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Nutrition Informatics Blog

Confused about Health Privacy and Security with EHRs?

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Posted by: Lindsey B Hoggle, MS, RDN, PMP

Questions about "HIPAA", health care privacy and security always require considerable time to answer. As the United States adopts and uses electronic health records and other sources of health information technology, multiple parameters should be used to evaluate risk. While data breeches involving credit cards allow for an easier recovery—such as credit monitoring and issuance of a new credit card, health data breeches are complicated. If private, very personal data that could be used to discriminate against individuals is erroneously accessed or shared—it cannot be "called back", "replaced" or "corrected". As privacy and security standards and policies are tightened, there is a great "one stop shop" for privacy and security of health data using EHRs. Members should also check their local, state level laws on health data policies as these pre-empt any national requirements. For more information, go to: Health Information Privacy, Security, and Your EHR.

Nutrition Informatics Education via the 10x10

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Posted by Lindsey B Hoggle, MS, RDN, PMP

This past May 7, the fifth Academy 10x10 Education Course in Informatics launched! Twenty students are enrolled in the only nutrition focused 10x10 program. Here are some interesting statistics about this program:

  • Ninety (90) students have passed the course in the first four years.
  • Students from over 32 states have participated (including Alaska and Hawaii) plus Canada, Puerto Rico and Germany!
  • Several of the positions held by students include: clinical, food service management, community, systems analysts and developers of health care software.
  • Each student authors a short project (either one they have or intend to implement or a conceptual one).
  • All students may receive graduate credit if they complete the Oregon Health and Sciences exam for this course (which includes a nominal fee).
  • The Foundation of the Academy of Nutrition and Dietetics has awarded over $40,000 in educational grants to students taking the 10x10!

Not ready for the 10x10 but want to investigate how nutrition informatics covers all areas of practice for nutrition?

Preview the HIMSS Town Hall Series for a snapshot of nutrition informatics: Nutrition Informatics 101, Nutrition Informatics Delphi Study, and Meaningful Use in Action-Exploring the Possibility of Nutrition Informatics.

Look for an upcoming Certificate in Nutrition Informatics and be sure to join the 1,136 members on the Nutrition Informatics Community of Interest by logging in with your Academy User ID and password.

And lastly, Congratulations to Marty Yadrick, MBI, MS, MBA, RDN, FADA, Past-President of the Academy for completing his Masters of Biomedical Informatics after taking the 10x10 and now serving as an instructor for the AMIA/Academy 10x10!!

Foundation Grants for AMIA 10x10 Education Program

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The FIFTH offering of the popular biomedical informatics program - Academy/AMIA 10x10 Education Program begins on May 7, 2014! This year, the Academy of Nutrition and Dietetics Foundation continues to offer grants to Academy members.  Read first the details about the Academy's offering of the Program and if interested in applying for a Foundation Grant, please complete the 2014 Application for Foundation Grants for the Academy/AMIA 10x10 by April 18, 2014. 

Meaningful Use: Data Integrity vs Data Specificity

(What is Nutrition Informatics, Clinical Nutrition, Professional Education, HITECH Overview and Updates) Permanent link

Submitted by John W. Snyder, DTR, RD

While working to implement the Health Level 7 (HL7) Role Code terminology set used to define the relationship to patient for family medical history, a question came up regarding how to map the end-user “pick-list” selections to HL7 terms. The vendor had not provided a full copy of the terminology set based on terms contained in OID 2.16.840.1.113883.5.111 and asked the following question:

What is the difference between “Son/Daughter” and “Natural Son/Daughter”?

The HL7 Role Code terminology set works as follows:

·   Child (Level 1)

  Son (Level 2)

oNatural Son (Level 3)

oAdopted Son (Level 3)

oFoster Son (Level 3)

oStep Son (level 3)

  Daughter (Level 2)

oNatural Daughter (Level 3)

oAdopted Daughter (Level 3)

oFoster Daughter (Level 3)

oStep Daughter (Level 3)


In an ideal world, all electronic health record systems (EHR-S) would provide users every possible selection, and users would select the correct value. The reality is that providing users with 80+ different types of relationships to select from when entering family history information is perhaps not realistic, and the Centers for Medicare & Medicaid Services has not mandated a level of specificity that all EHR-S must achieve for certification. This means we must map data selected by an end-user to a value in a terminology set.

In the above example, mapping a generic to a more specific (eg, Son/Daughter→Natural Son/Daughter) is not considered a good practice, because it creates invalid data. In this particular case, mapping Son/Daughter to Natural Son/Daughter has only about a 25% chance of accuracy. Mapping from the more specific to a generic (eg, Natural Son/Daughter→Son/Daughter) is an acceptable practice, because downstream it does not invalidate data even though it removes specificity.

The goal of gathering this information is to populate Summary of Care/Continuity of Care documents for interoperability, provide meaningful use data to the government via the Quality Reporting Document Architecture standard, research, and likely some other uses I have not thought to include. In all of these uses, it is necessary to consider sacrificing data specificity as an industry best practice in order to maintain data integrity/validity needs. 


Member Comment Requested: EHR/PHR Nutrition Best Practices Implementation Guide

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Post by Lindsey Hoggle MS, RD:

A dedicated group of over 20 members have been working through the summer to create an "EHR/PHR Nutrition Best Practices Implementation Guide" in time for release by FNCE2013. Due to additional clarification that is needed in certain areas prior to the release, a DRAFT copy for comment has been posted to the Nutrition Informatics Community of Interest at To comment, login using your login and password, download a copy and follow the directions in the document to send comments for the Final copy. This guide was prepared after many members have requested additional information on EHR implementations which are underway as a result of the HITECH EHR Medicaid/Medicare Incentive Program. See to read more about HITECH.

This EHR/PHR Best Practices Guide will utilize recent experiences to help dietitians who are at different stages of EHR implementation at their facility across many areas of care. It is intended to be an add on to the EHR Tool Kit offered at Shop The final Guide will be available at no charge to members on the Eatright online shop. Plans are underway for CPE credit for the Guide. We hope you will participate!

An Informatics Solution to Productivity Tracking

(What is Nutrition Informatics, Clinical Nutrition) Permanent link

Submitted by By Jan Greer-Carney, MS, MBA, RD, LD                     

I used to dread the end of every month when I had to report my department’s productivity. I would receive a stack of unruly papers from each of the registered dietitians and diet technicians with untotaled columns of various activities. It took me literally 8 hours to sort them out and add up the various categories for timely submission to accounting. Then, it took more time to generate productivity ratios.

I tried to automate the process by having my staff submit productivity on an Excel® document that was programmed to do the addition, but the varying levels of computer expertise among my staff actually made the process more difficult and time consuming for them and me. Determined to streamline this process, I made an electronic productivity tracking tool.

Now staff members can open the document, go to their page, select the current month, and enter their productivity information. It automatically enters their information into a summary sheet for me. I preloaded the budgeted productivity information into the summary sheet, so it automatically calculates the productivity ratios.

I can look at each individual’s productivity instantly and each category of productivity. I can see how many patients my department saw for various conditions each day. This is just another example of how informatics is used in practice!


Health IT: Four Dietetic Interns' Perspectives

(What is Nutrition Informatics, Clinical Nutrition, Professional Education, HITECH Overview and Updates) Permanent link

Submitted By Phyllis Fatzinger McShane, MS, RD, LDN,

and Erica Gavey, Christina Kalafsky, DoYoung Stacy Kim, and Christine Spahn, University of Maryland Dietetic Interns

University of Maryland College Park dietetic interns had the opportunity to attend Health IT 101 Basic Training, a lecture sponsored by the e-Health Initiative and the Healthcare Information and Management Systems Society during National Health IT Week August 16-20, 2013, in Washington, DC.


First observation

A huge number of health information technology (IT) acronyms were used that many of the attendees had never heard before. The undergraduate dietetics students have had little exposure to what is changing in health care as a consequence of the Health Information Technology Act (HITECH) of 2009. Their programs had not discussed HITECH in detail, so much of this was new to them. They also were not very familiar with the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program to encourage acute care hospitals to switch to EHRs. 

Second observation

Eight speakers each had 15 to 20 minutes to cover updates in their areas, which included the Value of Health IT, Health System Transformation, Managing Big Data, Health Information Exchange (HIE), Quality Care, HITECH Privacy/ Security, International Classification of Diseases (ICD)-10 Implementation, and Interoperability (implications with standards development). The students again heard new acronyms, creating a barrier to full understanding, but they definitely left the room with key speaker points.

Advancing HIE: Perspectives from the Field (Kansas)

By Laura McCrary, EdD

Attendees had the privilege of seeing HIE in action. A 10-minute video provided a good understanding of how to use the software. These programs are easy and provide privacy through the “opt-out” option. 

In Kansas, only 40% of referrals made by doctors are to other doctors. The remaining 60% are to other services that are necessary to include in the HIE through an online portal. Even in a state-of-the-art IT system (like Kansas), it is possible to find areas of improvement. These three main areas are unique patient identifiers, interoperability standards, and voluntary HIE certification focused on Stage 3 of Meaningful Use (MU3) measures. 

ICD-10 Industry Update

By Tori Sullivan, MHA, RHIA, PMP

The Centers for Medicare & Medicaid Services’ (CMS) mandate for implementation of ICD-10 coding by October 1, 2014, will hold. On this date, the ICD-10 code sets will replace the ICD-9 code sets currently used to report medical diagnoses and inpatient procedures. CMS also is urging industry to communicate with patients on ICD-10 changes. These changes may alter the diagnosis language that patients are used to seeing.

Health IT and Health System

By Patricia MacTaggart, MBA, MMA

Transformation into health IT is a journey, not a destination. Health IT is a tool to lead to better health, lower costs, and better care. Some of the challenges across IT systems include interoperability, privacy, keeping up with the pace of change, cost, valid data, and data analytics capability, just to name a few.

The Omnibus Rule: A Review

By Diane Warner, MS, RHIA, CHPS, FAHIMA

The Health Insurance Portability and Accountability Act (HIPPA) Omnibus Rule becomes enforceable on September 23, 2013. This act strengthens and protects patients’ privacy rights and access to their health medical records.

One significant change to HIPPA is that business associates need their own written HIPPA agreements with any subcontractors that handle private health records. Patients now have the ability to request a copy of their EHR in an electronic format. When patients chose to pay for their treatment with cash, they have the option of having their health care provider not share details or any information about their treatment to their health insurance provider.

The future

The dietetic interns left the room with their heads spinning from the large number of acronyms, and from a glimpse at the complexity of the “world of Informatics.” Everyone is looking forward to the new Academy of Nutrition and Dietetics’ EHR Toolkit, scheduled for release at the Food & Nutrition Conference & Expo, because hopefully it will contain the basic information that all interns will need to begin to understand this very complex important area that will impact their future practice.

Presentation PowerPoint® slides are available at