title: Presentation of body mass index within an electronic health record to improve weight assessment and counselling in children and adolescents.
abstract: BACKGROUND
  Assessment of weight and counselling on nutrition and physical activity is infrequently conducted during well child visits, despite recent expert recommendations.
  
  
  OBJECTIVE
  We investigated whether automatic calculation of body mass index (BMI) in an electronic health record improved assessment of weight and counselling on nutrition and physical activity.
  
  
  METHODS
  Retrospective review of well child visit records of children between two and 18 years of age (n =550) before and after implementation of an electronic health record system at an academic medical centre's paediatric clinic. Body mass index was automatically calculated and presented within the electronic health record. We measured clinicians' documentation of assessment of weight status, and assessment of and counselling for nutrition and physical activity risk factors.
  
  
  RESULTS
  Documentation of assessment of BMI and weight status did not increase. There were no consistent increases in assessment for or counselling on specific nutrition and physical activity behaviours, except with respect to high calorie food intake. Although overall assessment of physical activity decreased, physical activity counselling significantly increased. Documentation of the presence of high-risk family history increased significantly; the provision of counselling for high-risk family history did not show any corresponding increase. Patients with higher BMI percentile scores were more completely assessed for weight status. Completeness of weight status assessment was associated with increased counselling for nutrition and physical activity.
  
  
  CONCLUSIONS
  Passive changes, such as automatic calculation of BMI, are insufficient to result in systematic improvements in assessment of weight and counselling for nutrition and physical activity.
authors: Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA. ushaikh@ucdavis.edu
authors: Ulfat
authors: U
authors: Shaikh
authors: Rachel
authors: R
authors: Nelson
authors: Daniel
authors: D
authors: Tancredi
authors: Robert S
authors: RS
authors: Byrd
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002140:California; D002648:Child; D053198:Child Nutrition Sciences / Q000193:education; D002675:Child, Preschool; D003376:Counseling / Q000639:trends*; D057286:Electronic Health Records; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000639:trends; D006801:Humans; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012044:Regression Analysis; D012189:Retrospective Studies