Implementation Of The Physical Activity Vital Sign In An Electronic Health Record: Experience In An FQHC

PURPOSE: To implement the Exercise is Medicine (EIM) Physical Activity Vital Sign (PAVS) into the GE Centricity electronic medical record (EMR) of federally qualified health centers (FQHCs) in New Hampshire without reducing clinician productivity levels or practice income. METHODS: Three FQHCs participated, all part of the same Health Center Controlled Network and use the same EMR. A workgroup including clinical staff, EMR administration staff and quality improvement staff developed the implementation and roll out plan. A suitable location within the EHR was selected to create the PAVS screening fields. Training materials for clinical staff were developed for PAVS use and interpretation. Referral entries were created for the Granite YMCA central referral fax line in the computerized order entry system. Training materials were developed for the referral processing team for order processing and follow-up. CPT coding reference materials were created for the billing teams to include time-based calculations for physical activity claims processing workflows. User interface testing was done with clinical staff prior to rollout and where possible existing physical workflows were identified and emulated to make implementation minimally disruptive and to reduce the need for process specific training. RESULTS: In the first 12 months after implementation, 1,372 (11%) of patients with any medical visit received the PAVS screening. Since implementation there was no significant reduction in provider productivity as measured by the average appointments per hour or average appointment income to the 12 months prior to implementation (1.73 patients/provider/hour in 2023 vs 1.57 in 2022 and $160.31 in 2023 vs $156.84 in 2022, respectively). Computerized patient referrals to physical activity programs resulted in 100% delivery rate for referrals entered by providers. Providers reported overall satisfaction with the implementation at 6 months and 12 months. CONCLUSION: Providers at the FQHC clinics were able to screen for physical activity, diagnose physical inactivity and make referrals to YMCA based physical activity programs. Importantly, there was no reduction in daily productivity measures or discontent with the design and implementation process. CDC Grant NU58DP006448