If nutrition is a vehicle to good health, dietitians are in the driver’s seat, poised to lead consumers toward self-awareness and positive behavior change. But what road do you take? Which roads have been traveled? What are the paths to success? Where may there be roadblocks? The answer lies in the roadmap — data. By collecting and sharing data, we can build upon past success, push the profession forward, expand opportunities for registered dietitian nutritionists, improve patient outcomes, and increase funding for nutrition as a tool to prevent and manage disease.
Since 2014, the Academy’s Health Informatics Infrastructure, or ANDHII, has been promoting efficient and accurate use of the Nutrition Care Process and the Nutrition Care Process Terminology, or NCPT. ANDHII has tools for RDNs and NDTRs to input, track and report patient outcomes. Data is collected, then standardized and integrated with the NCPT, which helps streamline it for analysis and reporting. This dynamic platform offers options for researchers (such as randomization and blinding), produces data sets that can be visualized and standardized, and creates individual visit summary information that can be submitted to management teams or incorporated into electronic health records, or EHRs.
As with all data collection, patient privacy is essential. ANDHII is designed to operate within regulations governing patient privacy and does not allow entry of identifying information such as names, birthdates or insurance numbers. Rather, it provides secure storage of de-identified data for research and outcomes assessment.
Whether in private practice or as part of a health care organization, RDNs and NDTRs can enter patient data and biometrics into ANDHII and track specific metrics. Marcia Bauer, RD, CDE, LMNT, says using ANDHII allows her to be more proficient and efficient at work. “I called those responsible for making EHR changes at the facility and explained what ANDHII is and how it can be used to benefit our facility, patient care and reimbursement,” she says. “Within a short time, a link to ANDHII was added to my nutrition assessment in the EHR.” Bauer also was able to participate in a diabetes study with ANDHII which benefits her patients. If health experts can better track outcomes, they can design more effective interventions.
Long before using ANDHII, Nicole Brown, MS, RDN, LD, ACSM, EP-C, focused on measuring patient outcomes. After learning about ANDHII, she saw an opportunity to examine private practice data in her state. The Health Outcomes and the Impact of Nutrition Care for Clients of Registered Dietitian Nutritionists in Private Practice surveillance study began as a pilot and now is moving into the study phase. The study will observe current practices of a small sample of RDNs working in private practice by having them enroll in and learn to use ANDHII, then enter and track patient data. Resulting data can be reviewed to identify trends in conditions with greatest impact, conditions with room for improvement and differences in cases or care patterns that result in changes to outcomes. The number of minutes a client spends with an RDN can vary, as well as how much (if any) of that time is covered by insurance.
Collecting and reporting data on health outcomes can help support licensure and health insurance coverage. “To be able to go to an insurance company and show how positive outcomes correlate to a certain number of visits or number of minutes per visit can be of great value,” says Brown. She also points out that using ANDHII and NCPT does take practice. “We started out taking 45 minutes to enter a patient visit into ANDHII, but were able to get it down to 15 minutes.”
Time is of the essence for busy practitioners, but the benefits of using ANDHII ultimately are worthwhile. RDNs in similar practice areas can connect via dietetic practice groups and state affiliates to undertake ANDHII projects. The Academy offers training and support, and ANDHII subscriptions are available at no cost to RDNs and NDTRs.
ANDHII is currently undergoing an upgrade to enhance mobile access and navigation. With data on more than 700 unique patients and 1,200 registry visits, ANDHII is on course to achieve status as a qualified clinical data registry with the Centers for Medicare and Medicaid Services, or CMS. This opens the door for interdisciplinary utilization of ANDHII as part of reporting efforts via CMS’ Quality Payment Program Framework. It also furthers opportunities for dietitians, as they are slated to be included in the Merit-based Incentive Payment System under a provision of the Medicare Access and Children's Health Insurance Program Reauthorization Act (to be implemented in 2019). The timing couldn’t be better for RDNs and NDTRs to enroll in ANDHII and begin putting their mark on the future of dietetics practice.