Guest Blog of Dr. Nancy Collins

Catchy title but I know many of you are going to stop reading after the first few lines once you figure out what this is about. I promise you it will be worth it if you keep going!

Convergence. Transparency. Interoperability. HIE. TIGER. MU. OMG! The Healthcare Information Management and Systems Society (HIMSS) held their annual conference last week and these terms were casually tossed around by attendees like we toss around cachexia, dysphagia, and BMI. Just like the titular famous catch phrase from the television show Diff’rent Strokes, I wasn’t sure what many people were talking about. The only thing I was sure about is the fact that we all need to get up to speed pretty quickly because healthcare as we know it is ending and a new era has already begun. The exhibit halls were filled with vendors offering every aspect of healthcare technology you can imagine and those you have never even dreamt of. Most of these will change the way we do our jobs or perhaps, even eliminate some jobs, such as medical coding experts--just as switchboard operators and travel agents have come and gone.

So while you may think that this technological revolution does not pertain to you, trust me when I tell you it does. Every aspect of healthcare is undergoing a change. Rather than resist it, it is time to embrace it. Some of these things will make our jobs better! Here is an example. I worked at a nursing home and one of the residents required dialysis. She was sent by a medi-van three times a week to a dialysis center located only one mile from the nursing home. This seems simple enough and I am sure this is routinely done in nursing homes across the country. My frustration came every time I had to do a quarterly review for this resident. There was never any lab data in her chart. Obviously they were doing labs at the dialysis unit and I wanted it! I called repeatedly and asked for copies but rarely got them. I was told they sent them with the medi-van driver, they would fax them later, they would remember next time and so on. It was a constant problem that seemed so simple to fix. I could have walked the mile to the dialysis center and picked them up myself in the time it took to discuss this repeatedly with team.

Now consider something called Health Information Exchange (HIE). HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. A slightly different version of this is called the Direct Project, or simply Direct. Simply put, Direct is a secure email system that allows providers to communicate with one another and with their patients. I get secure emails from my banker all the time, so why not from my doctor? The key to all of this high tech communication is compatibility. Imagine if the dialysis center sent me my resident’s lab work but when I received it, I could not open the file. I am sure we have all tried to download a file and gotten the dreaded error message that our computer could not open it. It is maddening when it is only a photo of my nephew. Imagine if it is important health information or test results. The word for this function is interoperability.  

HIE, Direct and interoperability will solve some other common problems as well. One of the problems that arises in many of the lawsuits I review is lack of continuity of nutrition care. For example, consider the elderly wound care patient living in a nursing home with an order for a regular diet (according the facility liberalized diet policy), an amino acid product for wound healing, and thickened liquids to honey consistency for a swallowing problem. The resident is transferred to the hospital at the family’s urging because they feel her cognitive status has deteriorated and she has become disoriented. After a 48 hour stay at the hospital, she is returned to the nursing home with orders for a 2 gram sodium diet. There are no orders for the amino acids or the thickened liquids. The RD assesses that patient on the fourth day of this new admission and puts in a request to the physician for the regular diet, the amino acids and the thickened liquids. These orders are written two days later, or on the sixth day of admission. This is a common occurrence and a legal liability. Now imagine utilizing technology that can speak a common language understood by whatever electronic health record (EHR) the nursing home and the hospital uses. If the core data (pertinent information including demographic data) is ported from the nursing home to the emergency room (ER) before the resident evens leaves the nursing room and is waiting on arrival at the ER, the care can be more continuous.

Our job now is to make sure the people in our facilities understand how important it is to include nutrition information in every aspect of this as they build the systems. Hopefully, you now understand a bit about how information will travel with the patient. If you do not know where your facility is on this, just ask and show an interest. The other thing I am 100% certain of after attending HIMSS is that there are not enough trained personnel to handle the growth in this area. I am sure your facility would welcome your interest and input.

If you have found this lesson helpful and want me to continue teaching one little bit at a time, please send me an email at NCtheRD@aol.com. I am not an expert either but learning as I go along and attend various meetings.