New Electronic Health Records Incentive Program Includes Obesity Measures

By Casey Langwith and Anna Muldoon, Members of The George Washington University’s Research Team for the STOP Obesity Alliance

One of the central goals of thought leaders in the health care field is to promote innovation in the way health care is delivered, particularly with regard to effective use of Health Information Technology (HIT).  HIT has been heralded as a key tool to drive positive changes in daily medical practice.  However, because there is wide variation in the way that Electronic Health Records (EHRs) have been designed and implemented, defining meaningful use is essential for making HIT a reality.  In January 2010, the Centers for Medicare and Medicaid Services (CMS) issued proposed rules on the meaningful use of EHRs for an EHR incentive program, as directed by the American Recovery and Reinvestment Act of 2009 (ARRA).  We were encouraged to see that the final rules for meaningful use, released this month, include measurement of height, weight, blood pressure, and Body Mass Index (BMI) for everyone over 2 years old as core objectives.  The rules also note that for children, growth charts for height and weight should be used in combination with BMI, since BMI is an imperfect measure for people under age 18. In addition, the charting of height, weight, blood pressure, and BMI are included as Stage 1 criteria, meaning that these measurements would be required for hospitals and providers to qualify for the incentive payments. 

The final rules also include a measure that requires the recording of height, weight and blood pressure along with other vital signs for at least 50% of unique patients seen by providers or admitted to inpatient or emergency departments. (The measure provides an exception for physicians who believe that these signs have no relevance on their scope of practice).  We believe that the collection of this data may encourage providers to identify latent weight issues and will be a valuable resource to researchers focused on tracking the health complications and health care costs related to overweight and obesity.

In March, the STOP Obesity Alliance released a white paper, Improving Obesity Management in Adult Primary Care, which addressed HIT issues in our recommendations for improving the medical response to obesity.  As we note in the paper, tracking trends in weight and health over time is an important part of obesity management. The inclusion of weight-related measurements as Stage 1 criteria will incentivize providers to more consistently record this information.  Providers could use this data in the aggregate to examine treatment effectiveness for individual patients and the patient population as a whole. 

The focus on obesity in the EHR incentive program indicates an appreciation for the significance of preventing and treating obesity.  As the Administration releases rules and regulations related to ARRA and the Affordable Care Act, we hope to continue to see the recognition that addressing obesity is an essential part of improving the health of our nation.