Health Level Seven International (HL7), a global network of health care databases, has formally approved a Physical Activity Implementation Guide adding physical activity as a vital sign and enabling referrals between exercise professionals and health care professionals.

This is a major milestone on the road to establishing exercise professionals as a critical part of the health care team and adding physical activity as a standard vital sign in health care delivery- two fundamental tenets of ACSM's global health initiative, Exercise is Medicine®.

• Over the last 18 months, The Physical Activity Alliance (PAA) has been working with leading experts and board level organizations, including ACSM/EIM to develop our HL7 FHIR Implementation Guide that standardizes measures for PA assessment, prescription and referral in health care delivery. 
• In early May, the Physical Activity Implementation Guide (IG) passed through another major milestone by getting through its first HL7 balloting process.
• The expert work group is working with its technical consultant to review and reconcile comments received; which will need approval from the IG’s HL7 sponsoring work groups before it can be published.
• The first publication of the IG (by the Fall of 2023) will be considered a “standard for trial use”, which means the work group will shift resources and efforts toward catalyzing implementation and uptake, as well as refining the IG.
• The trial use period will take an additional 2-3 years of increasing implementation and uptake, and will go through two additional balloting cycles before it is considered a “normative” standard implemented throughout the US health care system.

Physical Activity as a Vital Sign

HL7 facilitates the transfer of clinical and administrative data between health care systems, enabling seamless communication between health care providers, institutions and systems. This is the first step in assessing a patient’s need for physical activity, including a referral to a certified exercise professional. The PAA has also applied to the Office of the National Coordinator (ONC) to have physical activity assessment included as a  part of the US Core Data for Interoperability Standards (version 4). ONC did include it in the draft which has been out for public comment and review by their advisory committees. The committees recommended to keep physical activity in the final version which will be published in July 2023. 

Exercise Professional Referral Framework

The HL7 Physical Activity Implementation Guide provides the mechanisms for patient referral to exercise professionals and outcome-based physical activity and exercise programs. The US Registry of Exercise Professionals (USREPS) is integrated into the referral framework and will be used to positively verify exercise professionals, including ACSM-certified exercise professionals, as qualified and in good-standing. The registry will also serve as the reference for registered exercise professionals who will receive referrals from health care providers.

The framework encourages health care providers to refer patients to exercise programs delivered by qualified exercise professionals. Doing so will improve population health by promoting physical activity and reducing the prevalence of diseases associated with a sedentary lifestyle. Additionally, exercise programs are a cost-effective intervention with long-term benefits in reducing health care expenses.

With the formal support of HL7, ACSM and EIM will continue their collaboration with the PAA and CREP to complete the development and implementation of these priorities in the months ahead. 

For more information, contact ACSM Vice President of Government Affairs Monte Ward.