Given the broad scope of the HITECH Act, there is one recurring theme which likely will provide a powerful catalyst to move health care to one of better consistency—that of standards harmonization. The Standards and Certification Interim Final Rule represents the “first step in an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health IT and to support its meaningful use.” (http://healthit.hhs.gov) While these standards are guidelines for one-step in “meaningful use” for providers to receive financial incentives, it also establishes a consistent framework of standards for all of health care.
Included in the standards rule is the validation of SNOMED-CT as a terminology for clinical terms. You may be wondering what this has to do with nutrition. At present, the ADA has created an International Dietetics and Nutrition Terminology (IDNT), which is a nutrition vocabulary that allows for coding of clinical nutrition assessment, diagnoses, intervention, and monitoring/evaluation. This work has been underway for over five years for providing a consistent approach to identifying and coding clinical components of the nutrition care evaluation process. While the two are not mandatory partners in care, IDNT is a logical extension of the Nutrition Care Process and Model (NCPM).
In order for nutrition to be a strong component of the electronic health record—and have an impact on quality care, it will be necessary to create a workflow that accomplishes the nutrition care of patients—then work with EHR vendors to assure that the functionality (technical capability within the EHR) is created and maintained within the system. With the NCPM and IDNT, there is no need to start from scratch—but instead integrate these standards into the EHR—and join in the nationwide efforts to provide a consistent approach to providing care.