Nutrition Informatics: Ten Top Things to Know in 2012

1. - Nutrition Informatics:Ten Top Things to Know in 2012 Marty Yadrick, MS, MBA, RD, FADA NDEP Area 2-5 April 13, 2012

2. Objectives - • Understand the impact that nutrition informatics has on the profession. • Apply the concepts of informatics to members’ areas of practice. • Identify how present regulations and nutrition related standards regarding health information technology are re-shaping the practice of nutrition. Suggested Learning Codes: 1065 (Informatics), 1020, 1070

3. Nutrition Informatics Streamlined definition: “The intersection of information, nutrition, and technology.” Nutrition Informatics Committee, 2010

4. When did it all begin? New or Old? First Publication: Thompson E, Tucker H. Computers in dietary studies. J Am Diet Assoc. 1962 Apr;40:308-12.

5. 10 Top Things to Know in 2012 • Health care is “going digital” at a rapid pace. • HITECH has created a “Window of Opportunity.” • Digital NCP, IDNT, Structured Data & Standards are necessary . • Both disruption & innovation are part of evolving health care. • Informatics can improve all areas of practice. • The future is: “Data follows the patient.” • Share Data when TPO: Treatment, Payment, Operations are present. • mHealth is revolutionizing healthcare. • Stay current as new technologies evolve. • Many rich opportunities exist for dietetic professionals in HIT.

6. 1 Health care is “going digital” at a rapid pace.

7. Evolution of Technologies & Health IT “Disruption Age” Information Age “Attention Age” 1989 1993 1998 2004 2006 2009 2012 Internet Search Engines Google LinkedIn Twitter HITECH Passed ERH Adoption Phase Social Media ~200+ EHRs ~1900+ EHRs

8. Technology - Goals • Improve • Reduce • Standardize • Accelerate • Protect IOM To Error is Human

10. “Your hospital will be paperless the same day my bathroom is …” Michael Shabot, MD Memorial Hermann Healthcare System

11. 2 We are in midst of a Window of Opportunity for Nutrition and Health IT

12. “HITECH Act” • Goal: Improving health and health care through the best possible applications of HIT. • To help accomplish this goal, the Act creates a system of incentives to encourage practices to implement EHRs and disincentives to penalize slow adoption. • “This initiative will be an important part of health reform as health professionals and health care institutions, both public and private, will be enabled to harness the full potential of digital technology to prevent and treat illnesses and to improve health.” ~David Blumenthal Office of the National Coordinator of Health IT

13. Health Care Technology Adoption 2004 2009 2010 2014 2016+ Electronic Health Record Adoption

14. Conceptual Approach toMeaningful Use Improved outcomes Advanced clinical processes Data Capture & Sharing From: Dr. David Blumenthal “Medicare Medicaid EHR Incentives NPRM 1-13-2010”

15. EHR Adoption From 2004 Forward

16. 3 Digital NCP, IDNT, Structured Data & Standards are necessary.

17. Integration of EHR at Healthcare Organizations While the majority of respondents reported that they are using an EHR at their organization, only one-quarter reported that their EHR uses International Dietetics and Nutrition Terminology (IDNT) and/or Nutrition Care Process (NCP). Using the definition above, please indicate the level of integration of your electronic health record at your organization (healthcare providers only) N= 2,146

18. Elements of ADA Nutrition Care Process/ Standardized Language in Use Use of ADA’s Nutrition Care Process Standardized Language has increased since this study was last conducted. At this time, approximately 61 percent of respondents reported that they use nutrition diagnostic terms. Not asked Not asked Not asked Which elements of ADA’s Nutrition Care Process Standardized Language are you using at your primary worksite? (Only those who said “yes” to question 15).

19. As HIT is adopted, formats & standards will evolve as needed for exchange of information. Human-Readable Paper Web browser PDF Machine-Readable Formats which a machine can interpret An example is the barcode.

20. Academy Work Related to Informatics Nutrition Informatics Committee Nutrition Care Process Stage 2 Comments Due Nutrition Informatics Work Group 2007 2011 2003 2005 2009 2012 2008 2006 2010 2002 2004 IDNT Stage 1 Final Rule HL7 Diet Orders EHR Toolkit EAL HITECH Dietetic Practice Based Network & Tool Kits

21. 4 Both disruption & innovation are part of evolving health care.

23. 5 Used wisely, informatics can improve all areas of practice.

24. Applications/Technologies Used in Past 6 Months Respondents were most likely to report that they used web tools for collaboration and communication to support daily activities. Three-quarters also reported using clinical nutrition management technologies in the past six months. Please indicate which of the following technologies or computer applications you have used in the past six months to support your daily activities. N= 3342

25. Comfort Level with Using TechnologyPatient Management Approximately one-quarter of respondents indicated that they are expert users of patient management technologies or applications; another third characterized themselves as intermediate users. One-third indicated that this type of technology is not applicable for them. N= 3342 Describe your comfort level with using technology or computer applications for each of the items below.

26. Comfort Level in Using TechnologyTop Ten “Expert” Areas Respondents were most likely to identify themselves as expert users of word processing systems. In all categories, more respondents reported being expert users in 2011 than in 2008. Describe your comfort level with using technology or computer applications for each of the items below.

27. Information - Intersects • Standards, processes and technology required to turn data into knowledge. E. Ayres 2008

28. Technology - Intersects • Humans plus technology can efficiently create knowledge Friedman, CP J Am Med Inform Assoc. 2009 Mar-Apr;16(2):169-70. Epub 2008 Dec 11

29. Technology/Computer ApplicationsMost Likely To Be Accessed Electronically Respondents were most likely to report that they access patient education materials and nutrient databases electronically. Nutrient database was most frequently selected previously. We have listed a number of areas in which you may require data to support your daily work activities. Through which means have you accessed this data in the past six months.

30. 6 The future is: “Data follows the patient.”

31. INTEROPERABILITY

32. Technology/Computer ApplicationsMost Likely To Be Accessed Electronically Respondents were most likely to report that they access patient education materials and nutrient databases electronically. Nutrient database was most frequently selected previously. We have listed a number of areas in which you may require data to support your daily work activities. Through which means have you accessed this data in the past six months.

33. HL7 EHR Nutrition Information System ADT Interface Diet Order Interface Interoperability EHRs HL7 HIE PHR EHR Functional Profile Diet Order Taxonomy Continuity of Care Document (CCD) Registries

34. 7 Share Data when TPO are present: Treatment, Payment, Operations.

35. Healthcare Privacy and Security – How does it apply to Dietitians? • Care settings • Hospitals • Wellness Programs with Health Plans • Long-term care • Public Health • Consultants • Other (schools, prisons, etc.)

36. Healthcare Privacy and Security – Legislation and Regulation • HIPAA Regulations – applies to “covered entities” • Health plans, health care clearinghouses, and health care providers that engage in electronic transactions for which HIPAA standards have been adopted • Applies to “Business Associates” - those that perform work for or on behalf of Covered Entities • Other regulations - Federal Privacy Act, Federal Trade Commission Act, Gramm Leach Bliley, Sarbanes Oxley, 42CFR Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records Rule, Other Laws (e.g., CLIA, FERPA, ERISA) Used with Permission: Willa Fields, DNSc, RN, FHIMSS & Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN

37. Breaches: By Device Type Source:Data was obtained on June 6, 2011 through the Department of Health and Human Services’ website for organizations reporting breaches which affected more than 500 individuals. www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html Used with Permission: Willa Fields, DNSc, RN, FHIMSS & Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN

38. Office of the National Coordinator for Health IT (ONC) 10 Best Security Practices • Use strong passwords and change them often • Install and maintain anti-virus software • Use a firewall • Control access to PHI • Control physical access • Limit network access • Plan for the unexpected • Maintain good computer habits • PROTECT MOBILE DEVICES • Establish a security culture http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3697

39. Healthcare Privacy and Security – Legislation and Regulation • ARRA/HITECH • Applied HIPAA to Business Associates - Privacy & Sec Rule • Created New/Updated Privacy Statutes – Privacy Rule • Breach Notification • Accounting of Disclosures • Business Associates ► • Modified Enforcement/Penalties - required update to Enforcement Rule • HHS must do Rulemaking and Promulgate Guidance • Marketing/Sale of PHI • Patient Access/Disclosure Restrictions • Limited Data Set/Minimum Necessary

40. Healthcare Privacy and Security – Patient Privacy Concerns • Types of information collected • How the information is handled internally • Whether and how information is disclosed to external parties • Children’s privacy • Security policies and procedures: physical and transmission • Data mining/analysis policies • AARP, “Personal Health Records: An Overview of What is Available to the Public” Used with Permission: Willa Fields, DNSc, RN, FHIMSS & Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN

41. Breaches • Users abusing their privileges (snooping, fraud, medical or financial ID theft) • Loss/Theft of Mobile/Portable Devices and/or Media • Business Associates – breaches of data they hold • Research • Test environment • Copiers Breaches willhappen!

43. 8 mhealth is revolutionizing healthcare.

44. “mHealth” or “eHealth”? “e-patients” “e-health” 2007 Health 2.0 Use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, ….in order to personalize health care, collaborate, and promote health education E-Patients represent a new breed of Informed health consumers, using the Internet to gather information about a medical condition or particular interest to them.

45. Gadget Ownership

46. Advantages Mobile Technologies • To Simplify Workflow • Record Keeping & Analysis • Increasing Productivity & Customer Satisfaction • Supporting Chronically Ill at Home • Collecting & Using Community & Clinical Health Data in Under-Resourced & Geographically Remote Areas • Real-time monitoring of Patient Vital Signs • Direct Provision of Care (Telemedicine)

47. mHealth Applications • Monitor heart rate • Measure blood glucose • Maintain medication compliance • Text alerts and reminders • Conduct eVisits • Access EHRs • View telediagnostics • View PACS images • Communication • Access to resources • Point of care documentation • Disease management • Education • Administrative • Financial • Ambulance/EMS • Public health • Pharma/clinical trials

48. Barriers • Protection of Protected Health Information • Different platforms: iPhone, Droid, Motorola, etc. • Learning Curve • “Filter Fatigue” • Regulation (FDA Guidance on “Mobile Medical Apps”) • “Culture of Safety” Focus • Political Climate (IOM vs FDA Stance on 510(K) Clearance

49. Transporting data with mobile devices is inherently risky. There must be an overriding justification for this practice that rises above mere convenience. http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3697 Used with Permission: Willa Fields, DNSc, RN, FHIMSS & Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN

50. Considerations for app design • Health literacy – 20% of Americans read at a 5th or 6th grade level • Readability tests http://juicystudio.com/services/readability.php • Use more graphics and audio • Cultural appropriateness • Patients with Disabilities (screen reader, captions)