behavior changes they need to set a goal. We developed this goal sheet to help the families set a goal that is SMART, standing for: specific, measurable, attainable, realistic, and timely.
Through giving these trainings and offering the same toolkit to pediatricians and WIC offices all throughout GA we noticed a commonality among the 2 healthcare providers… they very rarely speak or interact with each other.

3. Healthcare Gap
Lack of provider communication across different community sectors
WIC and Primary Care Pediatricians
So this brings me to one of the big healthcare gaps we found in the state of GA, and probably nationwide- communication between different providers across multiple sectors of the community rarely exchange information about patients unless they happen to be with in the same hospital network, using the same EMR system.
As I stated earlier we have found there is minimal to no communication between WIC and the pediatricians office except for discussing an infants formula needs. We saw this as a huge opportunity for Children’s Healthcare of Atlanta to help facilitate better communication between these 2 vital healthcare providers.
During our project we noticed pediatricians seemed to have a bias on what WIC truly offered and WIC clinics seemed to have a bias that pediatricians were not properly explaining weight to their patients. So we wanted to develop a pilot that would simply test the feasibility and usefulness of sharing information with each other and hopefully build a better relationship between these 2 healthcare providers.

4. Over 50% of pregnant women and infants in Georgia receive WIC
According to the CDC, just over 50% of pregnant women in Georgia report signing up for WIC during their pregnancy. This is significant! WIC providers have the potential to help women begin setting healthy habit behaviors early in their pregnancies. Pregnancy is the perfect time to begin obesity prevention for their baby! Also, healthy behaviors started during pregnancy and maintained after delivery can have a positive impact for mom/baby/and family.
WIC offers many great services from Free nutrition education with a registered dietitian, breastfeeding support, anthropometric records, and a nutrient dense food package that contains: whole grains, low sugar cereals, a $10 veggies and fruit voucher, low fat milk, and only enough juice for 4oz per day.
When we presented this information to Pediatricians they were surprised to learn WIC offered such great services to over half the infants in the state and were please to hear about the revised food package.
Source: CDC National Vital Statistics Reports, Vol. 62, No. 4, December 10, 2013

5. Improved Quality of Care
Increase collaboration between WIC and Pediatricians.
Ensure consistency and efficiency of messages and approach.
Accurate sharing of patient information.
The collaboration between WIC and pediatricians is a tremendous opportunity to start building a coordination of care to improve a patients quality of care.
Quality of Care can be improved by:
- Making sure there is consistency and efficiency of messages that are being discussed at both offices. So now each provider knows what went on at the other providers patient visit.
It increases the accuracy of patient information that is being shared and decreases the amount of work the patient has to do by briefing each healthcare provider on what happened at their other visit. Because we all know information can get lost during verbal communication, like the game telephone!
And lastly we hope to see an overall increased collaboration between WIC and pediatricians to ultimately improve Obesity Prevention
Obesity Prevention

6. Pilot Project WIC visit occurs. Information sent to Pediatrician
Pediatrician receives WIC patient information.
Pediatrician responds to WIC.
WIC visit occurs. Information sent to Pediatrician
We came up with a proof of concept on how we were going to facilitate communication between WIC and the pediatricians office. Much of this process required manual work by a research assistant to help with communication connection due to the difficulty of fully sharing data electronically.
The process started at the WIC office were participants would consent to being in the pilot if they met eligibility criteria. They then would go through the WIC appointment as usual but the one item that would change would be the information that was documented by the WIC nutritionist would be ed via the research assistant to that participants pediatrician through a HIPPA secure network.
The pediatrician would then receive this and store it away until the patient came in for their well child visit. At this doctor visit the pediatrician could see the goal they set at WIC, their previous ht., wt., and BMI, and any pertinent notes the WIC nutritionist felt was important to share. The pediatrician would then be able to update the patient goal, ht., wt., BMI, and any pertinent notes
and send back to WIC. This part did not work as efficient as excepted and the research assistant manually went to the office to retrieve this information.

7. The Communication between WIC and the pediatrician is vital to filling in missing gaps. WIC can see a patient up to 4 times a year were as the pediatrician may only see them 1x year for a well child visit. If the pediatrician now has 2-4 more additional plots on their BMI chart it can start to tell a better story of what is going on with the child's weight they can also see the goals that were set and the progress the family has been making towards achieve a healthier lifestyle.

8. Lessons Learned
Improved method of HIPPA compliant data sharing is needed.
Communication across healthcare systems is difficult due to the usage of multiple EMRs.
Referral process between WIC and pediatricians needs improvement.
Through out this pilot project there have been lessons learned that we hope to improve upon as we continue to work with WIC and pediatricians to improve their relationship and communication for obesity prevention.
We are looking forward to enhancing communication through an elite web-based HIPPA compliant data sharing system called FHIR (Fast Healthcare Interoperability Resource).
We have learned there is great difficultly for healthcare providers to share patient information electronically due to the multitude of different EMRs available.
One of our hopes in conducting this pilot project was to also increase referrals from the pediatrician to the WIC clinic. WIC is currently under utilized in the state of GA and we hoped that after educating providers on the wonderful services WIC offers they would want to start making referrals. Unfortunately we did not see this during the pilot but we hope to improve this going forward through implementing this into pediatricians EMR.

9. PCP EMR WIC EMR Primary Care Provider WIC Clinic Health-E-Goal System
Patient Identifiers /Demographics
Anthropometric & Biological Measures
Eating & Activity Patterns Assessment & Counseling Notes
Food insecurity assessment & Referrals as Needed
Primary Care Provider
Client Identifiers /Demographics
Referrals as Needed
WIC Clinic
Health-E-Goal
System
Family
Study Enrollment
We are excited to continue this work and develop a more technology based solution with less manual intervention. The process for our continued work to facilitate communication between WIC and pediatricians to help with obesity prevention will include integrating FHIR into to each healthcare providers EMR. We are excited to continue our partnership with Ga Tech to help make this happen. Our hope is a process like this could be implemented nationwide to increase ease and efficiency for communication between multiple healthcare providers across various sectors of the community.