The spectrum of nutrition implementation in Electronic Health Records (EHR) is both vast and highly inconsistent. A member recently reported that, as a private practice RDN, the physician's office she worked for did not want her to document in their record. Instead, they simply scanned her nutrition care note in and uploaded it into the EHR.
So what do you say to that?
- Data that is scanned into an EHR is seldom "re-usable" by the EHR because the data is not stored as structured (think of an Excel spreadsheet, in which you can identify data by columns and rows), nor does it occur alongside existing and future data already in the EHR (that is, weight/height recorded in a scanned document will not show up on the graph of the patient's weights).
- If the provider is reporting via Electronic Clinical Quality Measures (eCQM), additional documentation via mandated codes may help provide better reporting data. The Academy has been working for more than two years to map and submit the Nutrition Care Process Terminology – or MCPT (previously the IDNT) to now-mandated clinical terminologies in the United States – both SNOMED-CT (Systematized Nomenclature of Medicine Clinical Terms) and LOINC (Logical Observation Identifiers Names and Codes). These "mapping" spreadsheets should be used by your EHR vendor to assure nutrition care lands on the same "Care Plan" as other professionals in the EHR. The mapping spreadsheets are available via the 2014 version of the eNCPT.
- Nutrition Data can now be included in "transitions of care" documents between facilities – once the HL7 Draft Standard Consolidated Clinical Document Architecture (C-CDA) Release 2 is put into operation. That means that a patient on diet modifications can have that data arrive at the hospital on their next admission.
- Nutrition content in Health Care Information Technology Standards of the future can include "Clinical Decision Support" – or the ability to put nutrition care on the same option list of medications.
- Sharing patient data with the patient and across all episodes of care is a requirement of both the Meaningful Use Medicare/Medicaid EHR Financial Incentive program and will be an important part of performance indicators on quality care.
I could go on with other points. The takeaway is that nutrition advocacy comes with the territory of practicing nutrition care. We have made great progress, but the need for constant advocacy will continue.
Please share any stories you have of frustrations or successes!