Submitted by Cathy Welsh, MS, RD

Have you ever wondered which is faster: STAT, ASAP, rush, or now? The answer is that it depends on how your facility has defined the processes around these different priorities.

The priority of an order can affect the functionality of the order in your electronic medical record (EMR). For example, an order for a STAT blood draw can print the requisition (request for service) to the nursing unit for the nurse to collect the sample, whereas the blood draw ordered just as “routine” will print to the laboratory department for a phlebotomist to collect during rounds.

The priorities are defined differently for the pharmacy and for patient care orders vs a lab order. For example, medication orders placed as STAT may not print requisitions to the pharmacy at all, but may print on the unit for items that the nurse pulls from the nearby Pyxis MedStation®.

The main message when considering your EMR priorities is that when everything is STAT, nothing is STAT. People should choose the lowest level of urgency appropriate to the request, so that when the situation is emergent, the resources are available to meet that need in the minimum amount of time.

A good example of this is the experience of the Swedish Medical Center of Seattle (Priority-Based Hospital Order System Reduces Percentage of "STAT" Orders and Enhances Response Time—Especially for Clinical Results). This experience was reported on the AHRQ (Agency for Healthcare Research and Quality) Web site, which is part of the US Dept of Health and Human Services.

The problem was that physicians entered the majority of orders as STAT, believing that to do anything else would result in lengthy waiting times. This led to a heavy demand of laboratory services, and a lack of responsiveness to “true” stat orders. To resolve the problem, the facility had to define what each priority meant and to determine realistic turnaround times.

These are the three main categories of priorities:

1.STAT=turnaround time of 45 minutes or less. These orders have the highest priority, reserved for life-threatening situations, such as a serious allergic reaction. About 20% of all orders actually are STAT.

2.ASAP=turnaround time of 45 minutes to 2 hours. These “as soon as possible” orders are meant for situations that are not life threatening, but where obtaining the result quickly will have a significant clinical impact or prevent the backup of workflow. For example, all orders placed in the emergency department are considered “ASAP” at a minimum.

3.Routine=up to 8 hours. Routine orders cover laboratory orders or procedures that are obtained at the next most convenient time, taking the patient’s needs into consideration. For example, you can postpone a routine lab until the routine labs are drawn in the morning (4 am) to minimize the amount drawn and the need to stick the patient an additional time.  About 30% to 50% of orders are considered routine.

The result was that the number of orders entered as STAT reduced significantly. Overall, results came back more quickly and the length of stay was lowered.

Defining priorities is important. You can flex reports, requisition printing, firing alerts, and other functionalities to vary by priority. Get involved and become a part of any conversations that are happening at your facility. Remember, when everything is STAT, nothing happens very quickly.

The 2013 Health Datapalooza, sponsored by the Health Data Consortium celebrated it’s fourth year and the results were historic.  If you are wondering what kind of event would dare concoct such a name, there is a story (as always.) After the HITECH Act incentivized the adoption and meaningful use of electronic health records, the U.S. Chief Technology Officer Todd Park
embarked on his trademark enthusiastic, charge of “data liberacion”!!  Since that time, a
tsunami of public health data has been released to encourage problem solving
and innovation in health care.

This year over 2,000 participants joined HHS Secretary Kathleen Sebelius, well-known New Yorker magazine author-surgeon Atul Gawande,  and a wild mix of entrepreneurs, innovators, data scientists, designers, visualizers, and big thinkers in health and open data.

In terms of it being an historic event, it was as nutrition was front and center:

Winners of the $100,000 Data Design Diabetes Challenge was   Connect and Coach,
whose system is the First hybrid clinical and consumer application for Registered Dietitians and Certified Diabetes Educators to help educate the diabetes community.  Congratulations to this great team!  I hope this serves as a useful tool for dietitians and patients alike.

More nutrition in the News at the conference was Sunnie Southern, RD.  If you attended FNCE2012 in Philadelphia, PA you may have seen Sunnie’s participation in the Patient Engagement in Health IT session.  Not only was she on the Planning Committee, but she both moderated panels and spoke of her role in leading the city of Cincinnati in health IT innovation. 
Sunnie’s company, Viable Synergy, provides some exciting support for those hoping to launch innovative health ideas. 

And finally, yes—there were many other apps and mentions around nutrition, exercise, and
wellness!  I call this “Nutrition 2.0—the next generation of nutrition!”

Submitted by Peggy Turner, MS, RD/LD

Chair, Academy of Nutrition and Dietetics’ Nutrition Informatics Committee, 2013-2014

June 1 was the start of a new membership year within the Academy of Nutrition and Dietetics and a new year for all of the volunteer committees that the Academy depends on to help carry out its strategic plan.

This year will begin the 4th year for the Nutrition Informatics Committee (NIC). Looking back, it is amazing how far the concept of nutrition informatics has evolved in just a few short years. Thanks go out to the previous chairs (Marty Yadrick, RD, Elaine Ayres, RD, and Margaret Dittloff, RD) for their vision and leadership in the area of nutrition informatics.

During the 2012-2013 year, one of the key accomplishments by the NIC was the publishing of the Delphi Study, which established Nutrition Informatics Competencies based on the Dietetics Career Development Guide. The study was published in the December 2012 edition of the Journal of the Academy of Nutrition and Dietetics and also is available at eatright.org website.

The NIC also collaborated with Healthcare Information and Management Systems Society (HIMSS) for a Nutrition Informatics Virtual Town Hall Series. Three complimentary webinars were promoted to Academy members using social media, the NI Blog, and the AND dietetic practice groups’ newsletters. Participation was fantastic, and the audience asked great questions. Several Academy members also presented presentations at the HIMSS13 Conference in New Orleans.

The Interoperability and Standards (I & S) Sub-Committee did a phenomenal job participating with Health Level 7 (HL7) and the Office of the National Coordinator to help create nutrition standards and vocabularies. The sub-committee put in numerous hours and collaborated with many groups and professionals to make sure nutrition was included in the areas of structured documents, personal health records, orders and observation, allergies and intolerances, electronic health records, mobile health, clinical decision support, long-term care, Blue Button, and other vital areas.

And the next year will no doubt prove just as exciting and engaging. With some members completing their terms (thanks to all that just left us) and new members coming on board, the next year promises to keep us just as busy.

The new committee will work on the following this year:

Creating of a certificate in the area of nutrition informatics

Conducting the 3rd Nutrition Informatics Survey of Academy members

Continuing to get the message of nutrition informatics out to our members

Having ongoing collaboration with internal and external groups to keep the message of nutrition informatics out there

But you do not need to become a member of the NIC to get engaged yourself. Here are just a few ideas for you to consider:

Join us for the 8th Food and Nutrition Conference and Expo “Open Space” session, scheduled for Tuesday, October 22, in Houston Texas

Volunteer to become part of the Communication Team headed up by Dr Nancy Collins, PhD, RD, LD/N, FAPWCA

Join the Nutrition Informatics Community

Contact me at Peggy Turner with any ideas you would like to share

This is the perfect time to get involved. So, get engaged and you too can experience what nutrition informatics has to offer!

So what does the Future of Food have to do with informatics? So many times I find myself in the odd position of explaining why I am present at something that does not have informatics or health IT in the name. Frequently, I have to dig a bit to explain the relevance of nutrition informatics (defined by the Academy as the “intersection of information, nutrition and technology”. Although it’s been a full year since I attended the first event at Washington Post Live, hosted by Editor Mary Jordan, this time around the relevance of informatics was so easy. The Academy continues to sponsor this event, which serves as a real-life “mash-up” of everyone involved in food and hunger; Secretary of Agriculture Tom Vilsack—a favorite of many-- rounded out the morning.

Now back to the informatics thread.

• When registering for the event, participants were encouraged to donate via a “virtual food drive”for the Capital Area Food Bank.
• @PostLive Twitter followers and hashtag: #thinkfood, as always shared so many new points.
• Per Secretary Vilsack: Vilsack: “In the next 40 yrs we have to have the same level of productivity innovation as we had in the previous 10,000 yrs.” This kind of statistic comes from analysis of “big data” across multiple sources.
• Check out the Midwest Dairy Association’s Infographic!
• Multiple discussions on the use of technology to evaluate soil and determine how many plants should be planted as the machine is planting them, robots to milk cows, and determine how the milk should be collected.
• And of course, the usual—Facebook “like” options.
• The event was—true to it’s name—streaming “live”and highlights are available afterwards on the website.
• And finally, a quote from Grocery Manufacturer’s Association Executive Vice President, Government Affairs, Louis
  Finkle: “People look less and less to labels and more to smart phones and tablets.”

Who knew? Informatics is everywhere!

The U.S.
Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has developed an array of new tools to educate consumers and health care providers about the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. 

For Patients/Consumers:

Seven consumer-facing videos are available on the HHS OCR
YouTube Channel at http://www.youtube.com/user/USGovHHSOCR.

Fact sheets (available in eight languages) on the HIPAA Privacy
Rule:  http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers. 

For Health Care Providers: (Continuing Education credit
available)

OCR has also launched three modules for health care providers on compliance with various aspects of the HIPAA Privacy and Security Rules, available at Medscape.org:

1.   Patient Privacy: A Guide for Providers

http://www.medscape.org/viewarticle/781892?src=ocr2 

2. HIPAA and You: Building a Culture of Compliance

http://www.medscape.org/viewarticle/762170?src=ocr2 

3.  Examining Compliance with the HIPAA Privacy Rule

http://www.medscape.org/viewarticle/763251?src=ocr2

 The fourth offering of the AMIA/Academy 10x10 Informatics Education Program (with a focus on nutrition informatics)
begins on May 8, 2013, provides 54.5 CPEU and costs $2,195.  This online
program culminates with an “In Person” session on October 19, 2013 at FNCE in
Houston Texas.  Registration: http://www.amia.org/education/academic-and-training-programs/10x10-academy-nutrition-and-dietetics 

For questions, contact: Lindsey Hoggle at lhoggle@eatright.org. 

Partial scholarships are available for those who will be taking the AMIA/Academy 10x10 Course in Informatics –with a focus on
nutrition.  Complete the scholarship application by April 19, 2013: http://www.surveymonkey.com/s/9R9HKDV

Post by Cathy Welsh MS, RD
If you are documenting in the electronic medical record (EMR), chances are your information is stored, not directly, but in a land far, far away! More and more businesses are deciding to hire other companies to buy equipment and host applications, such as your EMR, over the Internet. I am most familiar with the software vendor, Cerner®, so let me explain “remote hosting” by quoting from its Web site.

• Predictability—service level, budget, and resources
• Operations excellence—client productivity
• Disaster recovery prevention and protection
• Client focus on core business of providing quality health care
• Affordability

Because of the sensitivity of private health care information and the need to avoid downtime, more and more facilities are considering remote-hosting options. Is this process truly “transparent” to you? Or if your EMR is remote hosted, does this affect you every day?

In this scenario, when you use an EMR program such as Cerner’s PowerChart®, you are likely to use a program like CITRIX®. CITRIX makes software products that companies use to make sure that they can keep their information secure and control which applications users can access.

Here are some tips on how to work in a remote-hosting environment.

Passwords

Your passwords will change every 3–6 months. Come up with a system to help keep it easier to remember your passwords, so you do not write them down. I use a word and then add a string of numbers at the end, which I increment each time my password changes. I also select passwords by first typing a series of numbers and letters that are easy on the fingers. Considering the number of times you will enter these keystrokes, it is something to consider!

Lost Work

The EMR is a dynamic system. When you log on to the EMR to do your work, my advice is to start your documentation, finish it, and then log off the system. Many things are going on in the system when you are doing your work. Other users may look at the same chart you are using. Sometimes software upgrades are running in the background. Many people have complained that they have lost their work when they stepped away from their computer. Do not let this happen to you.

Monday morning blues

Everyone jumps on the system first thing Monday morning, so realize that speed may remain slow for a while first thing on Mondays.

Smart Searching

Learn how to search smart. Even a few people running searches for a wide range of data from a long time ago really can impact the system. I once got a call from a medical student looking for documentation from 2008. I recommended that he go to Medical Records, because the kind of charting he was looking for was still on paper. In other words, do not become a “resource hog” (someone who uses more system resources than necessary).

Learn how to use flow sheets and filters, so that your searches are more direct, allowing you to pinpoint the information that you need. As the EMR matures and more and more data is input hourly, this will become even more important.

Access from anywhere

Depending on your facility, you may even have the ability to access the EMR from your home computer. This is a real benefit if you are on call over the weekend. Ask your Information Technology Department if you qualify for a device or if you can get added to the list of users who can have home access.

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