The EIM solution describes an approach to activating Exercise is Medicine^® through partnerships between local health care systems/medical practices and community fitness resources, building a “bridge of trust” for coordinated care.  

Patients are more likely to be referred for exercise guidance and to engage in recommended levels of physical activity when health care systems and community fitness enterprises work together, developing smooth referral and communication pathways. The goal is to implement physical activity interventions that will slow, stop and reverse the progression of chronic diseases.  

The adoption of Population Health Management strategies by health care stakeholders has created a significant opportunity for physical activity to be established as a standard in health care. Population health seeks to identify and invite groups of patients with similar diagnoses or medical challenges to participate in a healthy lifestyle or physical activity intervention. The objective is to improve health outcomes, cost-effectiveness and care coordination. Changing reimbursement models (the transition from volume-based to value-based care) and the consolidation of health systems will accelerate the adoption of this model.   

An EIM solution requires the commitment of collaborating health care and community leaders and champions and is achieved by:

• Assessing physical activity levels of each patient at every clinic visit. The most effective way to accomplish this is to embed a “Physical Activity Vital Sign (PAVS)” into electronic health records (EHRs).
• Providing patients with brief advice about physical activity and/or an exercise “prescription” tailored for their specific medical conditions.
• Referring patients to appropriate physical activity resources, such as an evidence-based physical activity program led by qualified professionals. (Some patients may benefit from physical therapy or cardiac rehabilitation programs before being referred to a generalized exercise program.)

EIM Greenville is a multidisciplinary team of stakeholders from a local health system, university, medical school and YMCA in Greenville, South Carolina that has successfully implemented an EIM solution. EIM Greenville has developed a comprehensive toolkit and offers consulting services that can be purchased by interested health care systems and community partners. Contact eim@acsm.org for purchasing details. 

Three different domains are essential in bringing about the vision of EIM:

1. Health Care Systems and Providers. Health care providers include physicians, nurse practitioners, physician assistants, nurses, physical therapists and others working together to provide optimal care and disease prevention. With the assistance of tools embedded in the EHR, providers can more easily integrate physical activity assessment and promotion into routine clinical care. Other members of the health care team play a critical role in creating a smooth workflow for EIM, including physician extenders, medical assistants and front desk staff. See EIM resources for clinicians.

2. Physical Activity Resources: Places, Programs and Professionals. Community partners can serve as an extension of the health care team through qualified exercise professionals and evidence-based programs.

• EIM Places should be conveniently located for patient access. They employ qualified fitness staff, provide safe and effective physical activity programs/services, and meet facility safety standards. 
• EIM Programs should be customized according to participants’ specific chronic disease(s), risk levels, physical and motivational readiness and personal preferences. Evidence-based interventions may include:
  • Small group-based exercise and lifestyle modification programs
  • Individually guided exercise training and behavioral support
  • Self-directed programs
• Exercise Professionals with the EIM Credential and/or clinical certifications (from NCCA or ISO/IEC 17024 accredited organizations like ACSM), can provide referred clients with tailored exercise, education and behavior modification guidance. See EIM resources for exercise professionals.
  • The EIM Credential is a designation signifying competence in the area of exercise prescription for patients who have chronic diseases and other co-morbidities. 

3. Digital Health Technology. Health care systems have a wide spectrum of technologies that can be used to accelerate the successful integration of healthy lifestyle interventions. These technologies allow for integration of the physical activity vital sign and referral pathways, identification of patients who would benefit from lifestyle interventions, and tracking patient data. Examples include: 

• Electronic health record (EHR) systems
• Population health management (PHM) applications
• Patient-centered medical home (PCMH) applications
• Health information exchanges (HIE)

On the community/fitness side, there has been an explosion in technology platforms, devices, and applications to facilitate activity tracking, promote participant engagement and monitor outcomes.