HSK was born from a practitioner’s frustration with addressing childhood obesity risks at well-child visits in a Denver clinic. New charts, guidelines, risk research, and counseling required combining a great deal of information quickly. In order to be well prepared for a visit a doctor or nurse practitioner required many minutes of math and graph work, performing measurements, asking about behaviors, and seeing the child in the exam room. This made it difficult to identify actual or potential health problems and provide guidance.
Inefficient use of time at a well-child visit is a lost opportunity to focus on the child’s present and future health. Well-child encounters are more frequent early in the child’s life, when development of protective and risk factors are also most active (see Halfon and Hochstein model). A study of time allocation in well-child visits did not bode well for addressing risks to lifelong cardiovascular health. LeBaron et al (1999) found the median primary care provider encounter time was about 16 minutes.
We realized that computerization of the screening, documentation, and graphing system would greatly enhance the speed and accuracy of a practitioner’s work. Modernization also had the potential to incorporate more relevant data on cardiovascular risk while involving children and families in the process - moving toward a patient-centered model. We set out to create a system that would combine patient data on diet, sedentary and physical activity, family history and smoke exposure with the routine office measurements of weight, height, and blood pressure. The result is a powerful tool to improve the care and advice our patients receive. The alarming data on increases in child and adolescent overweight prevalence, the lack of cost-effective interventions for weight reduction, the predictive value of childhood weight problems, and long-term implications for adult health and health care costs make this issue worth the extra effort and attention.
In the past several years the American Heart Association has published a series of scientific statements which put this issue in a more comprehensive childhood and community cardiovascular context (see Eckel, Williams, Kavey, Pearson, St. Jeor, Daniels, et al, 2002-2005). The HeartSmartKids system links the science to the child, clinician, and community. Jointly we can assess risks and identify resources in a cost-effective manner.
Following the success of the HeartSmartKids system in creating better conversations about childhood obesity, clinics demanded an extension of the same system to other health conditions. Thus the HSK approach was extended to screen for depression, child behavior issues, and much more. All of these conditions benefit from a similar concept - that a good conversation can be the start of anyone’s journey to be healthier.