New Nutrition Content in Health IT Standards

The adoption of electronic health records (EHR) in the U.S. is proceeding at an unprecedented pace — primarily due to the HITECH Act. As I have mentioned previously, the Academy has participated in the activities driven by this law since it began in 2009.

As a regular participant at in-person meetings (of both the HIT Policy Committee and the HIT Standards Committee) in Washington, D.C., I have had the wonderful privilege of meeting and asking the advice of national leaders in health care and health information technology. From my first public comments in September 2009 asking for use of the Academy’s Nutrition Care Process (NCP) and the International Dietetics and Nutrition Terminology (now called the Nutrition Care Process Terminology or NCPT), the recurring theme has been to ask for what I call the differentiating “brand” of nutrition care via the RDN — the NCP. As I asked one expert after another, “What do we at the Academy need to do to make sure we are included as a part of the health care team as health care goes digital?” The answer always has been the same for the past five years:

  • Nutrition care must be included in health IT standards via Health Level Seven (HL7).
  • Nutrition terminologies must be in those now mandated for use in Certified EHRs. Stage 2 mandates the use of SNOMED-CT® and LOINC®. Using the acronyms is easiest for now!
  • “Value sets” of nutrition terms that EHR vendors can use must be established.
  • We must continue to “turn up the volume” on why nutrition care is critical to all aspects of health care.

Following policy advice from Jeanne Blankenship (Vice President, Policy Initiatives and Advocacy) for “constant, appropriate, appreciable pressure,” the Interoperability and Standards Committee and member volunteers have pushed forward for all of the above. As a result, the NCP is now represented in the next release of a presently mandated HL7 standard. Release 1 of the standard must now be supported by all Certified EHRs. While the name may be intimidating (“HL7 Consolidated Clinical Document Architecture or C-CDA” for short), the message to RDNs and EHR vendors need not be:

  • Use HL7 C-CDA Version 2 (pending publication of the standard any day now) to send electronic documents between facilities. C-CDA R2 is a document template standard that identifies what data must be sent to and from facilities.
  • Use coded data contained in the C-CDA for documenting nutrition care via the NCP. While NCPT may be used on the “user interface” – it must be “mapped” to SNOMED-CT and LOINC on the “back end.” This is a critical point to assure we can document and measure care provided by RDNs from this point forward.
  • The second release has nutrition in 7 different template types (as compared to “discharge diet” being only one field in one template type in Release 1:
    1. Progress Note
    2. Transfer Summary
    3. Discharge Summary
    4. Referral Note
    5. Continuity of Care Record (CCD)
    6. Care Plan
    7. Consult Note

While having to advocate for nutrition care seems illogical to RDNs, it comes with the territory. We need to continue to impress that nutrition care be part of the treatment plan. For an example of why we need to use the HL7 health IT standards, which contain nutrition, read a recent HIMSS post. And, remember: constant, appropriate, appreciable pressure. It really does work!

Lindsey Hoggle
Lindsey Hoggle, MS, RDN, PMP, is director of Nutrition Informatics at the Academy of Nutrition and Dietetics where she advocates for nutrition inclusion in health information technology standards, regulations and terminology.