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IT’S TIME TO MOVE

A historic project to make physical activity assessment, prescription, and referral a standard of care in the U.S. healthcare system.

Last Updated: 08 Nov 2022

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Mission

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The mission of the Physical Activity Alliance is to lead efforts to create, support, and advocate policy and system changes that enable all Americans to enjoy physical activity lives.

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Vision

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We envision an active and healthy nation where the opportunity for physical activity is easily available in the daily lives of all Americans.

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Key Projects & Initiatives

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One of our Key Initiatives

  • It’s Time to Move Campaign
    • A multi-year project that will empower health care providers to seamlessly integrate physical activity clinical measures into patient care plans and help make physical activity prescription a standard of care.

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    • Our action plan will engage the HL7 process, the Office of the National Coordinator, Centers for Medicare and Medicaid Services, the American Medical Association, NCQA/NQF and other key stakeholders.

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PAA Multi-Stakeholder, Multi-Pronged Action Plan

HL7®– Measure Standardization

Centers for Medicare and Medicaid Services (CMS) – Coverage Determinations

American Medical Association (AMA) - CPT® codes

National Commission on Quality Assurance (NCQA) – Quality and Performance Measures

Office of the National Coordinator (ONC) – Integrating measures for PA assessment into the US Core Data for Interoperability

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Three Work Streams

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Project Timeline as of 1/10/23

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Important Links for the Project

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Core Measures

  • Muscle Strengthening Activity
    • As part of an average week, on how many days does the patient perform muscle-strengthening activities such as weight or resistance training?
  • Aerobic Physical Activity:
    • For an average week in the last 30 days, how many days per week did the patient engage in moderate to vigorous exercise (like walking fast, running, jogging, dancing, swimming, biking, or other activities that cause a light or heavy sweat)?
    • On those days that the patient engages in moderate to vigorous exercise, how many minutes, on average, do they exercise?
    • Mutiply days*minutes to obtain total minutes of moderate to vigorous physical activity/week.

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These standards are validated in the peer-reviewed literature, and are aligned with the 2018 U.S. Physical Activity Guidelines for Americans.

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Coleman KJ, Ngor E, Reynolds K, Quinn VP, Koebnick C, Young DR, Sternfeld B, Sallis RE. Initial validation of an exercise “vital sign” in electronic medical records. Med Sci Sports Exerc. 2012;44:2071–2076. doi:10.1249/MSS.0b013e3182630ec1

Harris C, Watson K. A data users guide to the BRFSS physical activity questions: How to assess the 2008 Physical Activity

Guidelines for Americans. Atlanta, GA: CDC; 2011.

US Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. 2018.

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The following LOINC codes correspond to components of the proposed measures�

89555-7 – Physical Activity – Days/Week - http://loinc.org/89555-7

�68516-4 – Physical Activity – Minutes/Day-http://loinc.org/68516-4

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82291-6 – Physical Activity – Muscle-Strengthening-http://loinc.org/82291-6

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Supporting Measures

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Supporting Measures

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United States Core Data for Interoperability

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  • Developed by ONC as a result of the Cures Act
  • USCDI elements – basic data points all EMR/EHR are expected to support
    • Facilitate healthcare information exchange
  • Levels denote importance
    • Comment (least important)
    • Level1
    • Level2 (most important) 🡪 included in new USCDI version 4 draft

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Physical Activity Status in the USCDI

  • Submitted application Sept 2022 – Received an aggregate Level 2 status score upon re-review

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  • On January 12th, PA assessment was included in the draft USCDI v4

ONC Health IT Standards Bulletin Issue 2023-1

| Interoperability Standards Advisory (ISA) (healthit.gov)

  • 20 new out of 150 submitted data elements were included in this draft version

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  • Will participate in public comment opportunity in Jan/Feb 2023
    • Final USCDI v 4 is expected to publish in July 2023

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  • To continue to strengthen our application:
    • Complete and publish our FHIR Implementation Guide in HL7
    • Show implementation and uptake and health information exchange between health care systems and providers

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Other activities

  • Upcoming meeting with NCQA to brief them on our HL7 work

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  • Participated in the September 2022 White House Conference on Hunger, Nutrition and Health
    • Submitted a letter to inform the National Strategy
    • Have been briefing the White House on our progress

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Questions/Discussion

Laurie Whitsel, Ph.D.

National Vice President of Policy Research and Translation

Senior Advisor-Physical Activity Alliance

American Heart Association

Laurie.Whitsel@heart.org

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Paul Chase, Ph.D.

Project Manager – It’s Time to Move

American Heart Association

Paul.Chase@heart.org

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Lloyd McKenzie

Management Consulting

lloyd@lmckenzie.com

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