Riding the Wave of EHRs for Nutrition...
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Riding the Wave of EHRs for Nutrition Practice April 15, 2015 Catherine Frederico, MS RDN LDN, Chair Consumer Informatics Work Group Academy of Nutrition and Dietetics DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Transcript of Riding the Wave of EHRs for Nutrition...
Riding the Wave of EHRs for Nutrition Practice
April 15, 2015
Catherine Frederico, MS RDN LDN, Chair Consumer Informatics Work Group Academy of Nutrition and Dietetics
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest
Catherine Frederico, MS RDN LDN Owner/President: Frederico Arts LLC nutrition & informatics consultant health app developer author, speaker Consultant: Max On Snax
© HIMSS 2015
Learning Objectives • 1. Illustrate the importance of mobile EHRs for nutrition and
applications currently available for the nutrition space.
• 2. Identify a framework for assessment of nutrition apps based on product plans, telehealth opportunities and health policies.
• 3. Assist the learner to find, select and use reputable health IT tools in clinical nutrition practice.
Definition of Terms • Academy • Academy of Nutrition & Dietetics • EMR • Electronic Medical Record • Historically used in hospitals & clinics • EHR • Electronic Health Record • Documents medical & beyond, extra information & data from patient, apps,
sensors, health games, etc that impact health • PHR • Personal Health Record • Patient generated collection of their medical information • May or may not be shared with others • PP • Private Practice • RDN • Registered Dietitian Nutritionist
Academy of Nutrition & Dietetics
•Centennial
•1917 - 2017
Dietitian’s Tool Box • Tools of the Trade
• food labels • food models • health models • diet histories • handouts • recipes • seasoning charts • patient charts • food scales • body scales
Diet Manual
Health Digital Health >>>
eHealth iHealth mHealth wireless health connected health Health 2.0
>>>
Farzad Mostashari
Former National Coordinator HeathIT.gov
“You need information to be able to do population health management.”
Digital Health Timeline: A Confluence of Technology, Policy & Society
2004 2007 2009 2010 2011
Bush Exec Order
to Digitize Medical Records
Congress ARRA & HITECH
Act $26B
iPhone
Apple App
Store
Google Android phone
& apps
Academy forms
Nutrition Informatics Work Group
Obama Inauguration
2005
AMIA 10x10 training
http://www.amia.org/education/10x10-courses/10x10-ohsu/course-description
“The way we practice has changed.
We are in the middle of a Nutrition Revolution.”
Lindsey Hoggle, MS RDN PMP Director of Informatics Academy of Nutrition & Dietetics December 2013
Academy of Nutrition and Dietetics, 2010, used with permission
New Digital Dietetic Toolbox
• paper • charts • pen • reference books • phone • fax • computer • copier • camera • voice recorder • medical device • meeting platform • so much more....
5.5”
Academy Member Informatics Survey 2014
• Results
• 2008, 2011, 2014 • N = 1140 (7% students, 2014) • majority 42% aged 50-64 • 14% aged 25-29 • 64% healthcare = 730 • 43% clinical practice = 490 • 2.7% informatics = 31
Student & Non-student Tech Access
99%
92% office
94% own
35%
63%
% Data Accessed Electronically
61% users
83% users
Data most likely accessed electronically:
• nutrient database • patient ed materials • continuing ed • professional journals • lay literature • evidence-based library • recipes/menus • standards of practice • social media & networking • patient data & info
Additional Functions >> Mobile
• webtools • clinical tools • telehealth • global reach • patient engagement • videos • apps • health games • digital magazines • Pinterest boards • podcasts • blogs • photo albums
• majority used > 1 year • 15% EHRs replaced within past year • data input structured + non-structured
use EHR
Academy Member Informatics Survey 2014
EHR Benefits
• efficient team input • available anywhere • statistical data analysis • patient access • caregiver access • cost savings • alerts • interactive flow charts • tailored order sets • better care coordination • better care • better health
hospitals
& clinics
since 1960
NIH. Electronic Health Records Overview. April 2006. http://www.himss.org/files/HIMSSorg/content/files/Code%20180%20MITRE%20Key%20Components%20of%20an%20EHR.pdf
Private practice RDNs need EHRs, too!
What about interoperability?
What about charting standards?
What do RDNs want in a PP EHR??? • Core Features
• time saver • organized • less paper • value added service • website • secure connectivity • RDN on design team • scheduling • charting • billing • reports • secure cloud storage • customer support • HL7 charting standards • interoperability
RDN private
practices
2010
Nice to have in a PP EHR??? • Nice Features • NCP • eNCPT chart language • food record tracking photos
• structured input forms ▼ • graphing • client resources • virtual meetings • patient sensor tracking • goal setting • app Rx • health game Rx • branding • Open Source
eNCPT, http://ncpt.webauthor.com
PP RDN Consulting Management Platforms (CMP) • February 2015 Survey • 9 CMPs • 53 questions • launched 2010-2014 • 9 have RDNs on team • 9 have goal setting • 9 store data • 0 health game connectivity • cost $0 to $99/ month • average cost $51/month • average cost $600/year
Healthy Bytes
Greenpie Datuit Fruit St
KaizenRD
Kalix Health MobileRD
Health Zooks
Connect & Coach
Frederico C. PP RDN Consulting Management Platform Survey 2015
8 7 6 5 4 3 2 1
food tracking HIPAA social media
OL scheduling OL forms
analytics charting billing
NCP NCPT reminders app connectivity client education
eNCPT structured charts ▼ sensor connectivity
video consults
PQRS reports send C-CDA R2 receive C-CDA R2
PP EHR Survey Highlights: Feb 2015
C-CDA = Consolidated - Clinical Document Architecture Frederico C. PP RDN Consulting Management Platform Survey 2015
Need
• standards • interoperability • certification • data graphing • patient access & use education
Workplace / Employer EHR portals
• NutriHand HealthFirstOnline.net • RealDietitian.com • Insurers • AthenaHealth.com • BCBS • Drug Stores • “Health Coaches” • others...
Why tech?
• 7.2 billion people • 6 billion cellphone subscriptions • every cellphone has text messaging • 2 billion smartphones • 75% of world has cell access • (Huffington Post, Oct 11, 2012)
• 35% of world has internet access
• http://mashable.com/2013/09/16/facebook-global-internet/
Pew Online Health Report 2013
• 320 M mobile phones in US • half are smartphones • 52% of smartphone owners search health • 6% of cellphone owners search health • 16% seek others with similar conditions online
search HEALTH
Patients Online
• ePatient Dave • Patients Like Me • Caring Bridge • Inspire • WeGo • CancerCare • WhatNext
iTunes App Store >> Health & Fitness >>
Health Apps- IOS • IMS Health, 2014
Healthcare Apps 23,682
Consumers 16,275
Professionals 7407
https://www.imshealth.com/deployedfiles/imshealth/Global/Content/Technology/mHealth/DevelopersGuide.pdf
Academy App Reviews
App Resources
• Allscripts –https://store.allscripts.com/allscript-resources/about-the-application-store • An App A Day www.AppyLiving.com, C Frederico • An App A Day for Health Professionals www.AppyLiving.com, C Frederico • Academy www.eatright.org/appreviews • Happtique www.Happtique.com • iMedical Apps www.iMedicalApps.com • Framingham.edu http://johnstalkerinstitute.org/blog/nutrition-app-guide/ • Wellable www.Wellable.co Clinton Foundation • Wellocracy www.Wellocracy.com Partners Connected Health • Frederico C. The Connected Dietitian: Power Up With Apps. Academy of Nutrition and
Dietetics’ Nutrition Education for the Public, Networking News. Fall 2014. http://www.nepdpg.org/members/page.cfm?page=networking-news-3
Critiquing Digital Health Resources
• Credentials • Functions • Ease of use • Design • Date • Comments • Star ratings • Cost • Financial support • Endorsements
- A Smart Start to Nutrition and Health Apps, E Schuster, http://extension.missouri.edu/p/N581 - An App A Day for Health Professionals, C Frederico, www.AppyLiving.com
Apps: Tools
USDA: DRIs
Academy: Is My Food Safe?
Academy: NutriGuides
Academy: Gluten
trackers, portions, BMI, food groups, vitamins, grocery
Apps: Health Games
Academy: Perfect Picnic AL Coop Ext: Body Quest, 7 apps
CDC: Solve the Outbreak
Nutrition Games
• Implementation
• Rx nutrition games • Patient challenges • Game Center connectivity • Offered in hospitals & clinics
Sensors
• weight scales • food scales • fork sensors • BP cuffs • activity trackers • sleep trackers • jewelry trackers • clothing sensors • Tricorder types • bandaid sensors • watches
Sensor Issues
• Validity • Reliability • Cost • New versions • Use fatigue • Data reports to whom?
RDNs are health informatics experts!
Academy Digital Health Timeline: A Confluence of Technology, Policy & Society
2004 2010 2012 2013 2014
Academy addresses nutrition
informatics.
Academy forms
NI Committee
HL7 ballot food
allergies &
Diet Order ---------------
S&I Committee ---------------
Academy forms
Nutrition Informatics Work Group
2007
http://www.amia.org/education/10x10-courses/10x10-ohsu/course-description
first AMIA/Academy
10x10 course
NI competency
Delphi Study
NIC Virtual
Town Hall ---------------
HL7 charting
standards: *C-CDA R2
*NCP in Snowmed &
LOINC *7 templates
NIC Video
Challenge ---------------
FNCE Genius Zone
FNCE Genius Zone
--------------- 3rd NI
Survey ---------------
Successful HL7 chart templates • Diet Order • Food allergies • Progress note • Transfer Summary • Discharge Summary • Referral Note • Continuity of Care Record (CCD) • Care Plan • Consult Note
Academy NIC 2015 Plans • HIMSS collaboration • HL7 collaboration • Consumer Health Informatics Work Group • Publish 2014 Survey Results • Create NI Certificate education program for members • Continue to advocate for nutrition needs in Health IT standards
Nutrition Informatics Resources
Academy - Find an RDN expert www.eatright.org
Academy Nutrition Informatics Blog
http://www.eatrightpro.org/resources/news-center/in-practice/nutrition-informatics
Academy - Telenutrition http://www.eatrightpro.org/search?keyword=telehealth
HealthIT www.HealthIT.gov
HIMSS www.HIMSS.org
HL7 www.HL7.org
mHealth Evidence www.mHealthevidence.org
Telehealth Resource Center http://telehealthresourcecenter.org
Summary
• Digital health is changing the way RDNs practice • EHRs are important to further advance nutrition practice & patient health • 9 EHRs for Private Practice RDNs • Need to further develop nutrition features in PP nutrition EHRs • RDNs use health apps with clients • RDNs interpret & follow sensor data with clients • RDNs use nutrition games to engage clients • RDNs are involved with Health IT standards • Academy offers many digital health resources
• RDNs are nutrition informatics experts!
Catherine Frederico, MS RDN LDN Questions?
• Academy of Nutrition & Dietetics,
Consumer Health Informatics Work Group, Chair
• President, Frederico Arts LLC
• @NutritionVision
• www.NutritionVision.info
• www.AppyLiving.com
• All photos and graphic used with permission from Frederico Arts LLC unless otherwise noted.
