Writing Behavioral Change Prescriptions in an EHR
By admin | Popularity: 3%As part of our work to promote more effective preventive care and health promotion, we are experimenting with various ways to best leverage information therapy. One idea centers on the systematic use of behavioral change “prescriptions” (ie. exercise and nurtition) to activate patients. Exercise prescriptions have been well-described in the literature and an early example of customized patient centered information therapy.
The Rx format elevate the importance of lifestyle changes for both the provider and the patient. Since the instructions are patient specific and customized to a patient’s interests & motivational stage, they could be a useful tool for clinicians to activate patients more effectively. Operationally, since prescriptions are a part of a typical visit workflow, writing exercise prescriptions can help integrate exercise/nutrition counseling into the usual flow of the visit.
One of the challenges of behavior change prescriptions is how best to support them within our EMR system. Inclusion of these non-pharmaceuticals as prescriptions can lead to unintended downstream consequences - like cluttering medication lists used in SmartText. Conversely, having these as prescriptions may reinforce regular review of patient lifestyle and piggybacks on existing medication reconciliation systems. Medications can also be reviewed on the MyChart patient portal. Finally, having exercise/nutrition Rx does allow us to centrally track specific actions around exercise and nutritional support for patients (ie how many patients with BMI > 30 received an exercise Rx in 12m).
As we consider how to pilot the use of these prescriptions, we continue to search for operational and IT alternatives. We have considered embedding them into our After-Visit-Summaries, yet concerned that it perhaps loses some of its “influence” when not in the expected Rx format. Any suggestions would be welcome!
Joe
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January 13th, 2008 at 2:44 pm
Hi Joe,
Great topic of discussion!
You want to elevate the physician’s recommendation for behavior change to the level of ordering a medication. Just as Ix is intended.
You are asking how to operationalize that in a comprehensive EHR system. Do you use the area that is intended for patient instructions, or do you use the area that is intended for ordering meds?
If there’s a way to do this to convey the same amount of influence in the part of the EHR that is designed for patient instructions, maybe we can help you figure that out. Is there a way to put a physician order here that is as valid to the patient as if it was entered into the “physician order entry” system?
Can you comment back with the kind of prescription you would write, and then we can ask the audience here (who are all patients) their thoughts, as to which process conveys the most influence, which I think is what you want.
Josh can also comment on what he knows from the literature about form of Ix - must it be identical to a medication prescription or are there features of Ix that make it as powerful without actually being entered as a medication order.
January 14th, 2008 at 4:02 pm
In response to Ted’s specific question (”the literature about form of Ix - must it be identical to a medication prescription or are there features of Ix that make it as powerful without actually being entered as a medication order”), there’s not very much in the literature to answer the question directly.
However, the peer-reviewed literature and other scientific surveys of consumers make it clear that people want to get specific information recommendations ideally directly from their clinicians. From that body of evidence, I think it’s a fairly safe assumption that an after-visit summary with specific health content/patient education links will not only be very popular with patients, but likely will drive some degree of action.
To be more specific, other research makes clear that the degree of action depends on the degree to which the system or clinician can make the content targeted to the patient’s particular moment in care and tailored to their specific characteristics (e.g., learning style, delivery preferences, readiness to change, etc.).