Using Data to Advocate for the Nutrition Care
Process
Alison L. Steiber PhD, RDNChief Science Officer, Academy of Nutrition and Dietetics
Adjunct Professor, Case Western Reserve UniversityCleveland, OH
Disclosures
Employee of the Academy of Nutrition and Dietetics Co-creator of ANDHII and it is managed by my
team at the Academy NCP and NCPT are a paid subscription within
the Academy and managed by my team
2
What is meaningful data?
Quality Accurate Reliable Replicable Feasible Standardized Time bound
Type Number of individuals served Population or sample
descriptors Surrogate indicators Health Outcomes
Standardizing Patient Outcomes Measurement
“….health care is shifting focus from the volume of services delivered to the valuecreated for patients, with “value” defined as the outcomes achieved relative to the costs.”
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Porter M, Larsson S, and Lee T. NEJM. Feb 11, 2016
Demonstrating Effectiveness in Practice
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Managed Care. 2013 Jan; 22(1):40-5
Of eligible individuals 5% used MNT benefit, the cost of MNT was 0.03$ PMPM*
*Per member per month = Total costs by total member months
Results from Algorithm Study
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Multiple countries
Prevalence of terms used
from NCP by risk factor
(from screening)
Lab value units were different
Solutions need to be EASY for user
Use of commas instead of periods to indicate decimal points
Date convention MM/DD/YYYY vs DD/MM/YYYY
Learnings from Algorithm Study
Academy of Nutrition and Dietetics Health Informatics Infrastructure = ANDHII
15
• NCPT Term
Instant Search
• Nutrition
Diagnosis
Suggestions• Remember
preferred units,
frequent
interventions, and
desired monitors
• Translate data
into narrative
note
Using the NCP to Collect Practice Data
ANDHII/DPBRNNCP/Informatics
EALEvidence
Based Nutrition Practice
Guidelines
Outcomes Research
Clinical Practice
Monitoring & Evaluation
Assessment
Diagnosis
Intervention
NCPT/ANDHII
/EHR
Translational Research
Positions, SOP, & Public Policy
Evidence Based Practice: Need more evidence!
EAL: Evidence Analysis Library; NCP: Nutrition Care Process; NCP: Nutrition Care Process Terminology (formerly IDNT)
ANDHII: Academy of Nutrition and Dietetics Health Informatics Infrastructure, DPBRN: Dietetics Practice Based Research Network
3/16/2017
Evaluating CareChange in Adherence to EBNPG for the Prevention of Diabetes,
Post-training
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900x475
Collecting nutrition outcome data for hospitals/clinics
Does your EMR have a nutrition section with the NCP
steps?
YesNo Are some or all of the nutrition
data you want to collect available in the Nutrition section of your
EMR?
Yes all
Follow facility procedure to track/extract
data
Steps to consider:1) Advocate for
NCPT* to be added to your EMR in all NCP
steps2) Meanwhile, use
ANDHII side by side with your
EMR
Not all
* NCPT has been mapped to the medial language used in EMRs = SNOMED & LOINC, mapping available with eNCPT subscription
Advocate for NCP steps & NCPT to be built into your EMR – see
tips for doing this in the EHR toolkit, Academy C-CDA
implementation guide, list other resources to assist
Meanwhile, use ANDHII side by side with your EMR to 1) assist with NCP/NCPT use, 2) when appropriate/feasible, assist in progress note
generation for inserting in EMR, and 3) collect nutrition outcomes data
Can ANDHII be used within your facility firewall/per policies*?
yes
*see letter to informatics officer on ANDHII.org/info regarding ANDHII HIPAA compliance and data use. Individual use of ANDHII is
free to all Academy of Nutrition and Dietetic members. To do facility or system level data collection, a subscription can be
purchased.
**Contact [email protected] for more information.
Go to ANDHII.org/info to learn about use of ANDHII
and ANDHII.org to become a
registered user.
no
Consider licensing
ANDHII with the Academy so it
can reside inside your
facility firewall**
Collecting nutrition outcome data for hospitals/clinics
Does your EMR have a nutrition section
with the NCP steps?
YesNo
Are some or all of the nutrition data you want to collect available
in the Nutrition section of your EMR?
Yes all
Follow facility procedure to track/extract
data
Steps to consider:1) Advocate for
NCPT* to be added to your EMR in all NCP
steps2) Meanwhile, use
ANDHII side by side with your
EMR
Not all
* NCPT has been mapped to the medial language used in EMRs = SNOMED & LOINC, mapping available with eNCPT subscription
Advocate for NCP steps & NCPT to be built into your
EMR – see tips for doing this in the EHR toolkit
Meanwhile, use ANDHII side by side with your EMR to 1) assist with NCP/NCPT use, 2) when appropriate/feasible, assist in progress note
generation for inserting in EMR, and 3) collect nutrition outcomes data
Ex: RDN in ICU wants to collect data nutrition
interventions in patients with malnutrition due to
acute inflammation. The RDN’s EMR does have a nutrition section. However, physical assessment signs of
malnutrition are not part of the assessment section.
The RDN works with her CNM to educate
IT on the needed NCPT terms related
to physical assessment and how they are mapped to
SNOMED/LOINC terms.
Collecting nutrition outcome data for hospitals/clinics
Does your EMR have a nutrition section
with the NCP steps?
YesNo
Are some or all of the nutrition data you want to collect available
in the Nutrition section of your EMR?
Yes all
Follow facility
procedure to track/extract
data
Steps to consider:1) Advocate for
NCPT* to be added to your EMR in all NCP
steps2) Meanwhile, use
ANDHII side by side with your
EMR
Not all
* NCPT has been mapped to the medial language used in EMRs = SNOMED & LOINC, mapping available with eNCPT subscription
Advocate for NCP steps & NCPT to be built into your
EMR – see tips for doing this in the EHR toolkit
Meanwhile, use ANDHII side by side with your EMR to 1) assist with NCP/NCPT use, 2) when appropriate/feasible, assist in progress note
generation for inserting in EMR, and 3) collect nutrition outcomes data
Ex: RDN in BF clinic wants to collect data on Moms who are breast
feeding. The RDN’s EMR does have a brief nutrition that captures
nutrition problem with a drop down box but the remainder is
free text.
1. RDN works with her CNM to advocate for a
comprehensive nutrition section in the EMR.
2. RDN begins to use ANDHII to collect data on 2-4 patients a week. The nutrition diagnosis
generated in ANDHII is also documented in the EMR
nutrition section. 3. Use of ANDHII helps the
RDN learn more about NCPT terms in this area and track key outcomes for use with
clinic administrators.
In conclusion:
Collecting nutrition and dietetic specific data is vital to:
determine whether our individual interventions are effective
determine how we are practicing and if it aligns with EBPG
determine whether we as a profession are improving the lives of our patients, clients and communities
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