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Nutrition informatics is an emerging area of health care informatics focusing on management of information needed for dietetics practice. In 2009, the Academy of Nutrition and Dietetics approved the following definition of nutrition informatics: the effective retrieval, organization, storage, and optimum use of information, data, and knowledge for food- and nutrition-related problem solving and decision-making. Informatics is supported by the use of information standards, processes, and technology.
Dietetics Areas of Practice that Use Informatics
Registered Dietitian Nutritionists work in a variety of settings and areas of practice, including community nutrition, clinical nutrition, consultation and business practice, food and nutrition management, education and research. The majority of registered dietitian nutritionists work in the treatment and prevention of disease often in hospitals, HMOs, private practice or other health care facilities.
Although information management tools and health information technology (HIT) have been used in health care since the 1960's, until the past 15-20 years use was limited mainly to finance and billing applications. Recent federal legislation such as the American Recovery and Reinvestment Act (ARRA) includes billions of dollars in funding for research, education, and use of health information technology, including promotion of implementation of electronic health records. Dietetics professionals are trained to work with protected health information (PHI), such as name, date of birth, and social security numbers in order to keep patient information confidential. PHI is most commonly used in dealing with health information technology (HIT), which are tools used to collect, store, and exchange health information in an electronic format.
Training for Dietetics Professionals in Informatics
The Academy of Nutrition and Dietetics and the American Medical Informatics Association (AMIA) offer an educational course called “the 10 x 10 Informatics Education Program.” The 10x10 program was established by AMIA in 2005 with the aim to train 10,000 health care and related professionals in medical informatics by the year 2010. The collaboration with Oregon Health & Science University (OHSU) provides introductory training for dietetics professionals to work in the information technology field to improve quality, safety, and cost-effectiveness of health care. This program is taught with a focus on nutrition and the growing field of nutrition informatics.
Clinical Information Systems Applied to Nutrition Informatics
Registered Dietitians use different clinical information systems in their everyday practice within health care. Some examples include the following:
EHR- An electronic health record (EHR) is defined as a longitudinal repository of health information stored in digital form that can be safely and securely accessed by authorized users in all care settings.
CPOE- Computerized Provider Order Entry (CPOE) gives health care providers with clinical privileges the responsibility of ordering medications, tests, procedures and other actions while caring for a patient. These orders may be entered electronically into an EHR to help improve legibility, accuracy of intended order, patient safety and efficiency of care. Every patient has a diet order, which must be ordered by a provider and communicated to the Nutrition Services Department. With the implementation of CPOE, the nutrition staff may receive diet orders and food allergies more timely and with higher accuracy than using paper charting.
CDSS- Clinical Decision Support Systems (CDSS) may be implemented in an EHR to provide information at the point of care in order to enhance decision-making. A provider may receive assistance during an encounter that is specific to that individual which may ultimately impact patient care. For example, if it is determined that a patient exhibits clinical signs and symptoms of malnutrition during a complete assessment by a Registered Dietitian, the EHR may have the capability to notify the provider which in turn may allow the physician to decide to provide further nutrition support for that patient, order additional labs or code the appropriate diagnosis. These may not only provide better patient care, but ultimately can help the health care facility positively impact their reimbursement from the government or accrediting agencies.
Importance of Nutrition Informatics to Improve Health Information Exchange (HIE)
Dietitians are encouraged by the Academy of Nutrition and Dietetics to use the Nutrition Care Process and Model (NCPM) and International Dietetics and Nutrition Terminology (IDNT). The NCPM provides dietetics practitioners in all practice areas with a framework for critical thinking and decision making. The IDNT is a standardized language that can be incorporated into the NCPM can ensure a common language is used within the EHR. If widely accepted, this standardization may help lead to improved interoperability and health information exchange across the care continuum.
Academy of Nutrition and Dietetics website: [www.eatright.org]
AND has a Dietetic Practice Group that includes Nutrition Informatics as an area of interest. Members of AND may choose to become a member of the Nutrition Informatics group to learn more.
American Medical Informatics Association website: [www.amia.org]
References Charney P, et al. Practice Paper of the Academy of Nutrition and Dietetics: Nutrition Informatics. Academy of Nutrition and Dietetics.
Submitted by (Julie McMullen RDN, LD)