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Nutrition Informatics: Ten Top Things to Know in 2012 Marty Yadrick, MS, MBA, RD, FADA NDEP Area 2-5 April 13, 2012 -

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Presentation on theme: "Nutrition Informatics: Ten Top Things to Know in 2012 Marty Yadrick, MS, MBA, RD, FADA NDEP Area 2-5 April 13, 2012 -"— Presentation transcript:

1 Nutrition Informatics: Ten Top Things to Know in 2012 Marty Yadrick, MS, MBA, RD, FADA NDEP Area 2-5 April 13,

2 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,

3 Streamlined definition: The intersection of information, nutrition, and technology. Nutrition Informatics Committee, 2010 Nutrition Informatics

4 When did it all begin? 4 First Publication: Thompson E, Tucker H. Computers in dietary studies. J Am Diet Assoc Apr;40: New or Old?

5 Top Things to Know in 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

6 1 Health care is going digital at a rapid pace.

7 Internet 2009 Information AgeAttention Age Twitter 1993 Search Engines 1998 GoogleHITECH Passed 2004 LinkedIn Social Media Evolution of Technologies & Health IT Disruption Age 2012 ERH Adoption Phase ~200+ EHRs ~1900+ EHRs

8 Technology - Goals Improve Reduce Standardize Accelerate Protect IOM To Error is Human

9 9

10 Your hospital will be paperless the same day my bathroom is … Michael Shabot, MD Memorial Hermann Healthcare System 10

11 2 We are in midst of a Window of Opportunity for Nutrition and Health IT

12 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

13 President Bush Issues Executive Order HITECH Act Passed Stage I MU Polices Created Stage 2 MU Begins Stage 3 MU Begins

14 14 Conceptual Approach to Meaningful Use From: Dr. David Blumenthal Medicare Medicaid EHR Incentives NPRM Data Capture & Sharing Advanced clinical processes Improved outcomes

15 EHR Adoption From 2004 Forward

16 3 Digital NCP, IDNT, Structured Data & Standards are necessary.

17 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).

18 Elements of ADA Nutrition Care Process/ Standardized Language in Use Use of ADAs 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 ADAs Nutrition Care Process Standardized Language are you using at your primary worksite? (Only those who said yes to question 15). Not asked

19 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 will evolve as needed for exchange of information.

20 Nutrition Care Process Nutrition Informatics Work Group EHR Toolkit Academy Work Related to Informatics Stage 1 Final Rule 2007 HL7 Diet Orders HITECH Stage 2 Comments Due 2002 Nutrition Informatics Committee IDNT EAL Dietetic Practice Based Network & Tool Kits

21 4 Both disruption & innovation are part of evolving health care.

22

23 5 Used wisely, informatics can improve all areas of practice.

24 Applications/Technologies Used in Past 6 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. 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.

25 Comfort Level with Using Technology Patient 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.

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 Areas of ExpertisePercent – 2008Percent – 2011 Word 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%23.7% 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 Standards, processes and technology required to turn data into knowledge. E. Ayres 2008

28 Technology - Intersects Humans plus technology can efficiently create knowledge 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 – 2011 Patient education materials72.1%81.5% Nutrient database78.4%81.1% Evidence-based library77.7%78.4% 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%66.8% Standards of practices64.5%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.

30 6 The future is: Data follows the patient.

31 INTEROPERABILITY

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 – 2011 Patient education materials72.1%81.5% Nutrient database78.4%81.1% Evidence-based library77.7%78.4% 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%66.8% Standards of practices64.5%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.

33 HIE EHRs HL7 EHR Functional Profile Diet Order Taxonomy Continuity of Care Document (CCD) PHR Registries Nutrition Information System HL7 EHR ADT Interface Diet Order Interface

34 7 Share Data when TPO are present: Treatment, Payment, Operations.

35 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.)

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 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

37 Device Type Number of Incidents % of Total Incidents Number of Patients % of Patients Portable 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. Breaches: By Device Type Used with Permission: Willa Fields, DNSc, RN, FHIMSS & Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN

38 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

39 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

40 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 Childrens 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

41 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!

42

43 8 mhealth is revolutionizing healthcare.

44 e-patients e-health 2007 Health 2.0 mHealth or eHealth? 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. 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

45 Gadget Ownership

46 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

47 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

48 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

49 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 Health literacy – 20% of Americans read at a 5 th or 6 th grade level Readability tests Use more graphics and audio Cultural appropriateness Patients with Disabilities (screen reader, captions) Considerations for app design

51 9 Stay current as new technologies are used in health care

52 iTunes Apps

53

54 10 Many rich opportunities exist for dietetic professionals in HIT.

55 The Door is wide open….. Come be a NIRD!

56 Competencies - Delphi Study Completed and will be published in the Journal Students Entry Level Practitioners Specialists Experts Informaticists

57 Introductory course in Biomedical Informatics w/Emphasis on Nutrition April 25 – Sept 26, 2012 (on-line) In person session Oct 6 at FNCE Tuition: $ CEUs !!! Option for 3.0 graduate credits from OHSU Visit AMIA/Academy 10X10

58 GET INVOLVED!


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