Ever since college, Reem Jabr, MA, RDN, LDN, has had an interest in using technology to improve processes. About a decade ago, before electronic medical records (EMRs) were the norm, she was working as an outpatient dietitian at Cambridge Health Alliance in Massachusetts and was able to combine her passion for technology with her passion for nutrition. Recognizing the potential for Epic, the hospital's EMR, to better serve the nutrition field, Jabr and her team worked with the IT department to develop disease-specific nutrition templates for documenting patient encounters. Now, flow sheets help monitor lab tests relative to specific diseases, if patients have had a nutrition referral or not as well as vitals needed for aiding in diagnosis and nutrition therapy. "When we implemented it there were not too many Epic accounts that had nutrition for the outpatient setting," she says.
Before the EMR implementation, Jabr and her team used hand-written medical nutrition therapy forms to document their patient interactions. The information was often overlooked by physicians, who were later impressed with what RDs were discussing with their patients once the EMR helped make that information easily-accessible. "It became more visible to the physician what the RD does," she says.
Aside from improving the visibility of the dietetics profession, EMRs improved information sharing across key members of the care team and with patients and proved useful in tracking medications and lab tests to improve patient care and continuity of care.
Jabr recently began working as an outpatient clinical dietitian at Massachusetts General Hospital and says her experience working with EMRs will help her adapt to new systems and create templates to better serve patients.
"Keeping track of quality measures data, and streamlining our practices by using evidence based recommendations and dietetics standardized language and practices help keep the value of the RDN front and center and improve the quality of our practice as well as outcomes."
Tell us about your work. Who are your audiences? What need does this work help serve?
We are in the age of information and informatics. I find myself integrating my informatics experience in every position I have worked; whether by developing content for the EHR, or when communicating with the medical team, insuring accurate recipe nutrient analysis, automating inventory control and cost management, training dietetic interns, or promoting the RDN. The registered dietitians are the nutrition experts, and we need to keep our message/recommendations visible and integrated in the electronic health record (EHR). Keeping track of quality measures data, and streamlining our practices by using evidence based recommendations and dietetics standardized language and practices help keep the value of the RDN front and center and improve the quality of our practice as well as outcomes. Also, through recommending to the patients the right technology resources for nutrition management and self-care insures the consumer gets the right health message and enhances patients' engagement.
What inspired you to undertake this work or project? Include when and how you became involved.
The emerging digital world back in my formative years. When I discussed my elective class choices with my academic advisor for my Master's in nutrition degree, I expressed interest in taking a computer class because I was curious and wanted to learn more about this new field. I was advised to sign up for word processing workshop with the computer lab at the university. After that, I worked part-time as student advisor at the computers lab of the university. While helping other students resolve their computer issues and answering their questions, I learned more about software and computers as new tools.
Later, when I was working as a clinical dietitian at MGH, I was selected to be the Assistant Manager for Dietetics Computer Systems. On the job, and through mentoring by Judi Manola, MS RD, who was the Manager for Dietetics Computer Systems, I learned to manage multiple software and hardware for the Nutrition and Food Services Department at MGH. Later, as the Manager of Computer systems, I was the co-chair with Martha Lynch, MS RD LDN FADA CNSD, of the nutrition order entry development committee at MGH. When we started implementing EPIC (EHR) at Cambridge Health Alliance, in collaboration with Elvira Johnson, MS RD CDE LDN, Jose Wendel, MS RD LDN, and the IT department, I developed the outpatient nutrition content for documentation and tracking tools for the EHR. Our thinking, practice, and modalities are so integrated nowadays.
What do you personally find most rewarding about your efforts?
Partnering with patients, teamwork, and ever dissolving boundaries between disciplines. Through developing meaningful connections with patients and empowering each one with individualized and culturally appropriate tools and resources that help them manage their health. Also, working with the multidiscipline team members and departments to create content and tools that serve the patients in the best way possible, and that facilitate collaboration and communication among the members of the team.
What about food, diet, nutrition or health drew you to this field?
Good old fashioned wisdom! I started college as chemistry major, but I was drawn to nutrition because it was an applied field and meant more interaction with people and patients. While growing up, I used to hear this proverb: "The stomach is the home of disease and restraint is the basis of the remedy." So I was interested in learning about the science behind this saying, the prevention and therapy components and how to best use nutrition and the diet as tools for being proactive for optimal health.