Food for Thought

HIMSS Clinical Informatics Insights

Any clinician caring for patients has a few patient events that likely haunt them. Most consider food and nutrition to be a fairly “safe” area of patient care. While I no longer practice in acute care clinical nutrition, I have inherited continued worries from colleagues. For example, the patient who transferred from Long Term/Post-Acute Care to the hospital with no diet order; at the hospital he was placed on a regular diet as there seemed to be no need for restrictions. Unfortunately, he was a stroke patient (whose diet was texture-modified, and appropriate for his ability to swallow); he aspirated (food/beverage into his lungs) and later died. Just one of many examples. Three recent events provide incredible promise for improved nutrition care coordination and appropriateness of nutrition/diet orders. They are:

  • Addition of “Nutrition Section” in the Health Level Seven (www.hl7.org) Consolidated Clinical Document Architecture (C-CDA) Release 2 standard was added.  Release 1.1, now a mandated standard for Stage 2 of Meaningful Use, had a single placeholder for “discharge diet” in one document type, the Continuity of Care Document). Release 2 (pending publication in July 2014) provides templates for all components of the Academy’s Nutrition Care Process, which is a systematic method of patient nutrition care by dietitians. Components of nutrition in the C-CDA are included in 7 different document templates, which should help mitigate nutrition data being left behind in care coordination.
  • The Centers for Medicare and Medicaid Services recently ruled that beginning July 11, 2014, registered dietitian nutritionists (RDN) can become privileged (based upon state and local regulations) to order diets for patients. While the details and policies will evolve by facilities, this is a monumental step towards optimal nutritional care management.
  • Academy members have worked for a consistent method of ordering nutrition/diet orders in the acute care setting. The HL7 Version 3 Nutrition/Diet Orders Clinical Messaging work is now a Draft Standard for Trial Use. This allows facilities to test and recommend changes to a diet order standard for use in consistent nutrition care delivery.

Together, these and other advancements demonstrate great potential for preventing avoidable mishaps with nutrition care. Diet orders being only one of them. 

About the Contributor                                

Building on a broad experience in clinical nutrition, Lindsey Hoggle transitioned to a consultant in health information technology in 2001. She has represented the Academy of Nutrition & Dietetics in advocacy efforts for nutrition inclusion in electronic health records (EHR) via the regulations of the Medicare/Medicaid EHR Incentive Program known as the *HITECH Act since 2009.

Lindsey and a colleague launched the creation of “nutrition informatics” in 2006, partnered with AMIA for the first nutrition focused AMIA/Academy “10x10” Informatics Education Program  in 2010, and collaborates broadly to drive consistent inclusion of nutrition in health information technology for the overall purpose of improving healthcare.