How to Read a Pediatric Reminder/Guideline Document

Clinical Condition, Clinical Indications, Due/Overdue Status

(e.g., Obesity, (BMI>95%), Overdue for lipid profile)

Clinician Summary

The aim of this section is to provide clinicians with a description of the reminder and when the EHR will trigger the reminder to be presented to a clinician for review/action.

Some reminders have a number of triggering conditions, such as:

10 ≥ Age ≤ 18; and
BMI>95% at least once within the last 24 months; and
Most recent LDL is older than 24 months; and
Most recent total cholesterol is older than 24 months; and
Patient has a recorded height and weight within the last 24 months.

References

This section lists the clinical guidelines, medical society consensus statements, and other documents that form the basis of why the reminder was selected for inclusion in the EHR system.

Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000 Mar;23(3):381-9.
Prevention of Pediatric Overweight and Obesity. Pediatrics. 2003 Aug;112(2):424-430.
Obesity Evaluation and Treatment: Expert Committee Recommendations. Pediatrics. 1998 Sep;102(3):e29.

Web Links

This section provides links to documents and Web sites that provide additional details on the clinical relevance of the reminder.

American Academy of Pediatrics
http://pediatrics.aappublications.org/content/112/2/424

Bright Futures
http://brightfutures.aap.org/clinical_practice.html

Implementation Notes

This section provides notes for those who wish to implement the reminder in their local EHR system.

Rule category	Obesity
Rule title	Obesity, high BMI, Overdue for lipid profile
Primary Clinical Area	Pediatrics
Secondary Clinical Area
Risk Group Definition	age ≥ 10 yrs AND age ≤18 yrs AND BMI >95%
Details for Risk Group	BMI % calculated flowsheet
Triggering Condition	Most recent total cholesterol ≥ 24 months AND most recent LDL ≥ 24 months AND Last record of BMI < 24 months
Details for Triggering	LDL, total cholesterol, For BMI, the most recent height AND weight must be within the past 24 months.
Condition	If either height or weight is more than 24 months old, patient does not belong to this risk group.
Displayed Message	Patient’s BMI >95%. Consider lipid profile every 1 to 2 years.
Coded Responses These options are presented to providers to allow them to indicate the action or response to the reminder.	Snooze Periods The time interval during which the reminder will not fire again, given the coded response.
A: Done/Scheduled B: Patient Refuses C: Deferred D: Other E: Done elsewhere F: G:	A': 2 years B': 6 months C': 3 months D': 1 month E': 2 years F': G':

Disclaimer

This section cautions clinicians that guidelines and reminders change over time, requiring period updates. Furthermore, clinicians should carefully examine reminders before implementing them to ensure they are appropriate for the local patient population.