Beyond BMI: a feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMRs)

Introduction: Primary care providers have a role to play in supporting the development of healthy eating habits, particularly in a child's early years. This study examined the feasibility of implementing the NutriSTEP (R) screen-a 17-item nutrition risk screening tool validated for use with both toddler and preschooler populations-integrated with an electronic medical record (EMR) in primary care practices in Ontario, Canada, to inform primary care decision-making and public health surveillance. Methods: Five primary care practices implemented the NutriSTEP screen as a standardized form into their EMRs. To understand practitioners' experiences with delivery and assess factors associated with successful implementation, we conducted semi-structured qualitative interviews with primary care providers who were most knowledgeable about NutriSTEP implementation at their site. We assessed the quality of the extracted patient EMR data by determining the number of fully completed NutriSTEP screens and documented growth measurements of children. Results: Primary care practices implemented the NutriSTEP screen as part of a variety of routine clinical contacts; specific data collection processes varied by site. Valid NutriSTEP screen data were captured in the EMRs of 80% of primary care practices. Approximately 90% of records had valid NutriSTEP screen completions and 70% of records had both valid NutriSTEP screen completions and valid growth measurements. Conclusion: Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration.