6.0 Final Report. MCIR BMI Notebook Altarum Institute 179
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1 6.0 Final Report A final report with an overview of project activities, a summary of in-clinic testing, and identification of future needs for launching and implementing the MCIR BMI Growth Module follows. MCIR BMI Notebook Altarum Institute 179
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75 6.1 Future Project Needs and Recommendations Excerpted from the Final Report is a listing of future project needs. Completing MCIR BMI Growth Module Development: Programming of a small number of functions (printing of patient metrics on growth charts) must be completed before the MCIR BMI Growth Module can be released. Additionally, a small number of modifications to existing functions have been recommended including, most notably, adding a field for actual delivery date. Reports for administrative, clinical, and surveillance use; specifications for adding height and weight to the MCIR File Transfer program; and the extraction of BMI and counseling data for HEDIS reporting must be developed and tested. In September, 2010, the CDC began recommending use of the WHO international growth standard for assessment of growth in children age 0-2 instead of the CDC standard reference population. The CDC has been silent on whether the associated BMI-for-age growth charts should be used. The MCIR BMI Growth Module should remain harmonized with emerging standards for assessing obesity among infants. Access to BMI data should be defined for various categories of MCIR user. MCIR user agreements should be reviewed to ensure that access to BMI data is covered. Special consideration should be given to sensitivities around weight-related data, particularly concerning commercial access. Preparing for Roll Out: To optimize the representativeness of MCIR BMI data for surveillance purposes, clear guidance should be developed concerning when height and weight values should be reported, and by whom. Providers need clear guidance concerning their obligations for notifying patients, and/or obtaining patient consent for reporting their height and weight information to MCIR. Many providers require significant training in obesity screening and counseling. The MCIR BMI clinical decision support tools should be promoted as a means of helping providers streamline complex professional guidelines when access to state-of-the-art tools are not otherwise available. Due to continuing concern that they will not be reimbursed for their time, efforts to expand insurance reimbursement for obesity screening and counseling must continue. Providers should have a mechanism for reporting when claims for covered services are rejected. To take full advantage of MCIR BMI s screening tools, some clinics will need to make significant, possibly challenging, modifications to the flow of patients in the clinic. Tools are available to support these changes. The adoption of EMRs, which is expected to expand in the next couple of years, represents an optimal window to modify processes to allow for expanded BMI screening and counseling. The federally-funded Michigan Center for Effective IT Adoption (M-CEITA; facilitated by Altarum Institute) is assisting hundreds of private practices throughout Michigan in making these transitions. Efforts to disseminate the MCIR BMI Growth Module should take MCIR BMI Notebook Altarum Institute 253
76 advantage of ongoing clinic re-engineering to promote integration of BMI screening in private practice. Changing office practices to allow for BMI screening and counseling, requires input and buy-in from all clinic staff. As the costs and benefits of changing processes differ for different clinic staff, all perspectives should be represented when re-engineering is undertaken. Plans to roll out MCIR BMI should replicate those typically used when other new MCIR features are released. Innovative strategies such as social media should be explored to reach providers and clinic staff regarding the MCIR BMI Growth Module. The rapid expansion of these tools in public health and medicine suggest that they hold promise for future use with MCIR BMI. Assessment and Data Quality: Baseline levels of provider awareness comfort with, and efficacy in conducting routine BMI screening and counseling should be established prior to dissemination of MCIR BMI. These assessments should be repeated periodically after its introduction. Quasi-experimental assessment methods should be used to understand the role of the MCIR BMI Growth Module in improving BMI screening rates, and the impact on childhood obesity prevalence and trends. BMI screening and counseling rates should be monitored, along with insurance claims and rejections to assess changes to care quality and obesity prevention insurance coverage. MCIR BMI data quality assessment procedures should be established, consistent with MCIR data quality monitoring procedures, but also with standards used for other obesity surveillance data programs. Future Directions: HL-7 messaging capacity should include transmission of data needed for BMI calculation (date of birth, gender, date of measurement, and height/weight and length). Consider adding adult BMI tracking, to facilitate continuity of care for children reaching adulthood and to support obesity prevention and surveillance of the entire population. MCIR rules concerning data retention and notification for data sharing, however, must be addressed. Efforts could be explored for bi-directional exchange of BMI data with the WIC and Medicaid EPSDT programs. An alternative model for improving obesity screening and counseling would be for clinics to make free-standing touch screens available for patients to complete family history and nutrition and physical activity surveys. Integration of such a model with MCIR BMI should be explored. MCIR BMI Notebook Altarum Institute 254
77 List of Acronyms AAP BMI CDS CHOMP EMR FPRTF HKHM HPAT M-CEITA MCIR MDCH MOA American Academy of Pediatrics Body Mass Index Clinical Decision Support Childhood Obesity Prevention Mission Project Electronic Medical Record Family & Provider Resources Task Force Healthy Kids Healthy Michigan Health Policy and Action Team Michigan Center for Effective IT Adoption Michigan Care Improvement Registry Michigan Department of Community Health Memorandum of Agreement MCIR BMI Notebook Altarum Institute LOA-1
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