Meaningful Use in Action - Exploring the Possibility of Nutrition Informatics

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1 Presented by HIMSS and the Academy of Nutrition & Dietetics for the Nutrition Informatics Community Meaningful Use in Action - Exploring the Possibility of Nutrition Informatics Presenter: Jan Greer-Carney, MS, MBA, RD, LD Member of Nutrition Informatics Committee Director of Nutrition Services, Concord Hospital, New Hampshire Maggie Gilligan, RD, CGS, LDN Executive Vice President of Customer Success SureQuest Systems, Inc. North Carolina Panelists: John Snyder, DTR, RD EHR System Analyst EPICCare Ambulatory Geisinger Health System Pennsylvania April 11, 2013

2 Agenda/Objectives 1. Provide a general overview on how Nutrition Informatics relates to all areas of practice. 2. Provide an overview on regulations which are driving use of health information technology standards in the United States. 3. Describe how structured nutrition data is necessary for future nutrition care and outcomes reporting. 2

3 HIMSS Healthcare Information Management & Systems Society A cause-based, not for profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare. 46,000+ individual members 560+ corporate members 300+ not-for-profit organizations (Organizational Affiliate) 240+ Non profit Partners & REC Affiliates 3

4 HIMSS Clinical Informatics Community A multidisciplinary framework focused on thought leadership that is supported by membership programs for nutritionists, physicians, pharmacists, dietitians, clinical engineers and nurses. HIMSS Nutrition Informatics Resources 4

5 Academy Academy of Nutrition of Nutrition & Dietetics & Dietetics 74,000 Members ~ Largest Food & Nutrition Organization in the World At 73,000 members, is the Largest Group of Food Nutrition Professionals in the World Education and Research 7% 6% Consultation and Business 12% 8% Food/Nutrition Management 13% 12% Community 11% 12% Clinical 56% 57% Clinical Nutrition - Acute Care 30% 31% Ambulatory Ambulatory 17% 16% Long Term Care Care 10% 9% Compensation & Benefits Survey

6 Nutrition Informatics The intersection of information, nutrition, and technology. Nutrition Informatics Committee,

7 Academy Areas of Informatics Nutrition Informatics Committee (2010-Present) (8 Academy Members + Staff Leaders) Charged with Implementation of Recommendations to the BOD Fall 2009 Completed Second Nutrition Informatics Survey Jan 2011 HIMSS Analytics NIC Interoperability & Standards Sub Committee (2011-Present) (6 Academy Members + Staff Leaders) Creating Nutrition Standards in support of nutrition inclusion in health IT Leadership at Health Level Seven (HL7) and ONC Standards & Interoperability Showcase Consumer Health Informatics Work Group (May 2011-Present) (6 Academy Members + Staff Leaders ) Identifying consumer focused opportunities in nutrition informatics Working collaboratively with other Academy informatics areas 7

8 Academy Areas of Informatics (continued) Dietetic Practice Group (DPG) Subgroups: (2007-Present) Clinical Nutrition Management DPG Subgroup on Nutrition Informatics established 2007 Nutrition Entrepreneurs DPG Subgroup on Internet Health IT Nutrition Roadmap Planning: (May 2012-Present) Multi-Committee Collaboration for Strategic Planning: Coding & Coverage, Quality Management, Nutrition Care Process/Standardized Language, Nutrition Informatics and Research 8

Informatics Impacts All Areas of Nutrition Practice Community School Lunch, Food Safety Health Departments, Food Availability Food & Nutrition Management Nutrition Information Systems, Food

9 Informatics Impacts All Areas of Nutrition Practice Community School Lunch, Food Safety Health Departments, Food Availability Food & Nutrition Management Nutrition Information Systems, Food Purchasing & Distribution Research Leveraging digital data for outcomes evaluation Education Translation of Technology To Practice Clinical Electronic Health Records Consultation & Business Practice Mobile Monitoring & Consumer Access 9

Regulations Driving Use of Health Information Technology in the United States Health Information Technology for Economic and Clinical Health (HITECH)* Medicare/Medicaid financial incentive program

10 Regulations Driving Use of Health Information Technology in the United States Health Information Technology for Economic and Clinical Health (HITECH)* Medicare/Medicaid financial incentive program for eligible hospitals and providers who adopt and meaningful use electronic health records to improve health Accountable Care Organizations+ A network of doctors and hospitals that shares responsibility for providing care to patients. *Part of the American Recovery & Reinvestment Act +Patient Protection & Affordable Care Act 10

11 Conceptual Approach to Meaningful Use Advanced clinical processes Improved outcomes Data capture and sharing 11

12 Interoperability Data Follows the Patient 12

13 Future Nutrition Care 13

14 Meaningful Use Those eligible for incentive payments must prove they are meaningful users of certified electronic health records (EHR) Meaningful Use defines Measures that Eligible hospitals And Eligible Professionals must collect and report (Enter height & weight into chart) Certification Criteria define functionality that certified EHRs must be able to perform (Calculate BMI from entered height & weight) Standards & Interoperability Specifications designate Standards on how data is recorded and sent (HL7 V 2.6) 14

15 Nutrition Standards Standardized Language (IDNT) Food Labels Nutrition Composition Tables Nutrition Care Process Evidence Analysis Library 15

16 Academy Committee are Leaders in HL7 Work Groups Nutrition Orders Domain Analysis Model Nutrition Orders Clinical Messaging Allergies, Intolerances & Adverse Reactions Domain Analysis Model PHR, Mobile Health and Structured Documents, Orders & Observations, Assessment Screening Tools and more EHR-S Electronic Nutrition Care Process Record System Functional Profile (ENCPRS)

17 Nutrition Data Exchange Present & Future EHR HL7 ADT Interface Nutrition/Diet Order Interface HL7 Messaging EHR Requirements Nutrition/Diet Orders Documentation Allergies and Intolerances Nutrition Information System HIE EHRs PHR Registries 17

18 Structured Data Controlled vocabulary not free text Necessary for sharing information between different systems Required for outcomes measurement Evolving as adoption occurs 18

19 Nutrition- 3 Cases of Digital Evolution Food Allergies Body Mass Index (BMI) Diet Orders NUTRITION 19

20 Food Allergies Example of Real Life Diet Technician reviews EHR Diet Worksheet for Food Allergies or DTR discovers food allergy in screening process Food Allergy is on EHR Diet Worksheet NO Verify allergy with patient & write allergy order with rxn in paper chart YES Done YES Food Allergy is on Nutrition Worksheet Pharmacist enters allergy into EHR HL7 Interface DTR enters food allergy into LDA section of Nutrition System as a Dislike with a note alerting the user of the allergy Code for allergen in EHR must be exactly the same as code in Nutrition System Food Allergy received by Nutrition System DTR checks LDAs in Nutrition System against Food Allergy on Diet Worksheet prior to all meal periods DTR removes note in Nutrition System once Food Allergy has been entered 20

21 Food Allergies Need data to follow patient Patient Safety Issue Quality Issue Work Around for DTR Time Waste for DTR and Food Service Staff YOUR FOOD ALLERGY DATA IS TYPICALLY NOT SHARED BETWEEN INSTITUTIONS UNLESS IT IS ENTERED IN STRUCTURED DATA! 21

BMI Meaningful Use Stage 2 requirements Objective: Record & chart vital signs including height/length, weight, BP (>3 yrs old), calculate and display BMI, plot growth charts including BMI for 0-20yrs

22 BMI Meaningful Use Stage 2 requirements Objective: Record & chart vital signs including height/length, weight, BP (>3 yrs old), calculate and display BMI, plot growth charts including BMI for 0-20yrs of age Measure: >80% of all patients seen by an EP or admitted to EH or ED must have BP (if >3yrs old) and height/length and weight recorded as structured data. EHR Certification Criteria: Electronically record, change and access height/length, weight, and BP; Calculate BMI & electronically display 22

23 BMI Structure data necessary for Nutrition care BMI Standards Referral to outpatient programs Data following patient to other healthcare sites Surveillance in national databases Rates of obesity Clinical interventions that work 23

24 HL7 Healthy Weight Implementation Guide Guide will contain a profile That describes the transmission of body mass index (BMI) data (height, weight, Gender, DOB, date of measurement) from EHRs to public health surveillance systems. Requires Standard for healthy weight data transmission LOINC Logical Observation Identifiers Names and Codes vocabulary is required for ht and wt results to calculate BMI in Public Health system UCUM - Unified Code for Units of Measure cod systems is required for units of measure by public Health systems Interoperability between EHRs and Public Health Systems 24

Patient Interview Appropriate for education Provide: 1. BMI Card 2.

Outpatient Nutrition Services Guide EHR Consult Yes BMI >30 No Unsure ASK RD Yes if you are interested, I

Poor prognosis Comfort Care New cancer dx Pregnant <6mos postpartum Severe dementia Advanced age with

25 Patient Interview Appropriate for education Provide: 1. BMI Card 2. Healthy Nutrition unless other education is more appropriate * 3. Outpatient Nutrition Services Guide EHR Consult Yes BMI >30 No Unsure ASK RD Yes if you are interested, I can provide you with additional information? Poor prognosis Comfort Care New cancer dx Pregnant <6mos postpartum Severe dementia Advanced age with decreased mobility Severe illness *Is RD going to see patient? Check with RD to see what education patent should get. No STOP Obesity Algorithm Adult >19 years Limited m o t i v a t i o n High Additionally Provide : Limited Motivation Package Develop Individual Plan

26 RDs & Healthy Weight Surveillance System Our goals are the same Inform and prioritize obesity prevention Quality improvements in clinical practice BMI included in Clinical Quality Measures 26

27 Nutrition Data Vital signs Height, Weight, Blood Pressure, etc Laboratory values Hemoglobin A1c, Blood Glucose, Magnesium, etc Medications Diet Orders Food Allergies Nutritional content databases 27

28 Diet orders Nomenclature is important Patient is admitted from a SNF with no order Admitting provider orders a Heart Healthy diet Patient left her dentures at the SNF Frail elderly patient is not a good advocate for herself Patient can t chew foods without teeth 28

Diet orders Nomenclature is important Patient from LTC admitted without diet order Admitting provider orders House diet for patient Provider doesn t

29 Diet orders Nomenclature is important Patient from LTC admitted without diet order Admitting provider orders House diet for patient Provider doesn t realize patient has had a stroke Patient aspirates and develops aspiration pneumonia With Diet Ordering writing privileges, RD could have prevented this 29

30 Diet orders Nomenclature is important Patient from SNF admitted with CVA late Friday afternoon without diet order SLP is gone for the day. Swallow study ordered for Monday Provider doesn t want to risk patient choking so provider orders NPO Frail elderly patient has no nutrition for 3 days Weak debilitated patient becomes even more frail 30

31 Work Underway Diet Order Standards 1. Designing a qualitative, quantitative way to describe diet orders 2. Creating a standard way to package them to exchange between systems 31

32 Paradigm Shift in HOW we THINK Structured Data Where Possible Data Follows the Patient Work is Underway on Nutrition Standards Examine Paper Workflow & then Design System Workflow 32 Realize digital efficiencies & value

33 Ancient History - Almost 33

34 34 Questions?

35 Thank You Academy Members Input Elaine Ayres Jean Bouche Amy Buehrle Light Curt Calder Margaret Dittloff Nancy Munoz Carolyn Silzle John Snyder Lee Unangst Marty Yadrick 35

36 Academy Members All webinar participants will receive their CPEU Certificate From Lindsey Hoggle within 7 days via Questions: Contact lhoggle@eatright.org HIMSS Members To get CPHIMS credits, you can go to the Nutrition Informatics web site for the paperwork at 36

37 Thank You! Jan Greer-Carney, MS, MBA, RD, LD Maggie Gilligan, RD, CGS, LDN John Snyder, DT, RD Jennifer Roniger, MPH HIMSS Program Manager, Informatics Christel Anderson HIMSS Director, Clinical Informatics Lindsey Hoggle Academy, Director Nutrition Informatics 37

Lessons Learned from Meaningful Use Implementation. Cynthia L. Bero, MPH Partners HealthCare May 19, 2011

Lessons Learned from Meaningful Use Implementation Cynthia L. Bero, MPH Partners HealthCare May 9, 20 Meaningful Use Plan of Action Learn the HITECH program Certified EHR Technology. Analyze gap between