Nutrition Informatics:Ten Top Things to Know

in 2012

Marty Yadrick, MS, MBA, RD, FADA

NDEP Area 2-5April 13, 2012

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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

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Streamlined definition:

“The intersection of information, nutrition,

and technology.”

Nutrition Informatics Committee, 2010

Nutrition Informatics

When did it all begin?

4

First Publication:Thompson E, Tucker H. Computers in dietary studies. J Am Diet Assoc. 1962 Apr;40:308-12.

New or Old?

Top Things to Know in 20121. 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.

10

1Health care is “going digital” at a rapid pace.

1989 2006

Internet

2009

Information Age “Attention Age”

Twitter

1993

Search Engines

1998

Google HITECH Passed

2004

LinkedIn

Social Media

Evolution of Technologies & Health IT

“DisruptionAge”

2012

ERHAdoption

Phase

~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, MDMemorial Hermann Healthcare System

10

2 We are in midst of a Window of Opportunity for Nutrition and Health IT

• 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

“HITECH Act”

President

Bush Issues

Executive Order

HITECH Act Passe

d

Stage I MU

PolicesCreated

Stage 2 MU

Begins

Stage 3MU

Begins

2004 2009 2010 2014 2016+

Health Care Technology Adoption

Electronic Health Record Adoption

14

Conceptual Approach toMeaningful Use

From: Dr. David Blumenthal “Medicare Medicaid EHR Incentives NPRM 1-13-2010”

Data Capture & Sharing

Advanced clinical processes

Improved outcomes

EHR Adoption From 2004 Forward

3 Digital NCP, IDNT, Structured Data & Standards are necessary.

Integration of EHR at Healthcare Organizations

N= 2,146 Using the definition above, please indicate the level of integration of your electronic health record at your organization (healthcare providers only)

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).

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

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).

Not asked

Not asked

Human-Readable Paper Web browser PDF

Machine-Readable Formats which a machine can interpret An example is the barcode.

As HIT is adopted, formats & standards willevolve as needed for exchange of information.

2004

2010

2005

2006

20092003

Nutrition Care

Process

Nutrition Informatics Work Group

EHR Toolkit

Academy Work Related to Informatics

Stage 1 Final Rule

2007

HL7 Diet

Orders HITECH

2008

2011

2012

Stage 2 Comments

Due

2002

Nutrition Informatics Committee

IDNTEAL

Dietetic Practice Based Network & Tool Kits

4 Both disruption & innovation are part of evolving health care.

5Used wisely, informatics can improve all areas of practice.

Applications/Technologies Used in Past 6 Months

N= 3342Please indicate which of the following technologies or computer applications you have used in the past six months to support your daily activities.

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.

Comfort Level with Using TechnologyPatient Management

N= 3342 Describe your comfort level with using technology or computer applications for each of the items below.

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.

Comfort Level in Using TechnologyTop 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 ApplicationsMost 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%

Drug data/information from patients/clients NA 70.7%

Data information about patients 64.7% 66.8%

Standards of practices 64.5% 66.8%

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.

6 The future is: “Data follows the patient.”

INTEROPERABILITY

Technology/Computer ApplicationsMost 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%

Drug data/information from patients/clients NA 70.7%

Data information about patients 64.7% 66.8%

Standards of practices 64.5% 66.8%

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.

Interoperability

HIE

EHRsHL7

EHR Functional Profile Diet Order Taxonomy

Continuity of Care Document (CCD)

PHR

Registries

Nutrition Information

System

HL7

EHR ADT InterfaceDiet Order Interface

7 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

Device Type Number of Incidents

% of Total Incidents

Number of Patients

% of Patients

Portable Devices 43 15% 1,353,260 13%Laptop 72 26% 1,630,236 16%Hard Drives 3 1% 1,207,654 11%Desktop Computer 54 19% 883,622 9%

Network Servers 34 12% 1,440,954 14%Paper Records 50 18% 241,256 2%Other 16 6% 2,630,970 25%E-mail* 9 3% 9,347 <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

Breaches: By Device Type

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• Accounting of Disclosures • Business Associates ►

– Modified Enforcement/Penalties - required update to Enforcement Rule

– HHS must do Rulemaking and Promulgate Guidance

• Marketing/Sale of PHI • Patient Access/Disclosure Restrictions• Limited Data Set/Minimum Necessary

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:

8 mhealth is revolutionizing healthcare.

“e-patients” “e-health” 2007 Health 2.0

“mHealth” or “eHealth”?

E-Patients represent a new breed ofInformed health consumers, using theInternet to gather information about a

medical condition or particular interest to them.

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

• 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)

Advantages Mobile Technologies

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

• 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

Barriers

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

• 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)

Considerations for app design

9 Stay current as new technologies are used in health care

iTunes Apps

How you communicate will change

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

Introductory course in Biomedical Informaticsw/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

AMIA/Academy 10X10

GET INVOLVED!