Chapter 25 Electronic Health Records and Other Health Care Technologies

will continue to evolve. By providing better documen- tation, automatically checking for medication errors and drug interactions, providing fail-safe systems to track test results, and following up with clients, EHRs can reduce the risk of malpractice (11). As subject matter experts in nutrition care, regis- tered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs) are qualified to define the requirements for nutrition care in the EHR. The RDN and NDTR must follow evidence- based practice standards and documentation policy and procedures when ensuring that nutrition care and the EHR are optimal. These same professionals have a responsibility to provide strategic leadership in nutri- tion health information and support for developing and organizing standard nutrition practices as related to the EHR, including developing the benefits versus the drawbacks of an EHR. To accomplish this, RDNs and NDTRs must collaborate in EHR initiatives at national, health system, and local levels (10). The Academy has developed both benefits and drawbacks of EHRs, as shown in Table 25.1 (see page 354). To be able to extract diagnoses, treatments, diet orders, clinical documentation, and laboratory values, RDNs must be able to navigate the core facility infor- mation system. They also must be able to document nutrition assessment, diagnosis, interventions, and out- comes using the EHR and provide this information readily to other members of the health care team (10). As an RDN or NDTR asked to participate in deci- sions for purchasing or developing an EHR, it will be important to first identify those who may be involved or affected in some way by the process. It will be imperative to keep an open mind in determining all who may have an interest in the project. Certainly the organization leadership, software engineer, and clini- cians will need to be involved with development as well as changes. A number of other groups within the organization that deal directly or indirectly with the resident/client may need to have significant involve- ment in the design and acceptance testing of an EHR. Financial personnel will also likely be involved in the budgeting and funding of the project. Remember that an interface may need to take place between the current EHR and any new systems being developed or purchased. An interface is a con- nection between two computer applications that allows information to flow from one application to the other— for example, a nutrition system that could interface with other assessment systems being used within the facility. Interfaces are labor-intensive and can be one of the greatest barriers to successful EHR implementa- tion. It is important to involve the informatics team in assessing software interface ability so that the correct

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questions will be asked and answered. It will need to be determined early in the process whether the inter- face is a one-way or two-way interface and exactly what data need to be transferred. There are cost impli- cations for this customized programming, and it is important to clarify who is responsible for this expense.

Health Level Seven (HL7) is a term that is often used in relation to interfaces. HL7 is an organization involved in developing international health care data standards, including standard data field definitions for use in creating application interfaces. For data to be passed from one application to another, their format must be compatible with HL7 field formatting and the receiving application must be able to receive the HL7 field.

Tools and Resources The Academy of Nutrition and Dietetics has taken an active role in providing guidance to members on EHR considerations. The Academy has developed an Electronic Health Records Toolkit that includes road maps to aid the RDN/NDTR in purchasing an EHR system, building a system, or revising a current system. The online toolkit provides information and resources of the road map steps in the EHR imple- mentation process and the relevant Nutrition Care Process/standardized language considerations. Examples of the road map can be seen in Figure 25.1 (see page 357) and the decision tree can be seen in Figure 25.2 (see page 358).

The need for analyzable data to evaluate and demon- strate the impact of nutrition care has long been known. To help address this need, the Academy has developed the Academy of Nutrition and Dietetics Health Informatics Infrastructure, ANDHII (pronounced “ANDI”; www.andhii.org). This is a new Nutrition Care Process and Terminology–based software platform that provides an infrastructure on which tools for the advancement of evidence-based nutrition practice research can be built. Launched in 2014, ANDHII included an initial suite of web-based tools—the Dietetics Outcomes Registry (DOR), Smart Visits, and Nutrition Research Information—that uses electronic Nutrition Care Process Terminology (eNCPT) to docu- ment and track nutrition care and promote patient out- comes, conduct research, and contribute to a national quality registry. The platform allows for the aggregation of nutrition care and patient outcome data that can be used for benchmarking and evaluation. Although data placement within this platform at the ANDHII website is done voluntarily by the RDN and NDTR, ANDHII can analyze collected data to demonstrate the impact that