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Nutrtional informatics is an evolving field.
The present definition of nutrition informatics posed by the ADA Nutrition Informatics Work Group in 2007, and approved by the House of Delegates is " t
he effective retrieval, organization, storage, and optimum use of information, data, and knowledge for food and nutrition related problem solving and decision making. Informatics is supported by the use of information standards, information processes, and information technology”.
(ADA Nutrition Informatics Work Group, 2007) Adapted from the definition of biomedical informatics in Biomedical Informatics by Shortliffe & Cimino Springer Science & Media 2006.
As valued members and decision makers of the health care team, registered dietitians and dietetic technicians, registered, practice in a wide variety of settings from corporate wellness to the intensive care unit. Each of these work settings has unique information needs such as patient health, eating habits or history, goal setting etc but all require that dietetics practitioners have immediate access to accurate information. Successful dietetics practice in today's rapidly changing environment requires skills in finding, evaluating, and sharing accurate food and nutrition information. The term
is used to describe the science of managing, storing, and communicating information. While not required for informatics practice, use of computers greatly facilitates management of large amounts of information. Health informatics focuses on the application of information science within the health care arena. The field of health informatics includes medical, nursing, pharmacy, dental, public health, and now nutrition informatics. Registered dietitians and dietetic technicians, registered, are now creating nutrition informatics as a new area of dietetics practice. Current use of informatics in health care includes electronic health records, outcomes research, and knowledge acquisition.
Registered dietitians are employed by hospitals, outpatient clinics, schools, and some work in private practices to take care of the nutrition needs of patients. Similar to other medical professions, applications in health informatics can improve the cost and quality of care in the field of nutrition. According to the Academy of Nutrition and Dietetics, nutrition informatics is: "The effective retrieval, organization, storage and optimum use of information, data and knowledge for food and nutrition related problem solving and decision making. Informatics is supported by the use of information standards, processes and technology."
HIMMS and the Academy of Nutrition and Dietetics have agreed to collaborate together so that knowledge and resources can be shared within the domain of nutrition informatics. This alliance will help create the foundation for nutrition informatics competencies for Registered Dietitians and Dietetic Technicians (RDs/DTRs). Together they hope to create a complete electronic record of clinical patient encounter and other applications such as evidence based medicine, quality management, outcomes reporting and the support of nutrition knowledge.
Technology has many applications within in nutrition because nutrition informatics is more than just registered dieticians working with clients. It also involves the food service industry, education (including school lunches) and research. Computers are used in food service management in food procurement, preparation and delivery. Technology is also used for education and data collection as software programs allow consumers to learn about nutrition. Analysis of nutrient intake is also calculated by computers. Moreover, much of nutrition relies on nutrition facts such as calorie, protein, carbohydrate and fat content of various foods. This information was accumulated in books that a dietician kept on hand. Now this information can be digitized and made more accessible, making it easier and more efficient for dietitians to look up information. Furthermore, in the clinical setting, dietitians utilize EHR programs in addition to other software, whether it is part of the EHR program at a hospital or in a private practice.
To get an idea of the applications of nutrition informatics, here are some examples of software and programs that are available from Vision Software. Vision Software offers stand alone programs or hosted programs. Most of these programs are geared towards registered dieticians who work in hospitals and take care of nutrient needs of the patients.
Example of Tray Tracking Software
Room Service Software:
- Some hospitals run on a concept of a “on-demand" meal system to give patients more control over parts of their hospital stay. This software allows providers to automate room service delivery process.
This is used to monitor room service processes. This allows dieticians to tray the tray from the time the order is made, to when it leaves, when it reaches the patient and when it goes back to the kitchen.
Patient Menu Ordering:
This software includes mobile menus and an interactive TV ordering system.
Patient Menu Checking:
This compares the patients choices of food to their patterns, food-drug interactions, and allergies. It can help with nourishment, supplement and feeding tube management so that the information is tracked and kept for billing records.
Dashboard Screen of Tray Tracking Software
Statistics from Vision Software About Their Products:
Patient Menu Management Software
1% estimated food cost savings
5 hrs/day productivity increase
4% non-food expense reduction
6 hrs/day productivity increase in admissions, discharges, transfers
2% non food expense reduction
Room Service Software
15% estimate food cost savings
16 hrs/ day productivity increase
1% non-food expense reduction
Evidence Based Practice using Evidence Base Library
The way that registered dietitican can use technology is by using the EAL.
The EAL is the Evidence Analysis Library which is a tool used to make proper decisions pertaining to nutrition practice. The library provide research articles as well other websites needed to provide information on certain chronic diseases that are associated with the nutrition intake of individuals. This library was developed by the Academy of Nutrition and Dietetics formerly ADA as they determine whether the information would be feasible to use in the database to help make a god decision. This is very helpful in evidence-based practice as it provides certain guideless and toolkits to help in even writing a PES statement. You can find research articles using the tabs at the top of the pages. These tabs include Diseases and Conditions, Foods, A-Z index, and the Search feature. These options can give an individual both specific and general ways to do certain research on certain topics.
The information on the website can be downloaded and printed. There are two main ways the information is provided through Library and Guidelines. The library provides bibliographies of research on a particular topic, conclusion statements on the research given, grades of the quality of the research, evidences summaries that analysis the research topics and provides data tables and worksheets of the research studies that has been analyzed which provides major findings, methodology and quality of each study.
The guidelines section contains systemically developed statements using scientific evidence which would assist the clinical practitioners and patients. The guidelines include recommendation which provide specific goals and plans used to help the practitioner help the patent to control a particular disease. It also includes recommendation strength and narrative where each recommendation is graded by how helpful it would be and it contains an explanation as to how it was derived. Algorithms are also found in the guidelines which provide a step by step procedure as to how to use the recommendations as it shows how the flow of a treatment for a disease or condition would go. Lastly a link to evidence is provided where each recommendation is linked back to the evidence and you can backtrack to see a conclusion statements, evidence summaries and individual article worksheets.
The EAL used evidence based nutrition practice guidelines, toolkits and MNT protocols. The guidelines are a series of statements and treatment algorithms for identifying, analyzing and synthesizing the scientific evidence. Toolkits are documents which contain disease or condition specifics and detail as to how the information would be applied to the evidence based practice. The tool kit includes documentation forms, outcomes monitoring sheets, patient/client education resources, case studies and MNT protocol for implementation of the evidence based nutrition practice guidelines.
The protocols are plans and sets of steps which are based on the analyzed data that provides evidence. This helps to clarify the level, content and frequency of the nutrition case that is related to the disease or condition of the patent. The toolkit would be helpful and most incorporated into acute care facilities, sub acute facilities, post acute facilities/rehab centers/skilled nursing facilities and continuing care/retirement facilities, nursing homes, home health care, clinics or physicians office. The protocols would incorporate the ADIME process.
The EAL provides a certificate of completion to ensure that this process of evidence based practice would be able to be in use efficiently since this is the procedure used to appropriately follow the ADIME method in dealing with clinical cases. The evidence based practice guidelines are free to its members and includes the EAL. The Academy established the evidence analysis process, procedures and resources. The tools include the MNT protocol and are developed as an aid to the RD. The Nutrition Care Process is a framework for the development of the evidence based recommendations.
Registered Dietician (RD)
Registered Dietician technician (RDT)
HIMMS- The Healthcare Information and Management Systems Society
The Academy of Nutrition and Dietetics
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