Combining Clinical Nutrition, Law and Public Health
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Transcript of Combining Clinical Nutrition, Law and Public Health
Sandra Raup, R.D., J.D., M.P.H.TCDDA Meeting
April 10, 2012
Nutrition EducationB.S. Nutrition from University of Minnesota (1977)
Internship at Midway Hospital (1979)
Nutrition Support 1970’s through 1990’sAmerican Society of Parenteral and Enteral Nutrition first meeting in 1975
JPEN first published in 1977
Beagle puppies first fed with IV nutrition in the 1960’s Taken from: Sanchez JA, Daly JM.
Stanley J. Dudley, M.D.: A Paradigm Shift. Arch Surg 145(6):512-4 (2010).
Evolution of Nutrition SupportBetter central linesBetter parenteral nutrition solutions
Crystalline amino acids instead of hydrolyzed protein solutions and better lipid emulsions
Customized solutionsAdvanced enteral nutrition solutions
Specialized productsBetter tubes
Better monitoring and supportBetter pumpsBetter delivery systems for home supportBetter control of serum glucose levels
Education in Law and Public HealthJoint Degree in Law and Public Health from The George Washington University (2005)
Summer abroad program in health policy (2003)
New Frontiers:Interest in quality managementWork with plaintiff’s firms while in law school
Quality manager at a clinic in Minneapolis after returning to MinnesotaPay for performance programs
Process improvement for diabetes care Reporting for various diseases and screening
Chronic care program for heart diseasePatient satisfaction
Involvement in Health Information Technology (HIT)Asked to join leadership team of CareFacts, a software company for home care, hospice and public health
Participated in creating vision for new technology that facilitated cross-provider collaboration and communication and a more patient-centered approach to care delivery
Eventual sale of the company (December 2010) and creation of new company (March 2011) to develop and market new technology and its applications
Pros
Broadens your outlook to enter another professional community
Introduces you to current technologies
Expands career possibilities
Leverages nutrition background in diverse directions
ConsExpense that may not be easily recouped
Opportunities are not always available to older graduates
Nutrition background not always understood and/or appreciated“Are you a nurse?”“I’ve heard about hospital food!”
Effects of advancing age may be underestimated!
Bottom LineLook at your motivation to pursue another degree – will it get you where you want to go?
Evaluate the total costEducational expensesLost wagesLost timeOpportunity cost
Thoroughly evaluate your options – are there other possible paths to your goal?
Health Information In Silos
The Competition in Their SilosBig
HospitalSystems
ClinicSystems
CommunitySystems
PersonalHealthRecords
Health Information Exchanges
What Competition?Provider organizations
Professions
Payers
Software vendors Where’s the patient??
Patients and Providers Working Together
Medical Home Principles(As articulated by TransforMED)Continuous relationship with a personal physician who coordinates wellness and illness care
Clinician-patient communication based on trust, respect, and shared decision-makingPatient engagementProvider-patient partnershipCulturally sensitive, whole person care
Medical Home Characteristics*ACCESSTRACKING AND REGISTRIESCARE MANAGEMENT AND GUIDELINESSELF-MANAGEMENT SUPPORTELECTRONIC PRESCRIBINGTEST AND REFERRAL TRACKINGPERFORMANCE REPORTING AND IMPROVEMENTADVANCED ELECTRONIC COMMUNICATIONS
*Taken from the Patient-Centered Medical Home Content and Scoring published in the NCQA Physician Practice Connections (July 2008).
The NeedShared access to and utilization of Shared access to and utilization of patient information among healthcare patient information among healthcare providers and patients are needed to providers and patients are needed to support:support:
Patient-centered, coordinated care modelsParticipatory medicine - - patients having an active role in driving their care
Quality incentives and bundled payments that span providers
Government and other payer incentives for collaboration
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Specialty Care
Disease ManagementDiagnostics
Pharmacy
Primary Care
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•Coordinate•Collaborate•Communicate
Specialty Care
Disease ManagementDiagnostics
Pharmacy
Primary Care
Patient
The Solution: Applications Using Shared Documents
• Aggregate separately authored, standards-based electronic health documents in a Document Bank
• Flexibility to plug-in and un-plug Patient Care Applications
• Development tools for clients and third-parties to create applications
• Architecture cloud-based for real time use
• Security ensured with rights-based access by providers and consumers
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Patient Care Applications
Document Bank
Datuit Care Plan ManagerEnables capabilities Enables capabilities to:to:
Creatively communicate with patients, their families and providers
Bring many others into the conversation at the patient’s discretion
Facilitate data collection that can be used to manage populations and achieve Medical Home objectives
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Are We Ready For This?What Does It Mean?
Contact information:Contact information:Sandra RaupSandra [email protected]@datuit.com651-894-2814651-894-2814