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Nutrition Informatics Blog

BMI Measurement - Electronic Qualities

(HITECH Overview and Updates) Permanent link   All Posts

The HITECH Act, as you may know, provides financial incentives for certain Medicaid and Medicare eligible providers to adopt and prove that they “meaningful use” electronic health records.  ADA has made recommendations to HITECH regulations which impact anyone using health information technology under this program.  During Stage I of the program, which is occurring now, the Centers for Medicare and Medicaid (CMS) accepted several of ADA’s recommendations. Below are two of the recommendations taken:

Body Mass Index (BMI)

Providers are required to enter height and weight into their EHR for individual patients.  Certified Electronic Health Records are required to calculate this into BMI.

Adult Weight Screening & Follow-up (PQRI 128/NQF 0421)

ADA also recommended PQRI 128/NQF 0421 (Adult Weight Screening and Follow-Up) as a Core Quality Measure.  This means EVERY provider must report they are meeting a threshold of this measurement in their patients or not receive incentive payments.  This measure is one of three core quality measures required (blood pressure measurement and tobacco screening being the other ones.) Likewise, there are three alternate measures which can be used if the three above are not relevant.  The substitution for PQRI 128/NQF 0421 is NQF 0024 Weight Assessment and Counseling for Children and Adolescents.

The next step is to identify specific data elements which must be consistent across all EHRs so that “data can follow the patient.”  The Office of the National Coordinator’s Standards and Interoperability Framework has work underway to do just that.  ADA is participating in this effort. 

If you have experience using either of these two (BMI or PQRI 128/NQF 0421) in an electronic format (EHRs, Personal Health Records, patient registries or health information exchanges) please share your experiences, as now is the time to help create best practices for electronic standards!

We have used an EHR for 5 years or more. Like other electronic databases, accurate data entry is crucial for accurate calculation of BMI. Patients' readings vary depending on factors like fluid shifts & which nurse or aide weighed them. Staff need continual training on how to weigh & measure accurately.
Posted by: Jane Thompson( Visit ) at 12/1/2011 7:38 AM

Is this for inpatient or outpatients?

I am glad to see that there are some quality measures related to nutrition. I do think that BMI should include a subheading to note when a patient has edema or abdominal fluid that may be affecting their weight status.
Posted by: Megan Waltz at 12/1/2011 9:06 AM

We have used an EHR for years but only recently has it calculated the BMI. Height and weight must be entered at the same time in order for BMI to be calculated by the EHR. Stated weights are problematic. We enter adjusted dry weights for patients with hydration issues so we don't over or under state patient BMIs.
Posted by: Jan Greer-Carney at 12/6/2011 12:39 PM

Thank you for your comments--yes there ate multiple variables which impact the use of BMI and dietions are great at sizing up the outliers. Since we want this data to move to all providers and via all electronic media, it is important to have a specifice description of BMI. Since it is calculated now in EHRs, there are other attributed which much be linked with that measurement as the "data follows the patient". (Such as the date/tme of the measurement, self-reported or clinician measured, etc.)
Posted by: Lindsey Hoggle at 12/7/2011 8:24 AM

Hi Jane and Megan,
These are great comments and insight! Part of the clarification of BMI for use in digital systems is the need for "clarifiers", such as your comment on edema, whether the patient has an amputation, or any other symptom or condition that would affect the BMI. One situtaion which sometimes comes up is a high BMI in a patient who trains/exercises regularly. Their body weight is higher due to more muscle mass so the BMI may reflect overweight status when in fact, that is not the case. Thank you for contributing--these are helpful discussions and I would love to hear more.
Posted by: Lindsey Hoggle at 12/9/2011 8:37 AM

To answer your question--these are basically ambulatory measures, but since EHRs are required to calculate BMI, it will be present in some non-ambulatory systems. Since the end goal is that "data follows the patient", then data created in one system should show up downstream in the patients record.
Posted by: Lindsey Hoggle at 12/9/2011 8:42 AM

We are finding that heights are not measured and may be inconsistent over several hospital admits, where you will see a different heights entered. Heights may be estimated by the RN or stated by the patient and so are inconsistent. We usually try to address this if possible to then provide a more realistic BMI. I work in the hospital setting of a medium community hospital. We also, address fluids, amputations, or anything else that may be pertinent.
Posted by: Helen Jackson at 12/21/2011 8:50 PM

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