6/17/2015. Making the Most of the Nutrition content in Electronic Health Record. Speaker: A.S.P.E.N. EHR Survey

Transcription

1 Making the Most of the Nutrition content in Electronic Health Record Wisconsin Academy of Nutrition & Dietetics webinar June 17, 2015 Speaker: Jean Bouche, RD, CD Clinical Dietitian - HSHS St. Mary's Hospital Medical Center - Green Bay, WI Academy of Nutrition & Dietetics Nutrition Informatics Committee member Wisconsin Academy of Nutrition and Dietetics Professional Education member and past chair Epic Super User Interactive and Instructional Presentation CPE level (II) and learning code: (1065) Informatics, (1070) Leadership, critical and strategic thinking As RD s learn strategies to implement nutrition documentation into your system's EHR, and as code upgrades bring new functionality, updating your documentation and include new options are important. We can achieve this by effectively and efficiently documenting our nutrition message utilizing the NCPT; not only for a nutrition diagnosis and a PES statement, but beyond, such as including a nutrition focused physical assessment and malnutrition documentation. Work with your EHR staff/vendor to improve interoperability and in the end the improved nutrition status of our population. A.S.P.E.N. EHR Survey Conducted in February 2012, Repeated / expanded in Concluded: The trend is that more and more hospital systems will be implementing EHRs and eventually most, if not all, will be using an EHR. This study should be a wake-up call for EHR developers/vendors, healthcare systems, and clinicians that the nutrition and nutrition support content of the current EHRs needs improvements. Nutrition support clinicians need to be actively involved in optimizing this EHR content Survey expanded to non-aspen members: ~50-60% of respondents showed a favorable response for each content area; nutrition documentation, ordering oral supplements, ordering oral diets, ordering tube feedings, and ordering parenteral nutrition. Vanek VW. Providing nutrition support in the electronic health record era: the good, the bad, and the ugly. Nutr Clin Pract Dec;27(6): Hospital EHR's (PHR) Epic Inpt Epic Ambulatory (MyChart) Vista/VA (Blue Button) Meditech Cerner McKesson Allscript Sorian Seimans Centricity Less common Health Care Systems Inc MedSphere Systems MNT Northwest PeriGen PeriBirth Prognosis Health Information Systems T System Technologies Wellsoft Nortec LTC PCC ECS Food Service Management CBORD Computrition Digital Dining Health Touch Common Sense Vision Technology RD specific EHR's; often private practice KaizenRD Greenpie MNT Assistant MyDietitian KalixHealth NutriHand On Demand Dietitian...ANDHII Other private practice Office ally PHRQL ("freckle") Practice Fusion Rise Dr. Chrono My Client Plus Therapy Notes Objectives: After this presentation you will be able to: 1. Understand how the NCPT is moving beyond the nutrition profession and positions the RD as an essential member of the healthcare team. 2. Learn how documentation in the EHR, and the work that is being done by many, keeps nutrition on the cutting edge of healthcare. 3. Network with others using similar EHR to make documentation in the EHR more efficient and effective. Not all inclusive, not an endorsement. Care Plan CPMRC Zynx 1

2 Objective # 1 Understand how the NCPT is moving beyond the nutrition profession and positions the RD as an essential member of the healthcare team. Understand how the NCPT is moving beyond the nutrition profession and positions the RD as an essential member of the healthcare team. a. Use of the NCPT ncpt.webauthor.com b. Inclusion of NCPT in with SNOMED and LOINC Malnutrition documentation c. Continuum of care documentation Clinic and outpatient departments, nursing homes d. Outcomes tracking Nutrition diagnoses, goals: research Finding the nutrition terminology c. Continuum of care documentation care plans, education Clinic and outpatient departments, nursing homes Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (encpt): Dietetics Language for Nutrition Care. Terminology. Accessed April 1, d. Outcomes tracking Go beyond documentation to embed quality outcomes into your EHR. Go beyond documentation to embed quality outcomes into your EHR Nutrition diagnoses, goals: research Facility specific reports Share your quality indicators for outcomes tracking Make the IT Department aware of the mandated quality indicators you follow and how they affect the health care system Repurpose your documentation to populate flow sheets, interactive pages, narrative notes, and other parts of the EHR. Align your monitor of key indicators such as height, weight, BMI with other departments 2

3 Academy of Nutrition and Dietetics Health Information Infrastructure = ANDHII Objective # 2 Learn how documentation in the EHR and the work that is being done keeps nutrition on the cutting edge of healthcare. Academy of Nutrition and Dietetics Health Information Infrastructure. Accessed April 1, 2015 Learn how documentation in the EHR and the work that is being done keeps nutrition on the cutting edge of healthcare. a. Foundation NCP/ Evidence b. Structuret Information Models Document Templates c. Content Vocabulary & Code Sets d. Information Exchange Interoperability (HL 7 work) C-CDA a. Building Nutrition Standards Information Exchange Care Coordination Content Vocabulary & Code Sets (IDNT, SNOMED, LOINC) Structure Information Models Document Templates Foundation Nutrition Care Process Evidence based Practice Structure Information Models Document Templates EHR and Food Service Management Systems Assessment Another area is of the content or the message format specific to the electronic environment. When information is exchanged, this defines the information contained in the message. These exist via the standards developed for health information technology such as Health Level Seven (HL7) standards. One example of this is the HL7 Version 2 interface standards which send facility patient-specific data such as Admission, Discharge and Transfers and Diet Orders/Allergies from EHRs to Food and Nutrition Information Systems. Monitoring and Evaluation Nutrition Diagnosis Interoperability through C-CDA using the Nutrition Care Process [C-CDA = Consolidated-Clinical Documentation Architecture] Intervention 3

4 New malnutrition codes in SNOMED-CT (US Extension) (Published March 1, 2014) Parent code Concept: [ ] Nutritional disorder (NEW) Starvation-Related Malnutrition: Concept ID: [ ] (NEW) Chronic Disease-Related Malnutrition: Concept ID: [ ] (NEW) Acute Disease or Injury-Related Malnutrition: Concept ID: [ ] (Existing) Nutritional deficiency [ ] (existing code under nutrition disorder) (NEW) Undernutrition: Concept ID: [ ] (child of nutrition deficiency) Information Exchange Care Coordination Diet orders are currently the only nutrition information required in the Continuity of Care Documentation (CCD). Goal: all nutrition care will transfer / interface with other electronic health records based on the structure seen earlier. Objective #3 Network with others using similar EHR to make documentation in the EHR more efficient and effective Network, network, network!! Connect with your EHR s user group. Connect on the Academy s Nutrition Informatics Community of Interest adanic.webauthor.com Network on CNM list serve, nutrition entrepreneurs Network on LinkedIn. A.S.P.E.N. Clinical Nutrition Informatics Committee (CNIC) Networking with other CERNER Users / UCERN Registered Dietitian Community / CERNER Health Conference Presentations Epic - userweb.epic.com CNM DPG invites members to join the Informatics Subunit! All CNM members are welcome and membership is free--and part of the CNM DPG member benefit. The purpose of the subunit is to provide education, leadership skills and resources to CNM members so they can keep pace with food and nutrition informatics, including electronic patient health records and diet order entries. To join the CNM DPG Food & Nutrition Informatics Subunit, cnmfoodandnutritioninformatics@gmail.com to let us know you'd like to join! Please include your member number and your name as it is listed in the Academy database. Epic Accessed April 1,

5 Enhancement examples Work done at the Academy of Nutrition and Dietetics level can help EHR vendors Nutrition screening on admission, especially for identifying malnutrition Opportunities for improvement in Nutrition data gathering, Notes, and Care Plans Continuing nutrition plan through the continuum of care (interoperability) Improving Entering of Nutrition Orders (diet, supplement TPN, TF orders, labs) Interfacing (HL7) with Nutrition Services Applications, identifying food allergies. Example of a diet order selection General Allergy / Intolerance Gluten, Milk Protein, Lactose, other Soft (low fiber), Dysphagia Easy to Chew/Tender, Dysphagia Mechanical Soft/Ground meat, Dysphagia Texture Puree Liquid Clear liquid, Full liquid, nectar thick, honey thick, pudding/spoon thick Fluid Encourage, 500 ml, 1000 ml, 1200 ml, 1500 ml, 1800 ml, 2000 ml, other CHO Consistent, per meal - 30 gm, 45 gm, 75 gm, 90 gm, hypoglycemic, GDM, other Protein 45 gm, 50 gm, 60 gm, 70 gm, 80 gm, 90 gm, 100 gm, 110 gm, 120 gm, other Fat 25 gm, 50 gm, other Cholesterol 200 mg, 300 mg, other sodium 2gm, 4 gm, NAS, other Potassium High, Low, 2 gm, 3 gm, 4 gm, 5 gm, other Phosphorus 800 mg, 1500 mg, other Fiber Low, high, other Age Infant, Toddler, Pediatric Energy/Supplements High Calorie, Calorie level: 1200, 1500, 1600, 1800, 2000, 2200, 2400, other. Vitamin Vitamin K consistent, other Schedule small frequent meals, other Room Service Appropriate, with Assistance, Not appropriate. NPO now, time specified Nutrition Support Tube feeding with/out tray, TPN with/out tray, other Communication Advance as tolerated per protocol, other Questions? brbjmb@yahoo.com 5