1. Brief Profile Proposal for Healthy Weight R2 Content Profile 2015/16 Yr 9 presented to the Quality, Research & Public Health (QRPH) Planning Committee Jennifer Foltz, MD, MPH, CDC Brittani Harmon, DrPH, MHA, CDC Lori Fourquet, eHealthSign October 17, 2014 October 2014

2. The Problem The current process of Body Mass Index (BMI) information collection via current survey methods is inadequate and inefficient: No measured data, no child data at local levels State-level data is not measured height/weight, and not available for children Labor intensive/costly Via EHR Transfer is inadequate and inefficient: Representativeness (not many participating: limited data) Involves inconsistent data capture methods Is duplicative: in some cases requiring dual entry by the provider into both the EMR and the reporting tool In some cases involves custom interfaces Inconsistent data quality in data entry and communication Data 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

3. 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

4. Value Proposition For public health, Improve Quality BMI Surveillance System Accuracy of Measured data Population representation for all children Timeliness Granularity down to the local level For Providers, refine interoperable approach for BMI data collection with minimal burden Enable 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

5. 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 patients Menu Set Option for Reporting to Disease Registries Quality Measures: Body Mass Index Assessment for Children/Adolescents Adult BMI Assessment Body Mass Index (BMI) Screening and Follow-Up Breast 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

6. 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 work Lose interest of the CDC Division of Nutrition, Physical Activity, and Obesity (DNPAO), and leveraging other partners Lack of available funding to provide technical resources for profile development in the future Lack of IHE involvement in proposed pilot projects Miss the window of opportunity Misalignment with National/International HW initiatives October 2014

7. Use Case Current 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 Case The 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

8. Proposed Standards & Systems HL7 HL7 v2.5.1 Implementation Guide for Height and Weight (DSTU) HL7 CDA Release 2.0 HL7/ASTM CCD IHE IHE Healthy Weight IHE Retrieve Form for Data Capture (RFD) Vocabulary Standards LOINC SNOMED-CT October 2014

9. Discussion What level of effort do you foresee in developing this profile? Small to Medium level of effort Profile Editor: Lori Reed-Fourquet, lfourquet@ehealthsign.com e-HealthSign, LLC Jennifer L Foltz, MD, MPH, igc2@cdc.govigc2@cdc.gov CDC: Division of Nutrition, Physical Activity, and Obesity (DNPAO) Brittani Harmon, DrPH, MHA, ygp5@cdc.govygp5@cdc.gov CDC: Division of Nutrition, Physical Activity, and Obesity (DNPAO) October 2014