Nutrition Informatics:
Ten Top Things to Know
in 2012
-
Marty Yadrick, MS, MBA, RD, FADA
NDEP Area 2-5
April 13, 2012
Objectives
• Understand the impact that nutrition
informatics has on the profession.
• Apply the concepts of informatics to
members’ areas of practice.
• Identify how present regulations and nutrition
related standards regarding health
information technology are re-shaping the
practice of nutrition.
Suggested Learning Codes: 1065 (Informatics), 1020, 1070
Nutrition Informatics
Streamlined definition:
“The intersection of
information, nutrition,
and technology.”
Nutrition Informatics Committee, 2010
When did it all begin?
New or Old?
First Publication:
Thompson E, Tucker H. Computers in dietary studies.
J Am Diet Assoc. 1962 Apr;40:308-12.
4
Top
10 Things to Know in 2012
1. Health care is “going
digital” at a rapid pace.
2. HITECH has created a
“Window of Opportunity.”
3. Digital NCP, IDNT,
Structured Data &
Standards are necessary .
4. Both disruption &
innovation are part of
evolving health care.
5. Informatics can improve all
areas of practice.
6. The future is: “Data follows
the patient.”
7. Share Data when TPO:
Treatment, Payment,
Operations are present.
8. mHealth is revolutionizing
healthcare.
9. Stay current as new
technologies evolve.
10. Many rich opportunities
exist for dietetic
professionals in HIT.
Health care is “going digital” at a rapid pace.
Evolution of Technologies & Health IT
Information Age
1989
1993
Internet Search
Engines
“Disruption
Age”
“Attention Age”
1998
2004
2006
2009
2012
Google
LinkedIn
Twitter
HITECH
Passed
ERH
Adoption
Phase
Social Media
~200+
EHRs
~1900+
EHRs
Technology - Goals
•
•
•
•
•
Improve
Reduce
Standardize
Accelerate
Protect
IOM To Error is Human
9
“Your hospital will be paperless the same
day my bathroom is …”
Michael Shabot, MD
Memorial Hermann Healthcare System
10
We are in midst of a Window of Opportunity
for Nutrition and Health IT
“HITECH Act”
• Goal: Improving health and health care through
the best possible applications of HIT.
• To help accomplish this goal, the Act creates a
system of incentives to encourage practices to
implement EHRs and disincentives to penalize
slow adoption.
• “This initiative will be an important part of health reform as health
professionals and health care institutions, both public and private, will be
enabled to harness the full potential of digital technology to prevent and treat
illnesses and to improve health.”
~David Blumenthal
Office of the National Coordinator of Health IT
President
Bush
Issues
Executive
Order
HITECH
Act
Passed
Stage I
MU
Polices
Created
Stage 2
MU
Begins
Stage 3
MU
Begins
Conceptual Approach to
Meaningful Use
Advanced
clinical
processes
Improved
outcomes
Data Capture
& Sharing
From: Dr. David Blumenthal “Medicare Medicaid EHR Incentives NPRM 1-13-2010”
14
EHR Adoption From 2004 Forward
Digital NCP, IDNT, Structured Data & Standards
are necessary.
Integration of EHR at Healthcare Organizations
While the majority of respondents reported that they are using an EHR at their organization, only
one-quarter reported that their EHR uses International Dietetics and Nutrition Terminology (IDNT)
and/or Nutrition Care Process (NCP).
N= 2,146
Using the definition above, please indicate the level of integration of your electronic health record at
your organization (healthcare providers only)
Elements of ADA Nutrition Care Process/
Standardized Language in Use
Use of ADA’s Nutrition Care Process Standardized Language has increased since this study
was last conducted. At this time, approximately 61 percent of respondents reported that
they use nutrition diagnostic terms.
Not asked
Not asked
Not asked
Which elements of ADA’s Nutrition Care Process Standardized Language are you using at your primary
worksite? (Only those who said “yes” to question 15).
As HIT is adopted, formats & standards will
evolve as needed for exchange of information.
Human-Readable
Paper
Web browser
PDF
Machine-Readable
Formats which
a machine can interpret
An example is the barcode.
Academy Work Related to Informatics
Nutrition
Informatics
Committee
Nutrition
Care
Process
Stage 2
Comments
Due
Nutrition
Informatics
Work Group
2003
2002
2005
2007
2006
2004
IDNT
EAL
Dietetic Practice Based
Network & Tool Kits
2009
2008
EHR
Toolkit
2011
2010
Stage 1
Final Rule
HITECH
2012
HL7
Diet
Orders
Both disruption & innovation are part of
evolving health care.
Used wisely, informatics can improve all areas
of practice.
Applications/Technologies Used
in Past 6 Months
Respondents were most likely to report that they used web tools for collaboration and
communication to support daily activities. Three-quarters also reported using clinical nutrition
management technologies in the past six months.
N= 3342
Please indicate which of the following technologies or computer applications you have used in the past six months
to support your daily activities.
Comfort Level with Using Technology
Patient Management
Approximately one-quarter of respondents indicated that they are expert users of patient
management technologies or applications; another third characterized themselves as
intermediate users. One-third indicated that this type of technology is not applicable for them.
N= 3342
Describe your comfort level with using technology or computer applications for each of the items below.
Comfort Level in Using Technology
Top Ten “Expert” Areas
Respondents were most likely to identify themselves as expert users of word
processing systems. In all categories, more respondents reported being expert
users in 2011 than in 2008.
Areas of Expertise
Percent – 2008
Percent – 2011
Word processing
41.0%
45.8%
Web/Internet
33.4%
36.5%
Slide presentations
27.0%
34.0%
Nutrition assessment
23.7%
33.2%
Nutrition screening
22.4%
30.7%
Nutrition histories
20.7%
29.8%
Nutrient analysis
20.4%
25.9%
Webinars
8.9%
23.7%
Patient management
17.5%
23.1%
Care plans
14.6%
21.5%
Describe your comfort level with using technology or computer applications for each of the
items below.
Information - Intersects
• Standards, processes and technology
required to turn data into knowledge.
E. Ayres 2008
Technology - Intersects
• Humans plus technology can efficiently create
knowledge
Friedman, CP J Am Med Inform Assoc. 2009
Mar-Apr;16(2):169-70. Epub 2008 Dec 11
Technology/Computer Applications
Most Likely To Be Accessed Electronically
Respondents were most likely to report that they access patient education materials
and nutrient databases electronically. Nutrient database was most frequently selected
previously.
Area
Percent – 2008
Percent – 2011
Patient education materials
72.1%
81.5%
Nutrient database
78.4%
81.1%
Evidence-based library
77.7%
78.4%
Continuing professional education
66.8%
78.0%
Professional journals
67.3%
77.3%
Recipes/menus
75.3%
75.8%
Lay literature
66.4%
73.1%
NA
70.7%
Data information about patients
64.7%
66.8%
Standards of practices
64.5%
66.8%
Drug data/information from patients/clients
We have listed a number of areas in which you may require data to support your daily work
activities. Through which means have you accessed this data in the past six months.
The future is: “Data follows the patient.”
INTEROPERABILITY
Technology/Computer Applications
Most Likely To Be Accessed Electronically
Respondents were most likely to report that they access patient education materials
and nutrient databases electronically. Nutrient database was most frequently selected
previously.
Area
Percent – 2008
Percent – 2011
Patient education materials
72.1%
81.5%
Nutrient database
78.4%
81.1%
Evidence-based library
77.7%
78.4%
Continuing professional education
66.8%
78.0%
Professional journals
67.3%
77.3%
Recipes/menus
75.3%
75.8%
Lay literature
66.4%
73.1%
NA
70.7%
Data information about patients
64.7%
66.8%
Standards of practices
64.5%
66.8%
Drug data/information from patients/clients
We have listed a number of areas in which you may require data to support your daily work
activities. Through which means have you accessed this data in the past six months.
HL7
EHR
ADT Interface
Diet Order Interface
HL7
EHR Functional Profile
Diet Order Taxonomy
Continuity of Care Document (CCD)
Nutrition
Information
System
EHRs
HIE
PHR
Registries
Share Data when TPO are present:
Treatment, Payment, Operations.
Healthcare Privacy and Security –
How does it apply to Dietitians?
• Care settings
– Hospitals
– Wellness Programs with Health Plans
– Long-term care
– Public Health
– Consultants
– Other (schools, prisons, etc.)
Healthcare Privacy and Security –
Legislation and Regulation
• HIPAA Regulations – applies to “covered entities”
– Health plans, health care clearinghouses, and health
care providers that engage in electronic transactions
for which HIPAA standards have been adopted
– Applies to “Business Associates” - those that perform
work for or on behalf of Covered Entities
• Other regulations - Federal Privacy Act, Federal
Trade Commission Act, Gramm Leach Bliley,
Sarbanes Oxley, 42CFR Part 2, Confidentiality of
Alcohol and Drug Abuse Patient Records Rule,
Other Laws (e.g., CLIA, FERPA, ERISA)
Used with Permission: Willa Fields, DNSc, RN, FHIMSS &
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
Breaches: By Device Type
Device Type
Number of % of Total
Incidents
Incidents
Number of % of
Patients
Patients
Portable Devices
Laptop
Hard Drives
Desktop Computer
43
72
3
54
15%
26%
1%
19%
1,353,260
1,630,236
1,207,654
883,622
13%
16%
11%
9%
Network Servers
Paper Records
Other
E-mail*
34
50
16
9
12%
18%
6%
3%
1,440,954
241,256
2,630,970
9,347
14%
2%
25%
<0.1%
Source: Data was obtained on June 6, 2011 through the Department of Health and Human Services’
website for organizations reporting breaches which affected more than 500 individuals.
www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html
Used with Permission: Willa Fields, DNSc, RN, FHIMSS &
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
Office of the National Coordinator for Health IT (ONC) 10
Best Security Practices
• Use strong passwords
and change them often
• Install and maintain
anti-virus software
• Use a firewall
• Control access to PHI
• Control physical access
• Limit network access
• Plan for the unexpected
• Maintain good
computer habits
• PROTECT MOBILE
DEVICES
• Establish a security
culture
http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3697
Healthcare Privacy and Security –
Legislation and Regulation
• ARRA/HITECH
– Applied HIPAA to Business Associates - Privacy & Sec Rule
– Created New/Updated Privacy Statutes – Privacy Rule
• Breach Notification
• Marketing/Sale of PHI
• Accounting of Disclosures
• Patient Access/Disclosure Restrictions
• Business Associates ► • Limited Data Set/Minimum Necessary
– Modified Enforcement/Penalties - required update to
Enforcement Rule
– HHS must do Rulemaking and Promulgate Guidance
Healthcare Privacy and Security –
Patient Privacy Concerns
•
•
•
•
•
•
Types of information collected
How the information is handled internally
Whether and how information is disclosed to external parties
Children’s privacy
Security policies and procedures: physical and transmission
Data mining/analysis policies
– AARP, “Personal Health Records: An Overview of What is Available
to the Public”
Used with Permission: Willa Fields, DNSc, RN, FHIMSS &
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
Breaches
• Users abusing their privileges (snooping, fraud,
medical or financial ID theft)
• Loss/Theft of Mobile/Portable Devices and/or Media
• Business Associates – breaches of data they hold
• Research
• Test environment
• Copiers
Breaches will happen!
Introduction
CMS Meaningful Use - Stage 1, Privacy and Security
ARRA/HITECH - New Privacy and Security Requirements
HIPAA
Guidance and Resources
Research/Data
Information for the Executives/Key Decision Makers
Looking for more privacy and security related information?
Please visit the HIMSS P&S Toolkit for an extensive catalogue of additional resources applicable to providers of all
sizes.
Help Us Grow the Privacy and Security Toolkit for Small Provider Organizations
Members are encouraged to contribute to the Toolkit by sharing tools they have found valuable, submitting ideas
for new content, or providing feedback that will help enhance this resource. All submissions will be reviewed by
the P&S Toolkit Content Review Task Force prior to posting.
Got feedback about the Privacy and Security Toolkit for Small Provider Organizations?
Send us your comments
Connect with us and share your thoughts with other health IT leaders:
mhealth is revolutionizing healthcare.
“mHealth” or “eHealth”?
“e-patients”
2007
E-Patients represent a new breed of
Informed health consumers, using the
Internet to gather information about a
medical condition or particular interest to
them.
“e-health”
Health 2.0
Use of a specific set of Web tools
(blogs, Podcasts, tagging, search,
wikis, etc) by actors in health care
including doctors, patients, and
scientists, ….in order to personalize
health care, collaborate, and
promote health education
Gadget Ownership
Advantages Mobile Technologies
•
•
•
•
•
To Simplify Workflow
Record Keeping & Analysis
Increasing Productivity & Customer Satisfaction
Supporting Chronically Ill at Home
Collecting & Using Community & Clinical Health
Data in Under-Resourced & Geographically Remote
Areas
• Real-time monitoring of Patient Vital Signs
• Direct Provision of Care (Telemedicine)
mHealth Applications
• Monitor heart rate
• Measure blood glucose
• Maintain medication
compliance
• Text alerts and reminders
• Conduct eVisits
• Access EHRs
• View telediagnostics
• View PACS images
• Communication
• Access to resources
• Point of care
documentation
• Disease management
• Education
• Administrative
• Financial
• Ambulance/EMS
• Public health
• Pharma/clinical trials
Barriers
•
•
•
•
•
Protection of Protected Health Information
Different platforms: iPhone, Droid, Motorola, etc.
Learning Curve
“Filter Fatigue”
Regulation (FDA Guidance on “Mobile Medical
Apps”)
• “Culture of Safety” Focus
• Political Climate (IOM vs FDA Stance on 510(K)
Clearance
Transporting data with mobile
devices is inherently risky.
There must be an overriding
justification for this practice that
rises above mere convenience.
http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3697
Used with Permission: Willa Fields, DNSc, RN, FHIMSS &
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
Considerations for app design
• Health literacy – 20% of Americans read at a 5th
or 6th grade level
• Readability tests
http://juicystudio.com/services/readability.php
• Use more graphics and audio
• Cultural appropriateness
• Patients with Disabilities (screen reader,
captions)
Stay current as new technologies are
used in health care
iTunes Apps
10
Many rich opportunities exist for dietetic
professionals in HIT.
The Door is wide open…..
Come be a NIRD!
Competencies - Delphi Study Completed
and will be published in the Journal
•
•
•
•
•
•
Students
Entry Level
Practitioners
Specialists
Experts
Informaticists
AMIA/Academy 10X10
Introductory course in Biomedical Informatics
w/Emphasis on Nutrition
April 25 – Sept 26, 2012 (on-line)
In person session Oct 6 at FNCE
Tuition: $2195
54.5 CEU’s !!!
Option for 3.0 graduate credits from OHSU
Visit www.AMIA.org/education/10x10-courses
GET INVOLVED!