You may have heard of e-prescribing, the electronic generation and transmission of medical prescriptions, but have you heard of Park Prescription (Park Rx)?

Park Rx is a public health initiative propelling healthy communities, and it’s worthy of the spotlight. It is a program under the National Park Service’s (NPS) Healthy Parks Healthy People US initiative. At its core, Park Rx fosters a unique patient-provider relationship where providers talk with patients about “how” to get on an exercise routine and effectively use their neighborhood parks to do fun physical activities most appealing to them. That’s right—health care providers are prescribing a healthy dose of nature by way of our national and local parks.

This piece is especially timely this week because we at ONC are happily commemorating National Public Health Week (April 7^th – 13^th), a time for public health and clinical health professionals to promote ways for individuals and communities to stay healthy and safe. And through programs like Park Rx, we can see how health IT is being used to combat epidemics of chronic disease.

NPS Director, Jon Jarvis, Dr. Maria Cristi Rueda and Dr. Robert Zarr with a young patient holding a copy of her park prescription.

DC Park Rx

Dr. Robert Zarr is a practicing primary care pediatrician at Unity Health Care’s Upper Cardozo Community Health Center here in Washington DC, and physician champion of DC Park Rx. Over 40% of Unity’s adult patients are obese, 25% of pediatric patients are obese and another 20% are overweight. These were the problems Dr. Zarr faced and sought Park Rx to be part of the solution plan. Unlike all other Park Rx programs which has participation in cities such as San Francisco, San Diego, Houston, and Philadelphia, Dr. Zarr has fully integrated Park Rx into Unity’s EHR system, and the existing workflow across the practice to make park prescribing easy for everyone.

How exactly does DC Park Rx work at Unity? Dr. Zarr worked with NPS, DC Departments of Health and Parks and Rec, National Environmental Education Foundation (NEEF), DC American Academy of Pediatrics (AAP), George Washington University (GWU), and Children’s National Medical Center (CNMC), to create a searchable park database of some 350 parks summaries (called Park Pages), with each Park Page corresponding to an individual park.  All parks are located within the city, and were rated on certain criteria (level of activity, accessibility, cleanliness, and safety, among others).  This robust database was then linked to their EHR. This allows any Unity provider to access the database through their EHR interface. The clinicians can complete all documentation during and post patient visits while they are in their EHR. Naturally, as a provider works to determine follow ups, referrals and treatment plans for patients –especially those with obesity, asthma, hypertension, diabetes and mental health diagnoses, Park Rx serves as another tool in the provider’s toolbox.  Providers ask their patients what activities might be of interest to them and then search the database to find the right park(s) closest to their homes.

This is a collaborative process for patients and providers and takes less than a minute. Patients leave the physician’s office with a printed copy of the prescribed park(s) and activity. Thinking beyond this initial use, Park Rx also provides a model for integrating other referrals to public health resources such as diabetes self-management and smoking cessation services that could be provided by health departments across the nation. For example, think of a database that captures characteristic information (languages spoken, operating hours, proximity etc.) of local diabetes management centers – physicians could use this information to discuss with patients and then match and refer them to a center most tailored to their needs and preferences. Long-term, public health departments could host this as a service and make it an open API for all providers to integrate into their EHR systems – this is what we mean about the Park Rx being a potentially replicable model for public health.

Patient & Provider Response to Park Rx

Since going live in July 2013, Dr. Zarr has succeeded in convincing 27 fellow health care providers to actively recommend and use electronic park prescribing with their patients. Over 500 park prescriptions have been made. “Providers love and appreciate that the consideration was made to build Park Rx into their existing workflow,” said Dr. Zarr.

As for patients, Park Rx has validated and enhanced their park experiences. “Even though many of our patients have accessible parks and some were already going, they didn’t think of going to the park as a way to improve their health. The kids get really excited when they see all the cool things some of their neighborhood parks offer that they hadn’t realized before,” Dr. Zarr continued. Maritza Villalta, whose daughter has been prescribed Park Rx, described how Park Rx has positively changed their lives: “The program [Park Rx] has helped me and my family to identify parks around my area that are safe and that has been remodeled to include new playground area. With the information provided by the program, my children are more active and I feel encourage to take them to the park. I am happy because on my last visit with the doctor, my daughter lost one pound. The parks recommendation is important and more people should visit them.”

Measuring Success & Opportunities

While Unity’s Park Rx program is just getting off the ground, Dr. Zarr is already thinking of ways to continue to use advances in technology to determine measureable outcomes for the program. What is currently missing from Park Rx is a feedback loop – being able to confirm with Parks that patients have indeed showed up for their visits and frequency, and the ability to collect, mine and integrate biometric data captured in apps and mobile health (mhealth) tools to track correlation and health outcomes. These efforts require resources to both establish infrastructure to enable that electronic feedback loop as well as to conduct a 3-5 year longitudinal research study design to show the Park Rx’s comparative effectiveness on positive health outcomes.

Dr. Zarr hopes to continue and expand this community health initiative, and to find new opportunities and the necessary resources to help Park Rx reach its full potential. The success of Park Rx and its future goal of optimizing health information technology with feedback components to measure patient outcomes could serve as a great model for other public health referrals. To learn more about Park Rx and Dr. Zarr’s effort, please go to: http://blog.childrenandnature.org/2013/11/05/why-i-prescribe-nature-in-d-c-pioneering-pediatricians-and-park-rx-offer-new-hope-and-health/ .