Enhancing Electronic Medical Records to Support Mass in Motion Kids Healthy Weight Interventions for Children

Doctor using computer

Increasing numbers of health care professionals are using electronic medical records (EMR) in their practices, thereby increasing opportunities for preventive medicine and improving population health.

EMRs can assist health care providers to better coordinate care, track chronic conditions over time, and reduce prescription mistakes. This kind of support is especially important in low-income, high-need areas where children and families can fall between the cracks.

The Massachusetts Childhood Obesity Research Demonstration project (CORD) project, Mass in Motion Kids, provided resources and technical support for enhancing the EMR systems in use at the Community Health Connections/Fitchburg Health Center and the Greater New Bedford Community Health Center to improve healthy weight interventions with their pediatric populations. The CORD/Mass in Motion Kids clinical team initiated conversations with the health centers’ leadership in January 2012 to facilitate changes to the EMR systems. Changes included software improvements such as embedded alerts, structured notes, and relevant referral sources. Prompts were added to ask providers questions that are specific to childhood obesity so appropriate services can be offered and detailed notes can be added to that patient’s record. Health center staff can also run reports on collected information to improve quality of care. These additions cost approximately $25,000 in New Bedford and $16,500 in Fitchburg. The cost differential is a result of the different EMR systems in use at the two health centers.

There are many challenges in modifying the Electronic Health Records used by health care providers. The Community Health Center Information Technology departments are generally understaffed and have many competing priorities. Identifying someone at each CHC to champion and shepherd the EMR changes was one of the challenges that had to be addressed before work could commence. Another challenge that delayed completion was that the EMR vendors had long project queues and were unable to begin the programming for several months.

In February 2013, the New Bedford enhancements were completed and the CORD clinical team conducted an initial training for providers on using the new EMR functions. Training is ongoing and feedback from providers continues to be gathered to identify any problems and to ensure that these enhancements have value for patient care. Although minor modifications are still being made to the Fitchburg Health Center’s EMR, these were largely completed in June and providers have completed their first training.

The CORD EMR enhancement work fits within the scope of meaningful use, the national initiative intended to promote the adoption and effective use of technology to improve patient care. Each health center now has in place a state-of- the-art system for identifying and managing the clinical care of children who are overweight or obese. “We are excited to be at the forefront of making our EMR system support the Mass in Motion Kids interventions,” said Shannon Santos, Medical Records Director at the New Bedford Community Health Center. “Our patients deserve this attention to detail and we are excited to witness the short- and long-term benefits.”

Collaboration between the CORD clinical team, health center staff, and EMR vendors was critical for the success of enhancing the EMR systems to include measures and interventions related to childhood obesity. Each community health center had its challenges and researchers and stakeholders learned that this is an iterative process that can take considerable time. Mass in Motion Kids anticipates seeing results from these EMR changes including a positive clinical experience for children and their families receiving care at the two health centers.