Evaluation of an electronic health record-supported obesity management protocol implemented in a community health center: a cautionary note

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In this study done by Stieglitz, et al (2015) [1] an obesity protocol and form was integrated in the EHR for the implementation of Evidence-Based Medicine. There is an epidemic for obesity among children and adults. However, according to this author many studies indicate that this health issue is not being adequately addressed in the primary care setting. Therefore, this study targets the adult patients in practices such as the Federally Qualified Health Centers. The purpose is to integrate into the EHR the implementation of 5A's based intake protocol and EHR weight management form designed to assist clinicians in identifying and managing adult obesity. [1]

5A's Intervention in Adult Obesity

  • Ask
  • Assess obesity
  • Advise weight loss
  • Agree on behavior change
  • Assist in developing action plan [1]

Materials and Methods

The study compared those patients outcomes among those who were exposed to the EHR obesity form (case group) versus those who were not exposed to the EHR form (control group). The materials used were the integration of a button that facilitated the inclusion of obesity into the EHR problem list. In addition, a check list of behavior change goals was added to the EHR problem list. In addition, four interventions were evaluated in this study for adult obesity. 3 approaches were taken to examine the implementation of 5A's protocol.

  • Clinician Study: 40 clinicians that served low-income Hispanic adults were included into the study. 12 respondents were surveyed 6 months before and after the integration of the protocol obesity form. The survey consisted in 52 item questions that focused on how often the clinicians assessed weight management in a patient. The responses from the clinicians were positive stating that this protocol facilitated the identification of obesity in adult patients.
  • Population Study: The whole population at the FQHC was evaluated extracting the recorded BMI entries during the 6 month pre and post period of intervention.
  • Exposure Study: The obese (46 cases) patients exposed to the EHR form were compared to the matched obese (control) patients not exposed to the form. EHR records for these patients were evaluated for demographics and outcomes. Some variables taken into account were age, sex, weight and BMI. [1]


Many clinicians reported improvement in the identification of obese patients in the FQHC health centers. The study showed potential to improve clinicians confidence and care practices regarding obesity. In contrast, barriers were found in reaching out to the whole population. Some of the barriers for the implementation and intake of the protocol EHR form were the following:

  • complex navigation to locate the form in the EHR
  • minimal training
  • time required to learn and use the form
  • lack of time of nurses or medical assistants in entering patients weight and height


This study provides evidence that the EHR intervention guided by the 5A's prompts the clinician and staff to assess and counsel obese adult patients. Clinicians may be easily prompt to provide weight loss counseling, facilitate their assessments on diet, exercise and diseases related to obesity. [1]


The implementation of evidence-based medical guidelines for identifying adult obesity in adult patients integrated into the EHR will enhance early diagnosis, early treatment, disease prevention and reduce medical errors.

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  1. 1.0 1.1 1.2 1.3 1.4 Evaluation of an electronic health record-supported obesity management protocol implemented in a community health center: a cautionary note, http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/?term=Evaluation+of+an+electronic+health+record-supported+obesity+management+protocol+implemented+in+a+community+health+center%3A+a+cautionary+note, Steglitz, J., Sommers, M., Talen, M. R., Thornton, L. K., & Spring, B. (2015). Journal of the American Medical Informatics Association, ocu034