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.”

3/16/2017

Porter M, Larsson S, and Lee T. NEJM. Feb 11, 2016

3/16/2017

Porter M, Larsson S, and Lee T. NEJM. Feb 11, 2016

Englis

h v

ers

ion o

f N

CM

6

Measuring Nutrition Care: Country-to-Country

3/16/2017

Norwegian

Swedish

French

3/16/2017

Collect Standardized Nutrition Data

Multi-lingual Terminology

Demonstrating Effectiveness in Practice

3/16/2017

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

Steiber et al JREN 2015

Converting Practice into Data

Results from Algorithm Study

11

Multiple countries

Prevalence of terms used

from NCP by risk factor

(from screening)

Resu

lts

of Alg

orith

mH

ow

do R

DN

s pra

ctic

e?

12

Algorithm Results: Improved outcomes?

13

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

The Many sides of ANDHII

16

Research and

QI projects

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

3/16/2017

Data from

Practice

EBPNG

Problem

Etiology

S & S

EB

NP

G into

Measura

ble

Data

Evaluating CareChange in Adherence to EBNPG for the Prevention of Diabetes,

Post-training

19

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 ANDHII@eatright.org 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.

RDNs can collect Meaningful DATA

24

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

3/16/2017