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Nutrition Informatics Blog

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!

 

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 http://www.ehidc.org/resource-center/publications/view_document/102-event-materials-ehi-panel-on-health-it-101-himss-national-health-it-week-2013-health-it-policy.

 

Health IT Week: Consumer Health IT and More

(What is Nutrition Informatics, Professional Education) Permanent link

Submitted By Kathleen Pellechia, RD

On Monday, September 16, I participated in the webcast version of the Consumer Health IT Summit, which was part of the 8th annual National Health IT Week celebration held in Washington, DC. Throughout the week, a variety of in-person and online presentations and discussions were held, focusing on the importance of national, system-wide adoption of health information technology (IT). The need for this technology is even more pressing in the wake of health care reform. According to the National Health IT Week Web site, more than 375 organizations participated this year (a 42% increase compared to 2012), which the U.S. Senate recognized by passing a Resolution declaring it National Health IT Week.

The Consumer Health IT Summit brought together a panel of speakers for presentations in the morning, followed by breakout networking sessions in the afternoon for those who attended on-site.

Some of the speakers included:

·   Farzad Mostashari, MD, ScM, national coordinator for Health IT, the Office of the National Coordinator for Health IT (ONC), Dept of Health and Human Services (HHS)

·   Patrick Conway, MD, MSc, chief medical officer and director of the Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services (CMS), HHS

·   Karen L. Smith, MD, PA, family physician and member, Meaningful Use Vanguard Program

·   Robert Tagalicod, director of the Office of E-Health Standards and Services, CMS, HHS

·   Len Lichtenfeld, MD, deputy chief medical officer, American Cancer Society

The overviews, case studies, and examples presented left me with the following “take home” nuggets.

 

Patient/client engagement

This is essential. The users of the technology must find it helpful or they will not use it.

Health history

Patients and caregivers are overwhelmed by the burden of remembering their health history. They need one place (online) to access their medical information, and they want to access that information on a range of technological devices. See the Blue Button Movement.

The challenge concept

Challenge mobile and e-health developers to create tools to meet the needs of the health IT community. “Cloud sourcing” or more importantly “cloud brainstorming” is key to saving time and money. This challenge approach should not only happen at the federal level, but also in our own regional and local communities. We need to work together to adapt and enhance existing technology tools and systems.

What can we do?

As registered dietitians, we need to sit at the discussion table for consumer health IT. We are experts at providing consumers with tools and resources to encourage and establish healthy eating and active lifestyle behaviors. Take a few minutes out of your day to explore healthit.gov. Watch webinars and videos that show best practices, and then bring these ideas to your employer. Challenge your organization to bring health IT to the forefront—one Web site, app, or text message at a time.

How to Find Health Apps

(What is Nutrition Informatics, Professional Education) Permanent link

Submitted by Catherine Frederico, MS, RDN, LDN

 

If you love digital health, then these are exciting times for you. Apple® boasts more than 900,000 apps in its App Store, and Android™ is close behind with more than 800,000 apps. It is estimated that tens of thousands are health-related apps. This
is amazing news, because the first app was published just 5 years ago. It also begs the question, “How do you find the ones you need?”


Both Android’s Googleplay.com and Apple’s iTunes App Store host app categories, but it is still often difficult to find them unless you already know the exact wording and spelling of the app. Just this year, Apple added a health category that helps somewhat. Voraciously reading health app reviews in magazines and newspapers also is a good idea. Still, one of the quickest and easiest ways to find a topical app is to just use Google’s search engine.


A more defined way to find health apps is to use www.Happtique.com. Happtique™ was begun by a group of hospitals in New York City. They hired health professionals to find and place health apps into 10 categories. They do not rank them, but have created detailed standards over the past year. Their business model is to market mini app store platforms to hospitals and medical clinics, which they can fill with their own apps or ones they recommend for their patients. Happtique also sponsors a weekly lunchtime BlogTalkRadiosm program about health apps on Thursdays.


The Academy of Nutrition and Dietetics also hosts app lists for gluten, weight control, and diabetes on its Web site www.eatright.org/appreviews.


I often am asked about my favorite apps. I have more than 300 in my collection and have made a business out of finding the best apps on health topics. As a registered dietitian, many of my apps have a food or nutrition theme. In December 2011, I
decided to write a guide to apps that I thought would interest health professionals, and then I wrote a separate version for consumers. Called An App A Day, they are available for purchase at www.AppyLiving.com. AnApp A Day for consumers has 11 categories and highlights 400 apps. 


I also have become an app developer and have designed or worked on eight apps in the iTunes App Store. These include Food Focus:Fruits, Veggie Garden Palooza, Breast Cancer Care, Max’s Plate, Mix and Max, App reSolutions, and Go Social.


These tips should help you find apps on the health topics you want.