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Nutrition Informatics Blog

C-CDA

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Posted by Lindsey Hoggle, MS, RDN, PMP

For sure, the adoption of electronic health records (EHR) in the U.S. is proceeding at an unprecedented pace-primarily due to the HITECH Act. As I have mentioned previously, the Academy has participated in the activities driven by this law since it began in 2009. As a regular participant at in-person meetings (both the HIT Policy Committee and the HIT Standards Committee) in Washington, DC, I have had the wonderful privilege of meeting and asking the advice of national leaders in health care and health information technology. From my first public comments (in September 2009) asking for use of the Academy’s Nutrition Care Process (NCP) and the International Dietetics and Nutrition Terminology (now called the Nutrition Care Process Terminology or NCPT), the recurring theme was to ask for what I call the differentiating "brand" of nutrition care via the RDN—the NCP. As I asked one expert after another – "What do we (the Academy) need to do to make sure we are included as a part of the health care team as health care goes digital?" The answer has been the same—consistently—for the past five years:

  • Nutrition care must be included in health IT standards -via Health Level Seven (HL7)
  • Nutrition terminologies must be in those now mandated for use in Certified EHRs (Stage 2 mandates the use of (SNOMED-CT®) and (LOINC®) – Using the acronyms is easiest for now!
  • Establish "Value Sets" of nutrition terms that EHR vendors can use
  • Continue to “turn up the volume” on why nutrition care is critical to all aspects of health care

Following policy advice from Jeanne Blankenship (Vice President Policy Initiatives and Advocacy) for "constant, appropriate, appreciable pressure" – the Interoperability and Standards Committee and member volunteers have pushed forward for all of the above. As a result, there is now the NCP represented in the next release of a presently mandated HL7 standard (Release 1 of the standard must now be supported by all Certified EHRs). While the name may be intimidating – (HL7 Consolidated Clinical Document Architecture or C-CDA for short) - the message to RDNs and EHR vendors need not be:

  • Use HL7 C-CDA Version 2 (pending publication of the standard any day now) to send electronic documents between facilities.
    (C-CDA R2 is a document template standard that identifies what data must be sent to and from facilities.)
  • Use coded data contained in the C-CDA for documenting nutrition care via the NCP.
    While NCPT may be used on the "user interface" – it MUST be "mapped" to SNOMED-CT and LOINC on the "back end".This is a critical point to assure we can document and measure care provided by RDNs from this point forward.
  • The second release has nutrition in 7 different template types (as compared to "discharge diet" being only one field in one template type in Release 1):
    1. Progress Note
    2. Transfer Summary
    3. Discharge Summary
    4. Referral Note
    5. Continuity of Care Record (CCD)
    6. Care Plan
    7. Consult Note

While having to advocate for nutrition care seems illogical to RDNs, it comes with the territory. We need to continue to impress that nutrition care be part of the treatment plan. For an example of why we need to use the HL7 health IT standards which contain nutrition, read a recent HIMSS post. And remember—Constant appropriate appreciable pressure. It does work!

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 http://adanic.webauthor.com. To comment, login using your Eatright.org 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 http://www.healthit.gov/policy-researchers-implementers/hitech-act-0 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 Eatright.org. 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!