Nutrition Informatics FAQ

Developed by Lindsey Hoggle, MS, RD, PMP

What is nutrition informatics?
“The intersection of information, nutrition, and technology.” Nutrition Informatics Committee 2011

Why is it important to the profession of dietetics?
It represents an evolution in the way we practice dietetics. As an immensely “data rich” profession (such as food/nutrient analysis tables), it provides us a more efficient way to perform our role in dietetics, which allows us to use our knowledge and skills more effectively.

Is it relevant to anyone other than those practicing in clinical care (those using an electronic health record)?
Yes! It is important for all areas of practice within dietetics. Early work by the Academy in 2007 established the critical need for informatics knowledge in all areas of the profession. Nutrition Informatics Work Group 2007

I hear the term “electronic medical record” or “EMR” and “electronic health record” or “EHR”. What is the difference and which term should be used?
The appropriate term is “EHR”. Digital (or electronic) medical records have been in existence for decades. Originally, the term EMR was used, as it best described the digital rendition of the existing paper chart or paper medical record in use. The term slowly evolved to “EHR” as additional information was added to the records—outside the scope of traditional “medical care” (such as preventative health measures, wellness data and any data considered by the provider to be relevant to health.) In recent years, it has been suggested that we adopt and use the term “EHR” as it better represents a record that collects any pertinent data for an individual’s health, rather than just treatment and medical care associated with disease. -David Blumenthal, NEJM

With all this focus on technology, will my job be replaced by technology, such as what happened with the travel planning industry?
This is a logical question, but it is unlikely. If your job is only objective, factual data driven work, then it would be more likely. This is not consistent with dietetics practice across any of the six areas of practice. Decision support functions within software and technology are adjuncts to problem solving and skilled, content driven decision making.

Along the same line, the explosion of mobile applications and nutrition analysis tools seem to be competing with what dietitians do. Is this true?
While it is true that the tool or application could be used by individuals who try to practice nutrition, many of the entrepreneurial companies and software companies have hired dietitians to assure that nutrition content and practice is appropriate and evidence based. Most consider this more of an opportunity than a threat.

Do clinical decision support (CDS) processes within software replace the knowledge and role in nutrition care?
Clinical Decision Support functions are typically found within EHR software for the purpose of providing an individual “checklist” for care which should be considered based upon an individual’s diagnoses, medications, allergies and other values affecting their health. There is wide variation amongst these systems and at present are poorly developed and utilized. Even with the best data, critical knowledge and skill from the dietitian is necessary. In addition, dietitians need to advocate for nutrition to be included in algorithms behind the software.

What is the difference between “computer skills” and “informatics”? Which do I need to practice dietetics?
You need both. The level of complexity depends upon the work you perform. Computer skill is that ability to use a computer effectively (software, hardware, etc) to do your job. Informatics is a big picture view into how do you use the information critical to your performance. For example, computer skills are the ability to use different software, such as word processing or a graphical presentation for communication or documentation. An example of informatics knowledge is an understanding that data must be “structured” (or represented in a standard way) to be effectively retrieved (via query or reports) for outcomes evaluation. Standard “text as paragraphs” are of limited use when generating data from health information technology.

How do nutrition standards and terms become part of EHRs?
At present, most “functionality” of EHRs is being driven by EHR certification criteria from HITECH. Embedded in these criteria are standards, vocabularies, quality measures and health terminologies which support consistent ways of using data exchange. Work is underway in multiple areas within the Academy to support nutrition inclusion in health information technology. Additionally the Nutrition Care Process and the IDNT (International Dietetics & Nutrition Terminology) provides the critical foundation for a standard process within health information technology that will allow for outcomes reporting and information exchange. As health standards evolve, however, they must become a component of endorsed processes and adopted by most practitioners to be of value.

What does the “alphabet soup” of standards mean?
Health Level Seven International (HL7), International Organization for Standardization (ISO), International Health Terminology Standards Development Organization (IHTSDO), the US Department of Health and Human Services Office of the National Coordinator (ONC) Standard & Interoperability Framework (S&I).
The present climate in health standards is one of both harmonization and disruption. There is considerable uncertainty about which standards will become adopted. As standards are written into the HITECH regulations, some will become more important than others, based in part on how valuable they are to all providers, ease of use and effectiveness in exchanging data electronically.