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Nutrition Informatics Practice Paper of the Academy of Nutrition and Dietetics: Nutrition Informatics ABSTRACT As valued members and decision makers of the health for informatics practice, use of computers greatly facilitates care team, registered dietitians and dietetic technicians, management of large amounts of information. Health registered practice in a wide variety of settings from corporate informatics focuses on the application of information science wellness to the intensive care unit. Each of these work within the health care arena. The field of health informatics settings has unique information needs, but all require that includes medical, nursing, pharmacy, dental, public health, dietetics practitioners have immediate access to accurate and now nutrition informatics. Registered dietitians and information. Successful dietetics practice in today’s rapidly dietetic technicians, registered are now creating nutrition changing environment requires skills in finding, evaluating, informatics as a new area of dietetics practice. Current use of and sharing accurate food and nutrition information. The informatics in health care includes electronic health records, term informatics is used to describe the science of managing, outcomes research, and knowledge acquisition. storing, and communicating information. While not required There is no doubt that food and nutrition practitioners related problem solving and decision-making. Informatics manage large amounts of information on a daily basis. is supported by the use of information standards, processes, The term informatics is used to describe how humans and technology. Figure 2 illustrates some of the myriad ways find, store, analyze, and manage information. Health care that dietetics practitioners in all areas of practice utilize informatics was developed as an area of specialization within informatics tools. informatics devoted to management of health information. As health care is becoming more specialized, the field of health care informatics now includes a collaborative effort Existing Nutrition Informatics Resources of interdisciplinary care aimed at provision of high quality, The Academy’s resources for nutrition informatics include the cost-effective health care in all settings. Nutrition informatics Nutrition Care Process and Model (NCPM), Standards of is an emerging area of health care informatics focusing on Practice and Standards of Professional Performance, Scope of management of information needed for dietetics practice. Dietetics Practice Framework, Dietetics Career Progression Figure 1 provides terms and definitions used in the practice of Guide, International Dietetics and Nutrition Terminology health care informatics. (IDNT), and the Electronic Health Record Tool Kit.1-3 Dietetics practitioners can utilize the NCPM, Scope of Information sources of varying quality abound. Widespread Dietetics Practice Framework, and Standards of Practice and availability of the Internet means that information can be Standards of Professional Performance documents to develop rapidly shared with many individuals. While methods to a personal scope of practice for nutrition informatics. While evaluate veracity of online information sources exist, including the NCPM provides dietetics practitioners in all practice areas voluntary standards organizations, trusted professional with a framework for critical thinking and decision making, websites, and government agencies, many are not aware that the IDNT gives those who are providing patient care in all there are no penalties for publishing erroneous information on care settings a set of terms that can be used to describe each the Internet. Thus it is imperative that dietetics practitioners step of the NCP. Use of a standardized terminology such as have a working knowledge of the fundamental concepts of the IDNT ensures that dietetics practice is considered an nutrition informatics. integral component of electronic health records (EHRs) in all care settings. NUTRITION INFORMATICS AND DIETETICS AREAS OF PRACTICE WHAT IS THE VALUE OF INFORMATION In 2009 the Academy of Nutrition and Dietetics approved MANAGEMENT TOOLS AND HEALTH the following definition of nutrition informatics: the effective INFORMATION TECHNOLOGY? retrieval, organization, storage, and optimum use of Although information management tools and health information, data, and knowledge for food- and nutrition- information technology (HIT) have been used in health care • American Recovery and Reinvestment Act (ARRA): Also • Meaningful use (MU): A set of criteria for EHR implementation and known as the “Stimulus Package,” ARRA is the federal legislation use specified in the Health Information Technology for Economic that includes billions of dollars in funding for research, education, and Clinical Health Act provisions of ARRA that providers and and use of health information technology, including promotion of organizations must meet in order to qualify for incentive funds. implementation of electronic health records.4 The three main criteria specified under meaningful use include: a) • Biomedical informatics: The interdisciplinary field that studies use of a certified EHR in a “meaningful manner,” b) use of certified EHR technology for exchange of health information, and c) use of and pursues the effective uses of biomedical data, information, 5,9 and knowledge for scientific inquiry, problem solving, and decision certified EHR technology to submit quality and other measures. making, motivated by efforts to improve human health.5 • Nutrition informatics: the effective retrieval, organization, storage, • Electronic health record (EHR): A longitudinal repository of and optimum use of information, data, and knowledge for food- health information stored in digital form that can be safely and and nutrition-related problem solving and decision making. securely accessed by authorized users in all care settings.3 Personal health record: A tool used by individuals to gather, track, and share information about their health status. Personal health • Electronic medical record: A clinical application utilized by a records can be either free standing or interfaced (connected) to an health care organization to store, organize, manage, and share EHR supported by a health care provider or organization.10 information about a person’s care delivered by that organization. • Protected health information (PHI): The privacy rules of the • Health care informatics: Applied research and clinical practice Health Insurance Protection and Accountability Act define protected informatics in the combined fields of clinical informatics and public health information as: “information, including demographic health informatics.5 data, that relates to an individual’s health conditions, as well as • Health information exchange (HIE): Safe and secure treatment and payment for treatment of the conditions, and gives communication and sharing of health data between health care a reasonable basis for identification of the person.” Most common organizations and/or providers.6 identifiers, including name, date of birth, and social security number are considered to be protected health information.11 • Health information technology (HIT): Tools used to collect, store, and exchange health information in an electronic environment.7 • Smart phone: A device that combines features found in personal digital assistant with a cellular phone. Smart phones typically include • Interoperability: The interconnection of different health high resolution cameras, wifi capability, web browsers and the technologies across distributed health care systems.8 ability to download and use small applications. Figure 1. Terms and definitions used in the practice of health care informatics. since the 1960s, until the past 15-20 years use was limited correctly are significantly safer and easier to access. When mainly to finance and billing applications. In 2001, the information is stored in secure formats with appropriate back Institute of Medicine publication, “Crossing the Quality up, risk for damage or loss is greatly mitigated. Chasm”6 described major challenges facing the US health care system, which included rapid advances in science Full integration of HIT across all care settings requires that and technology combined with a population burdened providers, patients, and health care organizations be able by increasingly complex health care needs. Health care to safely and securely share information. Development systems were described as fragmented, suffering from poor of methods for health information exchange means that communication, and overburdened with paperwork.6 In health information stored within an electronic medical addition, improvements being made in quality of care were record (EMR) held by one health care organization is made not commensurate with ongoing increases in the cost of accessible to authorized users through interoperability.9 An providing care.7 It became obvious that there was a need to individual’s health care may be provided by several clinicians rapidly translate growing knowledge in science and technology in different settings, making secure information sharing a to facilitate improvement in care provided. One solution vital component of health care informatics. Interoperable brought forth was to reinvent the nation’s health care system systems use agreed upon data standards to ensure that using HIT to support the changes needed. As a result of this, information flows quickly and accurately between providers greater attention has been
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