Presentation on theme: "Nutrition Informatics: Ten Top Things to Know in 2012"— Presentation transcript:
1 Nutrition Informatics: Ten Top Things to Know in 2012 -Nutrition Informatics: Ten Top Things to Know in 2012Marty Yadrick, MS, MBA, RD, FADANDEP Area 2-5April 13, 2012
2 -ObjectivesUnderstand 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
4 When did it all begin? New or Old? First Publication: But even before these landmark documents, our profession was already using nutrition informatics. We just had not called it that yet.One of the first references to Nutrition Informatics can be found dating back to More recently, Hoggle points outs that nutrition experts have used computers and electronic media since their introduction 4 decades ago. So what I’m going to talk about is what many of us have been doing for years, we just need to make sure where we areFirst Publication:Thompson E, Tucker H. Computers in dietary studies.J Am Diet Assoc Apr;40:
5 10Top Things to Know in 2012Health care is “going digital” at a rapid pace.HITECH has created a “Window of Opportunity.”Digital NCP, IDNT, Structured Data & Standards are necessary .Both disruption & innovation are part of evolving health care.Informatics can improve all areas of practice.The future is: “Data follows the patient.”Share Data when TPO: Treatment, Payment, Operations are present.mHealth is revolutionizing healthcare.Stay current as new technologies evolve.Many rich opportunities exist for dietetic professionals in HIT.
6 1Health care is “going digital” at a rapid pace.
7 Evolution of Technologies & Health IT “DisruptionAge”Information Age“Attention Age”1989199319982004200620092012InternetSearchEnginesGoogleLinkedInTwitterHITECHPassedERHAdoptionPhaseSocial Media~200+EHRs~1900+EHRs
8 Technology - Goals Improve Reduce Standardize Accelerate Protect With the help of technology we can:Improve communication, outcomes, quality and return on investmentReduce errors and duplicationStandardize nutrition careAccelerate access to nutrition informationProtect patient’s privacy and ensure securityIOM To Error is Human
10 “Your hospital will be paperless the same day my bathroom is …” Michael Shabot, MDMemorial Hermann Healthcare System
11 2 We are in midst of a Window of Opportunity for Nutrition and Health IT
12 “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 BlumenthalOffice of the National Coordinator of Health IT
13 Health Care Technology Adoption PresidentBush IssuesExecutive OrderHITECH Act PassedStage IMU PolicesCreatedStage 2MU BeginsStage 3There are three Meaningful Use Stages. The first stage began in October 2010 for eligible hospitals and January 1, 2011 for eligible providers.20042009201020142016+Electronic Health Record Adoption
14 Conceptual Approach to Meaningful Use 2-Apr-17Conceptual Approach to Meaningful UseImprovedoutcomesAdvancedclinicalprocessesThe levers for meaningful use are components of health care delivery which have the capability to improve health care. HITECH Programs, incentives and regulations focus on capturing health data for use and re-use, using the data to determine best clinical processes and overall--to improve health outcomes.Data Capture& SharingFrom: Dr. David Blumenthal “Medicare Medicaid EHR Incentives NPRM ”
16 Digital NCP, IDNT, Structured Data & Standards are necessary. 3Digital NCP, IDNT, Structured Data & Standards are necessary.
17 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).Using the definition above, please indicate the level of integration of your electronic health record at your organization (healthcare providers only)N= 2,146
18 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 askedNot askedNot askedWhich elements of ADA’s Nutrition Care Process Standardized Language are you using at your primary worksite? (Only those who said “yes” to question 15).
19 As HIT is adopted, formats & standards will evolve as needed for exchange of information.Human-ReadablePaperWeb browserPDFMachine-ReadableFormats whicha machine can interpretAn example is the barcode.As health information technology is adopted and health care data exchanged, the “rules”, workflow and how data is represented will change. We move from paper (human readable) to computers (human and machine readable display) to interoperability (which requires data to be captured differently (such as the movement from quality measures to e-measures.)
20 Academy Work Related to Informatics Nutrition InformaticsCommittee20102005200620092003Nutrition Care ProcessNutrition Informatics Work GroupEHR ToolkitStage 2Comments Due200720112012200820022004The timeline and speed for standards harmonization (and the entire HITECH Plan!) is very aggressive. Here are the key tasks ONC will be asking for collaboration on during just the next six months in regards to just the standards work. At the same time, there is a similar work plan for the policy determination which intersects and embraces the standards used in HITECH EHR adoption.IDNTStage 1Final RuleHL7 DietOrdersEALHITECHDietetic Practice Based Network & Tool Kits
21 Both disruption & innovation are part of 4Both disruption & innovation are part ofevolving health care.
23 Used wisely, informatics can improve all areas 5Used wisely, informatics can improve all areasof practice.
24 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.Please indicate which of the following technologies or computer applications you have used in the past six months to support your daily activities.N= 3342
25 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= 3342Describe your comfort level with using technology or computer applications for each of the items below.
26 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 ExpertisePercent – 2008Percent – 2011Word processing41.0%45.8%Web/Internet33.4%36.5%Slide presentations27.0%34.0%Nutrition assessment23.7%33.2%Nutrition screening22.4%30.7%Nutrition histories20.7%29.8%Nutrient analysis20.4%25.9%Webinars8.9%Patient management17.5%23.1%Care plans14.6%21.5%Describe your comfort level with using technology or computer applications for each of the items below.
27 Information - Intersects When you take pieces of data/information and combine it with the various process we use such as the nutrition care process you will obtain knowledge that you can use to improve patient outcomes or improve care.Standards, processes and technology required to turn data into knowledge.E. Ayres 2008
28 Technology - Intersects Humans plus technology can efficiently create knowledgeBy using our common sense and nutrition background, we can include technology in our daily routines to produce knowledge and seek ways to improve patient care and reduce cost.Friedman, CP J Am Med Inform Assoc Mar-Apr;16(2): Epub 2008 Dec 11
29 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.AreaPercent – 2008Percent – 2011Patient education materials72.1%81.5%Nutrient database78.4%81.1%Evidence-based library77.7%Continuing professional education66.8%78.0%Professional journals67.3%77.3%Recipes/menus75.3%75.8%Lay literature66.4%73.1%Drug data/information from patients/clientsNA70.7%Data information about patients64.7%Standards of practices64.5%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.
32 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.AreaPercent – 2008Percent – 2011Patient education materials72.1%81.5%Nutrient database78.4%81.1%Evidence-based library77.7%Continuing professional education66.8%78.0%Professional journals67.3%77.3%Recipes/menus75.3%75.8%Lay literature66.4%73.1%Drug data/information from patients/clientsNA70.7%Data information about patients64.7%Standards of practices64.5%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.
33 EHR Interoperability HL7 HL7 Nutrition Information System ADT InterfaceDiet Order InterfaceHIEEHRsHL7EHR Functional ProfileDiet Order TaxonomyContinuity of Care Document (CCD)PHRRegistriesInteroperability
34 7Share Data when TPO are present:Treatment, Payment, Operations.
35 Healthcare Privacy and Security – How does it apply to Dietitians? Care settingsHospitalsWellness Programs with Health PlansLong-term carePublic HealthConsultantsOther (schools, prisons, etc.)Hospitals/Long-term care and other provider institutions– dietitians working in the in-patient setting focus on proper food and nutrition in order to promote good health, often addressing dietary modification to address medical issues. The entity itself is a HIPAA Covered Entity. In this setting, the dietitian would have access to a patients medical record and would themselves be considered a covered entity as a medical practitioner.Public Health organizations and Health Plans are also covered and those that work for them are covered as well.Consultant dietitians can contract independently to provide nutrition services and educational programs to individuals and health care facilities as well as sports teams, fitness clubs, supermarkets, and other health and nutrition-related businesses. If they collect information on the patient in electronic form, they should follow HIPAA rules as well.If take information in electronic form it is covered under HIPAA
36 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 adoptedApplies to “Business Associates” - those that perform work for or on behalf of Covered EntitiesOther 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)Most of you have heard of “HIPAA.” HIPAA is a LAW that required congress to write two related regulations – the HIPAA Privacy Rule and the HIPAA Security Rule.HIPAA applies to organizations and their employees. Also, individual providers (not affiliated with an organization) are also covered.The major categories of organizations that are covered includes: health care providers, health plans, health care clearinghouses (organizations that are involved in payment processing). These are called “Covered Entities.”Individual providers (not affiliated with an organization) also can be covered.And as of February 2009, with the enactment of the “stimulus bill” (ARRA) - HITECH (next slide), so called “Business Associates” are also covered.Business Associates are organizations that perform work for or on behalf of a Covered Entity. So, whenever a Covered Entity shares electronic patient information with an external organization for the purpose of doing work for them, that organization becomes a Business Associate and is then covered by HIPAA.It is also important for organizations to know what other privacy regulations might apply to them based on the work they do – and I provide a short list of examples on this slide.Now, let’s talk about ARRA/HITECH ….Used with Permission: Willa Fields, DNSc, RN, FHIMSS &Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
37 Breaches: By Device Type Number of Incidents% of Total IncidentsNumber of Patients% of PatientsPortable Devices4315%1,353,26013%Laptop7226%1,630,23616%Hard Drives31%1,207,65411%Desktop Computer5419%883,6229%Network Servers3412%1,440,95414%Paper Records5018%241,2562%Other166%2,630,97025%*93%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.Used with Permission: Willa Fields, DNSc, RN, FHIMSS &Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
38 Use strong passwords and change them often Office of the National Coordinator for Health IT (ONC) 10 Best Security PracticesUse strong passwords and change them oftenInstall and maintain anti-virus softwareUse a firewallControl access to PHIControl physical accessLimit network accessPlan for the unexpectedMaintain good computer habitsPROTECT MOBILE DEVICESEstablish a security culture
39 Healthcare Privacy and Security – Legislation and Regulation ARRA/HITECHApplied HIPAA to Business Associates - Privacy & Sec RuleCreated New/Updated Privacy Statutes – Privacy RuleBreach NotificationAccounting of DisclosuresBusiness Associates ►Modified Enforcement/Penalties - required update to Enforcement RuleHHS must do Rulemaking and Promulgate GuidanceMarketing/Sale of PHIPatient Access/Disclosure RestrictionsLimited Data Set/Minimum NecessaryOn February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act of 2009, H.R. 1. The legislation aims to stimulate the economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare, providing nearly $20 billion to aid in the development of a robust IT infrastructure for healthcare and to assist providers and other entities in adopting and using health IT.The Health Information Technology for Economic and Clinical Health (HITECH) Act of ARRA contains a section with requirements for HHS to write some new privacy regulations.Here is a brief overview of the statutory requirement listed on this slide in case you get questions:Breach Notification – This provision establishes a federal security breach notification requirement for breaches of health information. It requires that an individual be notified if there is an unauthorized access, disclosure or use of their health information. It also requires that large breaches (those affecting 500 or more individuals) be reported to HHS.Accounting of Disclosures – This provision gives patients the right to request an accounting of disclosures of their health information made through an electronic health record.New HIPAA Business Associates - This provision ensures that new entities that were not contemplated when HIPAA was written (such as PHR vendors, RHIOs, HIEs, etc.) are subject to the same privacy and security rules as providers and health insurers, by requiring Business Associate contracts and treating these entities as Business Associates under HIPAA.Sale/Marketing of Protected Health Information (PHI) – These provisions require new restrictions on marketing using PHI and on the circumstances under which an entity can receive remuneration (money) for PHI.Access – provides an individual the right to have access to certain information about them in electronic formatLimited Data Set/Minimum Necessary – This provision requires CEs to limit the use and disclosure of PHI to a limited data set, or, if needed, to the “Minimum Necessary” to accomplish the purpose of the use or disclosure.And finally,Enforcement/Penalties – This section of the bill contains several provisions that are aimed at increasing civil and criminal consequences for violating HIPAA as well as providing for increased enforcement activities by HHS.It is important to understand that each of these statutory requirements requires the relevant Government agency (in this case, HHS) to conduct “rulemaking” or provide guidance that provides the specific implementation requirements for those covered by the laws. The rulemaking process for the statutory provisions listed on this slide is underway and is on multiple, parallel tracks or timelines. As well, some compliance deadlines are upon us.Some in place (e.g. Breach notification, others underway and some with draft language) just comment period finished Accounting of Disclosures in early AugustI would also like to add that the Act’s language is complex, and new rules are issued often, and as such, HIMSS’ staff and volunteer members will continue to review it and update our educational materials and guidance on this topic. None of the information provided in today’s webinar should be construed as legal advice. For additional clarification, I strongly encourage folks to read the legislative text and/or consult with legal counsel. HIMSS maintains a web page containing guidance and educational materials that provide basic information and tools for understanding and meeting these new laws and associated regulations.
40 Healthcare Privacy and Security – Patient Privacy Concerns Types of information collectedHow the information is handled internallyWhether and how information is disclosed to external partiesChildren’s privacySecurity policies and procedures: physical and transmissionData mining/analysis policiesAARP, “Personal Health Records: An Overview of What is Available to the Public”Here is a list of patient concerns about privacy (from an AARP survey). We won’t go over each of these in-depth, but it is important to note that patients (even in AARP’s demographic) are very sophisticated in their knowledge about electronic data and their related concerns. Each of our organizations and each practitioner should understand that this example list comprehensively covers these concerns.Used with Permission: Willa Fields, DNSc, RN, FHIMSS &Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
41 Breaches Breaches will happen! Users abusing their privileges (snooping, fraud, medical or financial ID theft)Loss/Theft of Mobile/Portable Devices and/or MediaBusiness Associates – breaches of data they holdResearchTest environmentCopiersWhat is a breach and what kind of things are happening? Most prevalent is internal – authorized user.Research – mis-use infoTest environment – IT implementations – not using live patient data.Copy machines have hard drivers – making a copy places it on the hard drive and now it is an electronic format.Probably know only about ½ of the breaches that are occurring.Breaches will happen!
44 “mHealth” or “eHealth”? “e-patients” “e-health” 2007 Health 2.0Use 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 educationNote: Used by both Patients and providers.E-Patients represent a new breed ofInformed health consumers, using theInternet to gather information about amedical condition or particular interest tothem.Health Project Partners, LLC
46 Advantages Mobile Technologies To Simplify WorkflowRecord Keeping & AnalysisIncreasing Productivity & Customer SatisfactionSupporting Chronically Ill at HomeCollecting & Using Community & Clinical Health Data in Under-Resourced & Geographically Remote AreasReal-time monitoring of Patient Vital SignsDirect Provision of Care (Telemedicine)
47 mHealth Applications Monitor heart rate Measure blood glucose Maintain medication complianceText alerts and remindersConduct eVisitsAccess EHRsView telediagnosticsView PACS imagesCommunicationAccess to resourcesPoint of care documentationDisease managementEducationAdministrativeFinancialAmbulance/EMSPublic healthPharma/clinical trials
48 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” FocusPolitical Climate (IOM vs FDA Stance on 510(K) ClearanceIOM recommends “robust post-marketing surveillance” as well as rebuilding the 510 (k) Clearance from the ground up. This program allows FDA Clearance on devices based upon “similarity” to previous inventions, and does not require clinical trials.Health Project Partners, LLC
49 Transporting data with mobile devices is inherently risky Transporting data with mobile devices is inherently risky. There must be an overriding justification for this practice that rises above mere convenience.Used with Permission: Willa Fields, DNSc, RN, FHIMSS &Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN
50 Considerations for app design Health literacy – 20% of Americans read at a 5th or 6th grade levelReadability testsUse more graphics and audioCultural appropriatenessPatients with Disabilities (screen reader, captions)
51 Stay current as new technologies are 9Stay current as new technologies areused in health care
54 Many rich opportunities exist for dietetic 10Many rich opportunities exist for dieteticprofessionals in HIT.
55 The Door is wide open….. Come be a NIRD! So the door is wide open, come on in and see how informatics will change the future of our profession. We want you to be a Nutrition Informatics RD
56 Competencies - Delphi Study Completed and will be published in the Journal StudentsEntry LevelPractitionersSpecialistsExpertsInformaticists
57 Visit www.AMIA.org/education/10x10-courses AMIA/Academy 10X10Introductory course in Biomedical Informaticsw/Emphasis on NutritionApril 25 – Sept 26, 2012 (on-line)In person session Oct 6 at FNCETuition: $219554.5 CEU’s !!!Option for 3.0 graduate credits from OHSUVisitGet new dates