Marty’s Corner - It’s All About Outcomes
In the field of nutrition and dietetics, we’ve been talking about outcomes for decades, especially in the clinical realm. Empirically, we know that our intervention makes a difference in helping our patients achieve positive outcomes. Unfortunately, we haven’t always had the opportunity to follow up with many of our patients, unless they are seen at our outpatient clinic, and even then, we may not have recorded information over time as thoroughly as possible. Because of the lack of outcomes data, the United States Preventive Services Task Force (USPSTF) repeatedly gives nutrition intervention a grade of B. What does this mean? “The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.” This in turn has affected reimbursement for our services. Someday we hope this grade will be an A.
Enter ANDHII. The Academy of Nutrition and Dietetics Health Informatics Infrastructure (pronounced “Andy”) was developed with the intent to create an outcomes registry where dietitians could record patient interventions using our own standardized language, the Nutrition Care Process Terminology (NCPT), via a secure, web-based portal. ANDHII access is free for all practitioners credentialed by the Commission on Dietetic Registration, so that means that any RD/RDN or DTR/NDTR can use it. Student members of the Academy are also eligible to use it; in fact, many faculty are now using ANDHII in their classes to help teach students about the entry of patient visits using the Nutrition Care Process and NCPT. Information is entered into ANDHII in deidentified format in order to comply with HIPAA; a reidentification code is randomly created after the first visit so that follow-up visits can be recorded for each patient. Changes in objective data such as labs, weight, BMI, etc. can easily be viewed via ANDHII’s graphing capabilities.
Before ANDHII was introduced, a feasibility study was conducted to assess dietitians’ perceptions of its ease of use, particularly with respect to the extra time it took to record visits in ANDHII while also doing so in the electronic health record (EHR).1 Researchers found that although initially it took an extra 36 minutes on average to record a visit in ANDHII, by the sixth entry, that time had dropped to 7 minutes, and could be extrapolated out to just 3.5 minutes extra, with additional experience using ANDHII. They rated its overall benefit as moderately to significantly high, with a positive time:benefit ratio. Of course, feedback since the study has been that practitioners do not have the extra time even for 3.5 minutes of “duplicate” entry of patient interventions. In response to this, the Academy is working on interfaces between ANDHII and EHRs using HL7’s FHIR (Fast Healthcare Interoperability Resource) format.
Stay tuned for more information in this regard. In the meantime, your department’s food & nutrition management software system can complement ANDHII by using its recorded information such as weight changes, diet order history, allergies, etc. to help determine your Nutrition Care Process entries in your EHR and in ANDHII.
1 Murphy WJ, Yadrick MM, Steiber AL, Mohan V, Papoutsakis C. Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII): A pilot study on the documentation of the Nutrition Care Process and the usability of ANDHII by Registered Dietitian Nutritionists, J Acad Nutr Diet. 2018;118(10):1966-1974.
Article by: Marty Yadrick, MBI, MS, RDN, FAND - Director of Nutrition Informatics and former President of the Academy of Nutrition and Dietetics; Fusion, 4th Quarter, 2018