Challenges and strategies for implementing decision support technology to a national audience

Background The prevalence of obesity and related chronic conditions in children has dramatically risen over the past four decades. National panels of experts have developed recommendations for obesity prevention that provide a comprehensive review of the current evidence on maintaining healthy weight in children and incorporates the use of motivational interviewing to collaborate with families on a plan of care. However, past research suggests that publication of guidelines rarely changes practice. HeartSmartKids™ (HSK) is a bilingual kiosk, HIT system with clinical decision support that generates tailored patient education materials that embeds the guidelines into daily practice. HSK compares lifestyle information to current recommendations. Standard growth charts are generated, and relevant health risks are highlighted in the HeartPrint, a summary of the child's risk factors.

Purpose The purpose of this presentation is to describe the implementation of HSK system into 12 practice sites in 6 states. The AHRQ funded study uses technology decision support to guide evidence-based care, to prompt providers in the use of motivational interviewing, and to provide tailored patient education materials.

Methods This study is a comparative effectiveness trial of implementing obesity guidelines in school-based health centers with and without technology decision support. We have implemented the technology nationally without local research team members. The challenges, barriers, and strategies used to overcome challenges will be presented.

Results Challenges included the lack of existing IT infrastructure, limited provider IT skills, provider discomfort with IT, and resistance to change. Strategies employed to overcome challenges included a team approach, a practice flow assessment, multi-modal training options, telephone coaching, remote desktop capabilities, and providing technology completely reconfigured and ready to go.

Conclusions Remote implementation of technology decision support is possible with careful planning, and a dedicated team to overcome barriers.