Combining Clinical Nutrition, Law and Public Health

1. Combining Clinical Nutrition, Law and Public Health Sandra Raup, R.D., J.D., M.P.H. TCDDA Meeting April 10, 2012

2. Nutrition Education B.S. Nutrition from University of Minnesota (1977) Internship at Midway Hospital (1979)

3. Nutrition Support 1970’s through 1990’s • American 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).

4. Evolution of Nutrition Support • Better central lines • Better parenteral nutrition solutions • Crystalline amino acids instead of hydrolyzed protein solutions and better lipid emulsions • Customized solutions • Advanced enteral nutrition solutions • Specialized products • Better tubes • Better monitoring and support • Better pumps • Better delivery systems for home support • Better control of serum glucose levels

5. Education in Law and Public Health Joint Degree in Law and Public Health from The George Washington University (2005) Summer abroad program in health policy (2003)

6. New Frontiers:Interest in quality management • Work with plaintiff’s firms while in law school • Quality manager at a clinic in Minneapolis after returning to Minnesota • Pay for performance programs • Process improvement for diabetes care • Reporting for various diseases and screening • Chronic care program for heart disease • Patient satisfaction

7. 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

8. Analysis

9. Pros • Broadens your outlook to enter another professional community • Introduces you to current technologies • Expands career possibilities • Leverages nutrition background in diverse directions

10. Cons • Expense 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!

11. Bottom Line • Look at your motivation to pursue another degree – will it get you where you want to go? • Evaluate the total cost • Educational expenses • Lost wages • Lost time • Opportunity cost • Thoroughly evaluate your options – are there other possible paths to your goal?

12. Old Paradigm Health Information In Silos

13. The Competition in Their Silos Clinic Systems Community Systems Personal Health Records Big Hospital Systems Health Information Exchanges

14. What Competition? • Provider organizations • Professions • Payers • Software vendors Where’s the patient??

15. New Paradigm Patients and Providers Working Together

16. 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-making • Patient engagement • Provider-patient partnership • Culturally sensitive, whole person care

17. Medical Home Characteristics* • ACCESS • TRACKING AND REGISTRIES • CARE MANAGEMENT AND GUIDELINES • SELF-MANAGEMENT SUPPORT • ELECTRONIC PRESCRIBING • TEST AND REFERRAL TRACKING • PERFORMANCE REPORTING AND IMPROVEMENT • ADVANCED ELECTRONIC COMMUNICATIONS *Taken from the Patient-Centered Medical Home Content and Scoring published in the NCQA Physician Practice Connections (July 2008).

18. The Need Shared access to and utilization of patient information among healthcare providers and patients are needed to support: • Patient-centered, coordinated care models • Participatory 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

19. Our Current Fragmented System: Patients Interact With Each Provider Separately Primary Care Specialty Care Pharmacy Diagnostics Disease Management

20. The Patient Centric Design: More Effective Communication Primary Care Patient Specialty Care Pharmacy • Coordinate • Collaborate • Communicate Diagnostics Disease Management

21. The Solution: Applications Using Shared Documents Patient Care Applications • 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-basedfor real time use • Security ensured with rights-based access by providers and consumers Document Bank

22. Datuit Care Plan Manager Enables capabilities 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

23. Are We Ready For This?What Does It Mean?

24. Questions? Contact information: Sandra Raup sraup@datuit.com 651-894-2814