Abstract
The release of the new practice guidelines for blood cholesterol in 2013 has placed an increased emphasis on the importance of lifestyle medicine to reduce cardiovascular risk. This may lead more patients and health care professions toward the adoption of lifestyle medicine practices. Documenting lifestyle medicine practices will soon emerge as an important component of the success of lifestyle medicine practices and ultimately patient outcomes. This article briefly discusses lifestyle medicine vital signs, charting lifestyle medicine, and the importance of electronic medical records in the communication of lifestyle medicine practices.
‘Documenting an individual’s lifestyle medicine activities is an important component of a lifestyle medicine program.’
In late 2013, the long awaited and much anticipated new treatment guidelines for blood cholesterol was published jointly by the American College of Cardiology (ACC) and American Heart Association (AHA). 1 In conjunction with these guidelines, the ACC and AHA also published new guidelines on lifestyle management to reduce cardiovascular risk. 2 Among other important treatment recommendations from the ACC/AHA, these new guidelines sent a clear message to health care providers and the public regarding the importance of lifestyle behaviors related to cardiovascular risk. As with all treatment guidelines, the widespread adoption and implementation aspect can be more challenging than synthesizing the evidence to write the guidelines. One important component that is often overlooked when discussing enhanced adoption of lifestyle medicine is documentation.
Documenting an individual’s lifestyle medicine activities is an important component of a lifestyle medicine program. Similar to other types of important medical information, lifestyle medicine specific data should be documented to provide a historical record of an individual’s past lifestyle medicine experiences, track progress, and to allow other members of the health care team to be fully informed about all treatment modalities. Unfortunately, most lifestyle medicine activities are only minimally recorded in a standard medical chart or not recorded at all.
Lifestyle Medicine Vital Signs
In a typical medical chart, a patient’s vital signs such as height, weight, blood pressure, heart rate, and respiratory rate are routinely recorded. Although unconventional in current practice settings, lifestyle medicine vital signs are also important to record—especially for those with a chronic disease. Tobacco use, alcohol use, and illicit drug use are all lifestyle medicine related vital signs and may currently be found in medical records. Effective documentation of lifestyle habits, however, should go well beyond these commonly recorded vital signs.
Vital signs are used to obtain a snapshot of important information about a patient. Briefly listing several lifestyle medicine related activities, such as those noted below, can serve the same purpose as traditional vital signs and provide a complete picture of a patient’s progress in managing their specific chronic disease(s): physical activity and purposeful exercise; eating habits (eg, fruit/vegetable, whole grain consumption); sleep (quantity and quality); stress level, emotional well-being; and stress reduction activities (eg, meditation). Other lifestyle medicine vital signs may also include body mass index and waist circumference measurements; barriers to implementing lifestyle medicine activities; social framework at home, workplace, and in the community; and life meaning and purpose (eg, religious beliefs).
Charting Lifestyle Medicine
A traditional medical chart contains information about a patient such as health history, medications, procedures, lab data, and progress notes. Additional information about a lifestyle medicine program could additionally include the following:
Lifestyle medicine program details. This section can include initial baseline testing, goals, and specific program details for physical activity, healthy eating, sleep success, stress management, alcohol consumption, and smoking cessation.
Lifestyle medicine progress note. A traditional progress note contains Subjective, Objective, Assessment, and Plan (S.O.A.P.) information documented each time a patient visits with his or her health care professional. This note could be redesigned to add lifestyle medicine information to the S.O.A.P. format.
Quality of life questionnaire data. Quality of life data could be assessed at baseline and on an annual basis to measure the impact of the lifestyle medicine program on self-perceived health.
Patient self-reflection goals. An important part of a lifestyle medicine program is the engagement of the patient. Goal setting exercises that are driven by the patient will help improve adherence and build a sense of ownership through a patient-centered experience.
Nutrition and physical activity diary records. The medical chart could serve as a repository for nutrition and physical activity diary information. A summary of the diary information may be needed if a paper diary is used because of the amount of information that would need to be stored. If an electronic diary is used, the information could be uploaded to an electronic medical chart if possible.
Computer-generated nutrition analysis. Information from a nutrition diary can be uploaded into a nutrition analysis software program to provide specific dietary information such as carbohydrate, fats, protein, fiber, sodium intake, and more.
Lifestyle journal data. A lifestyle journal can be used to track daily lifestyle-related habits. Like a nutrition and physical activity diary, the information can be summarized or stored electronically in an electronic medical record.
Paper and Electronic Charting
The documentation of medical information continues to move to an electronic medical record format, which brings tremendous opportunities for documenting lifestyle medicine activities—especially for those with chronic diseases. Many electronic applications (apps) available on smartphones and other mobile devices have been developed to record lifestyle medicine–related data. Some of these apps are more comprehensive in nature and are referred to as personal health records. An integration of personal health record data and electronic medical record data may provide a robust document that focuses on lifestyle medicine activities for the treatment of chronic diseases. If such a document were available where all members of a lifestyle medicine team and the patient had access, communication and overall care for chronic diseases may improve.
Conclusions
Lifestyle medicine is one of the few disease prevention and treatment modalities that crosscut every health care profession. In fact, the practice of lifestyle medicine has the potential to be the gold standard in interprofessional patient care. As the practice of lifestyle medicine continues to evolve and more health care professionals begin to work with patients to implement lifestyle medicine practices, communication between health care professionals will emerge as a critical component of the patient’s success. Establishing generally accepted methods of documenting and sharing lifestyle medicine practices is important to this end. Adopting concepts such as charting lifestyle medicine vital signs may be a good place to start. Challenges exist with sharing medical information between health care providers, but the forward progress of electronic medical records can narrow this gap in the future.